Accident insurance

Legal background

The Swiss Federal Accident Insurance Act (AIA) requires employers to insure their staff against occupational accidents and sickness – as well as non-occupational accidents if they work at least eight hours a week. People who aren’t in paid employment – e.g. housewives and house husbands, children, students, and pensioners – are by definition not exposed to the risk of occupational accidents. They must insure themselves against accidents and their effects through basic health insurance. Anyone registered as unemployed is automatically covered by the accident insurance scheme for unemployed persons. Self-employed people, who are essentially responsible for their own insurance, have the option of taking out private accident insurance under the AIA (Art. 4 AIA).

Occupational accident, occupational sickness, and non-occupational accident

Any accident that occurs while someone is doing their job or on a break at work or immediately before or after their working hours is regarded as an occupational accident. Any sickness that is mainly attributable to a person’s job – e.g. as a result of breathing in harmful substances – is regarded as an occupational sickness. Accidents on the way to or from work or during free time while taking part in sports, at home or in traffic are regarded as non-occupational accidents.

However: accidents on the way to or from work count as occupational accidents for people who work fewer than eight hours per week for a given employer.

Statutory accident insurance covers the cost of medical treatment, care, aids, rescue, and transport in the event of an accident. Added to these benefits are continued salary payment in the form of daily benefits and further financial benefits in line with the insured salary.

Insured medical care and cost reimbursements

Accident victims are entitled to outpatient treatment by doctors and medical staff, prescription medication and examinations, inpatient treatment on a general ward, and aids to help them cope with physical impairments (e.g. prosthetics). In addition to treatment costs, any necessary travel, transport, and rescue costs as well as the cost of necessary treatment outside Switzerland are covered, as are care and aids in the home if prescribed by a doctor. For medical treatment outside Switzerland, the maximum that can be paid out is twice the cost of the same treatment in Switzerland. Any costs incurred for transporting the victim’s body and a funeral are also covered.

Basic insured benefits

A range of benefits may be paid out in the event of an accident. These are based on the insured salary as per the AIA, which is limited to a maximum of CHF 148,200 per person.

Daily benefits: The entitlement to daily benefits begins on the third day after the accident. Insured persons receive 80% of their salary if they are entirely unfit for work or a lower percentage if there are partially unfit.

Pensions: If an accident leads to a permanent or long-term disability, the person affected is entitled to receive a disability pension from their accident insurance. If they die, their partner and/or dependents receive financial support in the form of a survivor’s pension.

Compensation: If an accident causes a severe physical impairment (e.g. loss of a limb) or a severe psychological impairment, the victim is entitled to compensation. Accident insurance also pays compensation to victims who permanently need help with everyday tasks as a result of their impairment.