If staff are unable to work because of an accident or occupational illness, both they and you have a lot of expenses to cope with. The legally required accident insurance (UVG) covers you and your employees against this financial fallout to a considerable extent, but not entirely.
Insurance obligations and options in the event of an accident
|Compulsory insurance obligation|
|Voluntary insurance option|
Compulsory accident insurance covers your employees against the consequences of an accident at work, an accident other than at work or occupational illness. Medical expenses, lost earnings and long-term reductions in income are largely covered.
The benefits paid by compulsory accident insurance may be extensive, but they do have limits. Supplementary accident insurance enables you to offer your employees protection over and above the obligatory minimum.
|1. Why is that employers are required to take out accident insurance?|
If you're not self-employed or insured by Suva (the Schweizerische Unfallversicherungsanstalt - Swiss Accident Insurance Institution), you are required by law to take out obligatory accident insurance for your employees.
If employees suffer accidents or occupational illnesses, this can have serious consequences for their everyday life and work. Compulsory accident insurance alleviates these consequences by providing sound basic financial benefits. By doing this, it prevents the event from plunging sufferers into desperate financial need.
|2. What costs do employers have to bear even if they have compulsory accident insurance?|
Benefits under compulsory accident insurance become payable from the third day after the accident. Art. 324b of the Code of Obligations states that the employer must arrange for at least 80% of the employee's wages to be paid during the first two days after an accident.
The non-occupational accident premium is paid by the employee, and the premium for occupational accident and illness cover by the employer.
The amount of the premiums varies from one insurer to another and according to the amount of the insured earnings. By contrast, the cover offered under compulsory accident insurance is always the same, no matter who provides it.
|3. The benefits provided by compulsory accident insurance are always the same, no matter where you insure your employees. What advantages does Helsana offer you?|
Helsana offers you all-round care of a kind only few other insurers can. We take preventive action and help you with additional benefits if you so request – such as courses on the early detection of physical and mental illness among your workforce. We also support you and your employees as they return to regular work.
We aim to keep your employees healthy and fit for work. We are experts in insurance and will help you deal with administrative tasks and communicate with other stakeholder institutions, such as the disability insurance office. In doing all this, we aim not only to strengthen your business, but also to share its burdens.
|4. Which benefits are insured?|
Compulsory accident insurance covers occupational and non-occupational accidents and occupational illnesses.
Occupational accidents are defined as all accidents occurring during working hours. The category also includes accidents sustained before and after work, provided that they are linked with work in some way. It follows that accidents on the way to work are always covered by insurance. Part-time employees working fewer than eight hours a week are covered only in respect of occupational accidents. Accidents sustained by them on the way to work are counted as occupational, while they are non-occupational in the case of all other employees.
Under the UVG, illnesses are treated as occupational in nature if they were brought on in the course of occupational activity mainly or entirely by harmful materials or certain types of work. The insurance also covers illnesses that can be demonstrated to have been brought on solely or very largely by the work done.
Persons insured under obligatory accident insurance are entitled, depending on the circumstances of the individual case, to medical expenses, daily allowances, disability pensions, integrity compensation, helplessness allowances and survivors' pensions.
Medical expenses relate to necessary medical treatment of the consequences of accidents. They also cover the cost of aids to compensate for physical injury, damage to property, and the costs incurred in travel, transportation, rescue, recovery and burial/cremation.
Daily allowances are paid as from the third day after the accident, amounting to no more than 80% of the insured earnings. Insured persons who are completely incapable of working receive the maximum amount. Those who are capable of work to some extent received allowances that are reduced proportionately.
Disability pensions, integrity compensation and helplessness allowances are insured for in the event of disability.
Persons who have become at least 10% disabled as a result of an accident can claim a disability pension. Disability pensions amount to 80% of insured earnings for persons who have become completely incapable of work, and are reduced proportionately where the incapacity is partial.
Anyone whose physical, mental or emotional integrity is substantially and permanently impaired as a result of an accident is entitled to integrity compensation. This compensation takes the form of a one-off payment calculated by reference to the maximum insured earnings and not exceeding it.
A person who has had an accident as a result of which they are disabled and need the help of others to cope with everyday living receives a helplessness allowance. This allowance is paid monthly and is equivalent to at least twice, but no more than six times, the maximum amount they could earn in a day.
On the insured person's death, the surviving family members can claim a survivors' pension. The spouse gets 40%, full orphans 25%, and half-orphans 15% of the insured earnings. All the survivors taken together, though, can receive no more than 70% of the insured earnings in total.
Spouses are entitled to a pension only if they have children who are themselves entitled to one or live with such children in a joint household. In addition, spouses who are at least two-thirds disabled or become so within two years of their spouse's death are entitled to a survivor's pension.
Unlike a widower, a widow is entitled to a pension if she is over 45 years of age or has children who are no longer entitled to a pension. The insurer may, moreover, pay the widow a one-off settlement even if she meets none of the conditions that would entitle her to a pension.
|5. When and for how long are payments made on a claim?|
|If an employee becomes incapable of work, you, as an employer, are obliged to continue to pay at least 80% of their wages from the day of their accident. Not until the third day after the accident does compulsory accident insurance take over and start paying a daily accident allowance. In the event of permanent incapacity to work, state disability insurance (IV) benefits complement accident insurance payments, if necessary until the day your employee retires. After retirement, the payments in lieu of salary are replaced by the AHV pension.|