Employers and companies are legally obligated to insure their staff. Mandatory accident insurance covers the costs that can arise due to occupational and non-occupational accidents and occupational diseases. Read on to find out more.
Mandatory accident insurance is governed by the Swiss Federal Accident Insurance Act (AIA) and its ordinances (AIOs), which set out the requirements for coverage and benefits.
Mandatory accident insurance covers all employed persons, i.e. anyone who has an employment contract, from a cleaner in a private home to a trainee at a small business and even a top manager at a large corporation. Special rules apply, for example, to people working in family businesses, farm laborers, and employees on temporary placements abroad.
People who are self-employed – and thus also company owners – aren’t covered by mandatory accident insurance because they don’t have an employment contract. However, they can voluntarily insure themselves and any family members working with them.
The following criteria determine whether and to what extent employees are covered:
A distinction is made between occupational accidents (OAs), non-occupational accidents (NOAs), and occupational diseases (ODs, e.g. skin complaints caused by cleaning products). Occupational diseases are treated the same as occupational accidents.
Anyone who works for the same employer for at least eight hours per week on average is fully covered for both OAs and NOAs.
Anyone who works for the same employer for less than eight hours per week on average is insured for OAs only.
N.B.: If someone with more than one employer has an accident, they must clarify which employer’s insurance covers it. The deciding factor is where the person was last working before the accident or, in the case of an NOA, where it’s covered (if at all).
Insured for both OAs and NOAs: on the day on which the employment relationship begins or on which entitlement to a salary begins. In the absence of a contractual start date, coverage starts with the first journey to work.
Insured for OAs only: with the first journey to work.
Insured for both OAs and NOAs: at the end of the 31st day after the date on which entitlement to half the salary ends.
Insured for OAs only: with the last journey home from work.
Insured for both OAs and NOAs: take out interim accident insurance to extend coverage for NOAs for up to six months or – if not immediately starting a new job – inform the health insurer (if the accident coverage under the Health Insurance Act is suspended).
Insured for OAs only: no action needed as health insurance covers NOAs in the absence of coverage through an employer. It might be advisable to take out a separate personal accident policy or make other arrangements.
The AIA sets out in detail which benefits are covered and to what extent.
The AIA states that “appropriate and economical treatment” is covered. This means that all treatments needed to ensure a swift recovery with no after-effects are covered within the limits set by the AIA.
Costs for the following are covered:
N.B.: Coverage for treatment costs outside Switzerland is subject to limits.
Daily benefits insurance covers earnings lost by someone who can’t work due to injury. The amount of daily benefits is determined by the degree to which the person is unfit for work. If the person is fully unfit for work, daily benefits amount to 80% of pensionable earnings. The entitlement begins on the third day after the accident and ends when:
A deduction for meals is made during stays in hospital or a rehabilitation clinic. This is based on the person’s family circumstances (i.e. whether they live alone or are responsible for caring for children or other relatives).
As with daily benefits, the amount of disability pension depends on the degree to which the person is unfit for work. For full disability, the disability pension is 80% of pensionable earnings; for partial disability, the pension is prorated. The sum of benefits from statutory old age and disability pensions (supplementary pensions) may not exceed 90% of pensionable earnings.
If someone dies as a result of an accident, members of their family receive a survivor’s pension. This is calculated as follows:
Long-term pension recipients are entitled to cost-of-living adjustments. These are implemented whenever the statutory old age and disability pensions are adjusted in line with the national consumer price index.
If an accident leads to a lasting physical or psychological impairment, impairment compensation is paid out as a one-time lump sum in line with the percentage of impairment.
Anyone who needs permanent assistance (or, in the worst cases, constant care) due to a disability is entitled to a helplessness allowance.
The amount of daily benefits or pension depends on the pensionable earnings. By law, a maximum of CHF 148,200 per year or CHF 406 per day is insured (figures correct as at January 1, 2016). If the annual salary is higher, supplementary insurance can be taken out to cover the difference.
Accidents must be reported to the accident insurer without delay. Those involved or their families must therefore inform the employer as quickly as possible so that it can write and submit the accident report immediately. If anything is unclear, the accident insurer is entitled to order examinations by medical specialists.
Insurance benefits are only reduced or refused entirely in extreme cases. Here are some examples:
To quote the insurance jargon, anyone who suffers or deliberately causes an accident through gross negligence, criminal activity, exceptional risks or hazardous activities can expect their insurance payout, daily benefits, and/or disability pension to be reduced or refused.
The insurance is in the employer’s name, so the employer pays the premium – but only the part for OAs and ODs. The premium for NOAs is normally deducted directly from the employee’s salary.
Many collective labor agreements stipulate that the employer must pay half the premium for NOAs. Companies without a collective labor agreement can decide for themselves whether to pay a share or even all of the premium for NOAs.