Accident insurance in Switzerland - blog post

[gaijin]

Some comments and thoughts about your great blog post about accident insurance in Switzerland.

You write:

Accident insurance (LAA in French and UVG in German) is the insurance that will cover the costs of accidents in Switzerland.

This is a very detailed point. The 'G' in UVG and the 'L' in LAA refer to the law about the insurance. It's therefore technically not the insurance as a product. I would rephrase as Accident insurance is the insurance that will cover the costs of accidents in Switzerland. It is based on the law about accident insurance (LAA in French and UVG in German).

So, a ski accident will be covered by the accident insurance, while bronchitis is covered by the health insurance. Both insurance types are mandatory.

Again, a technical point. Accident insurance is not mandatory if you are not employed.

Like any other insurance, in case of an accident, you will need to submit a claim. After the claim is accepted, the accident insurance will pay back the costs.

From my understanding, nowadays the costs are increasingly covered directly by the insurance. The insurance companies (maybe encouraged by the authorities) prefer to pay the money directly to the hospitals/doctors, ...

or you are exposed to chemicals in your office.

Do you mean a one-time exposure? From my understanding, becoming sick from continuous exposure is an illness (asbestos as an example for illness).

Self-employed people are not obligated to be covered for accidents.

I would extend this to 'self-employed and non-employed people are not obligated ...'

It is worth mentioning that accident insurance also works if you have an accident while abroad.

you might want to add a disclaimer that the accident insurance abroad might not cover everything. According to an information from ETH Zürich :

Erfahrungen haben gezeigt, dass gewisse Versicherungsleistungen im Ausland nicht übernommen werden.

This is called interim insurance.

I have no idea about French. But in German this interim insurance is called Abredeversicherung. This is a term that is unfamiliar to most German speaking people in Switzerland outside of HR professionals. I therefore suggest you add this term to the English text.

Only self-employed people have the choice.

Again, I think this is not true. Non-employed people also have a choice.

 

[Max]

This is a very detailed point. The 'G' in UVG and the 'L' in LAA refer to the law about the insurance. It's therefore technically not the insurance as a product. I would rephrase as Accident insurance is the insurance that will cover the costs of accidents in Switzerland. It is based on the law about accident insurance (LAA in French and UVG in German).

The insurance is really sometimes called the same as the law (against the logic).

 

[Baptiste Wicht]

Thanks for your feedback! I will try to integrate this this weekend.

 

[Baptiste Wicht]

Again, a technical point. Accident insurance is not mandatory if you are not employed.

I don't believe that's correct.

People that do not work have to subscribe to the accident insurance of their health insurance provider. And they can only cancel that coverage if they start working.

 

[gaijin]

People that do not work have to subscribe to the accident insurance of their health insurance provider

I don't see this written in the law.

What I see:

Sont assurés à titre obligatoire conformément à la présente loi:

• les travailleurs occupés en Suisse, y compris les travailleurs à domicile, les apprentis, les stagiaires, les volontaires ainsi que les personnes travaillant dans des écoles de métiers ou des ateliers protégés;
• les personnes qui remplissent les conditions visées à l’art. 8 de la loi du 25 juin 1982 sur l’assurance-chômage (LACI) ou qui perçoivent des indemnités en vertu de l’art. 29 LACI (personnes au chômage);
• les personnes qui participent à des mesures de l’assurance-invalidité dans un établissement ou un atelier au sens de l’art. 27, al. 1, de la loi fédérale du 19 juin 1959 sur l’assurance-invalidité (LAI) ou dans une entreprise, dès lors que leur situation est analogue à celle qui résulterait d’un contrat de travail.

(Source)

This list excludes retired people (I know, this was the issue. Still, I just realized that).
People who fall into the second category ('les personnes qui remplissent les conditions visées ...') are automatically insured by the unemployment insurance. So there is no need for them to have an additional insurance with their health provider.
Also, someone who does not have a job and is not registered at the OFP does not fall into this second category (this this person does not fulfill his/her reporting duty) that is required based on l’art. 8 de la loi du 25 juin 1982 sur l’assurance-chômage (LACI)

 

[Alnetix]

Hello,

As far as I understand, it's the law for the "LAA / UVG" = for people who have a job. It does not applied to people who are not in gainful employment. In this case, people need to applied to their health insurance, and the benefits are quite different (you don’t get paid if you’re off work due to an accident, for example)

Check at bottom of this link:

Assurance-accidents : Qui est assuré à titre obligatoire ?

Toute personne occupée en Suisse est assurée obligatoirement selon la LAA contre les accidents et maladies professionnels. Si elle est occupée au moins 8 heures par semaine auprès du même employeur, elle est également assurée contre les accidents non professionnels.

www.bag.admin.ch

Unfallversicherung: Wer ist obligatorisch versichert?

Jede in der Schweiz beschäftigte Person ist obligatorisch nach UVG gegen Berufsunfälle und Berufskrankheiten versichert. Sofern sie für mindestens 8 Stunden pro Woche beim selben Arbeitgeber beschäftigt ist, ist sie auch gegen Nichtberufsunfälle versichert.

www.bag.admin.ch

 

[Max]

I don't see this written in the law.

The Health Insurance Law (KVG) applies to non-employed persons:

Federal Law on Health Insurance (KVG)
Art. 1a Scope
1 This law governs social health insurance. It comprises mandatory health insurance and voluntary daily allowance insurance.
2 Social health insurance provides benefits in the event of:
...
b. Accident (Art. 4 ATSG), provided that no accident insurance covers the costs;

 

[Baptiste Wicht]

As mentioned by Alnetix and Max, it's not written in the LAA law because people not subject to the professional accident insurance are mandated to use the accident insurance from their health insurance.

Source: https://www.bag.admin.ch/fr/assurance-accidents-qui-est-assure-a-titre-obligatoire

 

[gaijin]

Thanks @Alnetix , @Max and @Baptiste Wicht for your explantions and the reference to the LAMal. I can now see the logic. Still, I would argue that, to an outsider like me, it's not immediately obvious (illness and accidents are first covered by LAMal. However, the LAMal hands most cases of accidents over to LAA, which makes LAA the primary law for accidents). I personally think that the law could be worded more clearly in this regard. But, yes, arguing such a case for more clarity would not impress any insurance or court

 

[Baptiste Wicht]

I agree that the law in this case is very unclear.