Swiss accident and occupational diseases insurance is a mandatory form of social security that is used to care for employees who have suffered an accident. These claims can be made on injuries caused in both occupational and non-occupational situations. The scheme is paid for by both the employer and the employee and is accessed through your social security number.
Details on Swiss accident and occupational diseases insurances
Accident and occupational diseases insurance is used when you are injured or become severely ill while employed. This does not include taking sick leave, as this is usually included in an employment contract or covered by your health insurance.
The scheme allows victims of illness or injury to claim insurance in order to pay medical expenses, take more time off, or even file for compensation if the accident leads to death.
Who pays for accident and occupational disease insurance in Switzerland
As part of the AHV / OASI insurance system, Swiss accident insurance is paid for by both the employee and employer. Although it is paid as a joint premium each month, the contributions are actually split, with contributions from employers going towards occupational accidents and diseases, and employee contributions compensating for non-occupational accidents.
Who can claim Swiss accident insurance?
Any Swiss resident who is working can claim accident and occupational disease insurance. Those who are actively looking for a job are also covered by accident insurance. If you are a child, student, retiree, housewife or househusband, you are not entitled to mandatory accident insurance. If you would like to be covered by accident insurance, you must include it as part of your supplemental health insurance.
Entrepreneurs can apply for accident insurance voluntarily through the Swiss National Accident Insurance Fund (SUVA).
How do I pay for Swiss accident insurance?
If you are employed by a company, said company will deduct your contributions to the insurance scheme from your salary. If you are self-employed or a freelancer, contributions are paid from your earnings directly. Percentage contributions are determined by your total income, with rates ranging from 1 to 2 percent of your gross monthly earnings.
Criteria for claiming accident and occupational disease insurance
The system is designed to cover an employee while both at work and not. In order to qualify for Swiss accident and occupational disease insurance, you must fulfil one of four criteria in order to apply. These criteria are strictly defined and must be fulfilled in order to claim accident insurance.
In this case, an accident is where sudden, unexpected injury is caused to the human body. This injury is involuntary and is the result of an unlikely cause. This cause must have the potential to harm physical, mental or psychological health, or has the potential to be fatal.
Occupational accidents are when an injury is caused while a person is performing a task that is associated with their occupation. This includes accidents during breaks or immediately before or after work, provided that the victim is at their place of work.
These are accidents that occur when not at a place of work. These can include travelling to work, recreation time, playing sports, road collisions and domestic accidents. Note that part-time workers whose working hours are fewer than eight hours per week per employer are not insured against non-occupational accidents, except for travelling to and from work.
This is associated with exposure to harmful substances while in certain types of employment, and also covers diseases that were caused or aggravated by the type of work being carried out. Occupational diseases could also be damage from continued and related exposure to something that is a feature of the type of work.
Coverage of Swiss accident insurance
You are covered by Swiss accident insurance from the date your contract comes into effect or on the first day you start work. Coverage ends 31 days after your contract expires or 31 days after you could have last claimed half your salary. In some cases, your health insurance provider will offer to extend your accident insurance coverage for a further six months. Ask your health insurance provider for more details.
When is an employee liable when claiming Swiss accident insurance?
In some cases where Swiss accident insurance is claimed, the employee is liable. In this situation, your benefits might be reduced or even withheld. Some situations in which the employee is liable are:
- If the illness or injury was caused intentionally by the employee. In this case, you will be refused benefit on the claim, with the exception of a grant for potential funeral costs.
- If a non-occupational accident was caused due to negligence on the part of the injured employee. In this case, benefits are usually reduced by up to two years.
- If the employee sustained the injury when committing a crime, benefits can be reduced in value or refused altogether.
How to claim Swiss accident insurance
If you are injured or become unwell, your employer or accident insurance provider must be informed as soon as possible by the injured person or a family member who lives in Switzerland. In the case of a fatality, the employer must be informed immediately.
Swiss accident insurance outside Switzerland
You can claim Swiss accident insurance while travelling abroad. If you become injured while outside of Switzerland, you must inform your employer immediately. Once this is done, most accident insurers will provide for the cost of any treatments you might receive from doctors and hospitals, up to a maximum of double what the cost would have been for similar treatments in Switzerland.
Swiss accident insurance benefits
Once you have successfully claimed Swiss accident insurance, you are entitled to a number of benefits. These range from non-cash benefits to the coverage of treatment costs. The type of benefit you receive is dependent on the injury you receive and the amount of treatment you require.
Treatment and reimbursement
Swiss accident insurance will cover the cost of appropriate treatment related to the injury you sustained. This covers the first point of medical contact, all the way to rehabilitation treatments such as prescribed spa treatments or rehabilitation equipment. This cost is also covered abroad and continues once you return to Switzerland.
Any cash payments that you may receive as part of Swiss accident insurance are based on the gross salary from your latest job, the same figure that is used when calculating contributions to your pension. Typically, this means that you will almost always receive a maximum salary while you are injured. This amount is capped to 148.200 Swiss francs a year or 406 a day.
Cash payments when incapacitated
If you become incapable of working due an accident that was sustained at work. You are eligible to take out daily cash benefits that amount to up to 80 percent of your salary, depending on the degree of incapacity. These payments are made every day, beginning three days after your accident. People who are unemployed receive the same amount of benefit that is given through unemployment benefits or other forms of welfare. These payments are maintained until you have recovered fully from the accident, or you begin claiming disability insurance.
Swiss helplessness allowance
In some cases, a person who is claiming accident insurance may require further treatment or assistance to support their condition. This is provided by the Swiss helplessness allowance. You can claim this allowance if it is decided that your condition requires permanent assistance from a third party in order to accomplish basic tasks.
Claiming an invalidity pension
If you are not expected to recover entirely or not for a long time, you can claim an invalidity pension. The amount you may receive is up to 80 percent of your salary, depending on the level of disability. If you claim this pension and then reach the age when you can claim old-age pension, the invalidity pension is reduced to 90 percent of the difference between your salary and old age pension and is then paid alongside.
Lump-sum for major injuries
If your accident involved you sustaining a dramatic and major physical, mental or psychological injury, then you may claim a lump sum to be compensated. Injuries may include the loss of limbs or vital organs, para or quadriplegia or becoming deaf or blind. Contact your employer or accident insurance provider for more details. If you believe that a lump sum is due but is not being offered, it is recommended to consult a lawyer.
Claiming a survivor’s pension
If a family member has passed away as a result of an accident that is covered by Swiss accident and occupational disease insurance, then you are entitled to a survivor's pension. This is a pension that is paid to the spouse and children of the person who is deceased.
It is calculated as a percentage of the salary of the deceased. Widows, widowers and civil partners receive 40 percent of their salary, a child who has lost their father or mother 15 percent, or a child who has been orphaned 25 percent. This amount is capped to a total of 70 percent of the deceased’s income. The policy ends if the spouse gets married again, the claimant dies, or when the child reaches the age of 19 (or 25 if they are still in education).
If a family member passes away while receiving an invalidity pension, the policy is usually paid to widows and children as a lump sum in the same manner as a second and third pillar pension.