«My employee has suffered an accident and cannot work. Who pays the employee's salary and covers the medical expenses? What steps do I have to take?»
No matter whether employees suffer an accident at work or during non-working hours, they are entitled to their salary. This is required by law, which also stipulates that medical expenses must be insured
Who pays what?
Continued payment of salary
For the first two days, you, as the employer, must pay your employee's salary yourself (at least 80%). An exception applies if you have taken out supplementary accident insurance under which the accident insurance covers the salary costs from the first day.
Your compulsory accident insurance takes over payment of the salary from the third day onward (daily accident allowance). This can be up to CHF 148,200 annually per employee. If you would like more extensive insurance coverage, you can take out supplementary accident insurance.
Medical expenses (such as hospital or treatment costs) are covered by your company's compulsory accident insurance until the employee is healthy again.
Employees whom you employ for fewer than eight hours per week are responsible for their own accident insurance. They can have the accident covered by their compulsory basic insurance, which will pay the medical expenses.
Accidents on holiday
In the event of accidents on holiday, employees may only claim additional holiday leave if the accident made them unable to take their holiday. Incapacity to take holiday is not the same as incapacity for work. This occurs, for instance, when a stay in a rehabilitation clinic, a bedridden state, or regular visits to the doctor or physiotherapist stand in the way of the rest and recreation that is the purpose of holiday.
Incapacity for work
Employees are considered incapable of working if their attending physician provides a medical certificate confirming that they are unfit for work for a specific period following an accident.
Taking holiday in the event of incapacity for work
Employees may choose to take holiday during the period of their incapacity for work. In this case, the following rules apply for taking holiday leave: Employees receive their regular salaries. There is no entitlement to daily allowances in this case. The same conditions apply as they would for healthy employees.
Working despite incapacity for work
The employee concerned may not work throughout the period of incapacity for work. If this nonetheless occurs, the insurer may request reimbursement of the daily allowance. If an employee is able to perform certain work despite their health problems, it is best that you discuss this with the attending physician, who may decide to reduce the degree of incapacity for work. Ideally, the physician will prepare a detailed medical certificate describing the work that the employee may or may not carry out.
You can find more information on medical certification of incapacity for work on the website of Swiss Insurance Medicine, for instance.
The aim must be to restore the employee's full capacity for work. This may also be accomplished on a gradual basis.
Termination / contractual amendments during the period of incapacity for work
For employees who are incapable of working following an accident, you may not terminate their position or amend their employment contract for a period of time specified by law. Following expiry of the trial period, protection against termination applies for 30 days, or for 90 days from the second through the fifth years of employment, and for 180 days starting from the sixth year of employment. After this blocking period is over, it is possible to terminate the jobs of employees despite their incapacity for work. No such blocking period applies for employees, who are allowed to terminate their employment subject to the normal termination notice periods. You can find more information on the topic of termination and a termination notice template available for download at www.ch.ch.
What can Helsana do for you?
Report accidents immediately
Report accidents to us as soon as possible so that we can provide optimal service to you and to the person who suffered the accident. The sooner you contact us, the more quickly we can find appropriate measures to handle the case in the best interests of all parties. For reporting accidents, the best option is to use the online form. We need the following from you:
- Your policy number
- The personal details of the employee who suffered the accident
- Detailed accident information (time, place, course of events, accident chronology, information about the attending physician or place of treatment, relevant liable parties and insurers)
The person who suffered the accident, or his or her relatives, must provide you with all information that can help clarify the course of events and the consequences of the accident. We need this information to determine the applicable insurance benefits.
If you only have supplementary insurance for accidents with Helsana, please send us a copy of the accident report that you submitted to your compulsory accident insurer.
The employee who suffered the accident may submit accident-related bills to us directly once you have reported the accident to us.
You can find more information on the reporting of accidents at Helsana for companies, Client Services division.
What needs to be done in the event of a long period of incapacity for work?
Power of attorney
We will contact your employee directly in the event of questions or points to be clarified. Depending on the situation, data protection regulations may require us to ask the employee for a power of attorney in order to process the claim.
We also need a medical certificate to be provided by you or your employee.
Accident report UVG
Your employee will receive a accident report UVG from Helsana. The employee must present this card at all physician's visits so that the physician can make the necessary entries. The employee must then provide us with a copy of the updated accident report UVG at the end of each month. Once the employee has fully resumed work, we will need the original daily allowance card in order to prepare the final invoice, as well as a final certificate from the attending physician.
Registration for disability insurance (IV)
If you and your employee decide that the employee will no longer be able to handle their normal workload in the future, it is necessary to register with the relevant disability insurance (IV) office (in the canton where your company is based). We would be happy to do this for you. The early intervention stage begins with the receipt of the IV registration by the IV office. The IV office will decide whether, and with which measures, early intervention may help your employee return to working life.
If complications occur during the healing process, or if recovery takes a long time, you and your employee can count on professional, customised advice and assistance from our team of specialists (case managers). Your case manager will also handle coordination with the other authorities and offices involved, and will strive to ensure the best possible outcome for the employee's return to work following an accident. You can find more information on this topic at Helsana for companies, Case Management division.
Studies show that an employee's relationship with his or her line manager contributes significantly to how quickly the employee can return to work following an accident. For interested corporate clients, Helsana offers management training that focuses on how to deal with employees in a respectful way. You can find more information on this topic at Helsana for companies, Health Management division.