The conundrum of delayed consequences

A fracture during a hike, or a sprain during a football game: accidents like these happen every day in Switzerland, but can still come with unforeseen consequences.   This is the kind of difficult experience Valais resident Kevin Hafner suffered several years ago. The young man, now 24, had dislocated his right shoulder during a fall while off-road biking in 2007. Set to begin the next summer as a mechanic’s apprentice, he suffered several relapses. In late 2009, doctors found that a new operation would be necessary and Kevin Hafner was taken off work for six months.  
 
But there was a twist: accident insurance refused to cover his wages, arguing that, since the accident took place while he was a student, the treatment should be covered by his own health insurance. In fact, if the accident insurance is compulsory in Switzerland, the cover provided depends on the employment status of each individual. As a result, Swiss residents without gainful employment (children, students, housewives and househusbands, retirees, etc.) benefit from cover for treatment expenses incurred during an accident covered by the compulsory health insurance. For their part, those who work benefit – in addition to medical cover – from the temporary compensation of their salary (or permanent, in the event of permanent disability), provided by the accident insurance. 
 
But things can get complicated in certain specific situations, especially in the event of a change of employer or insurance company, when the cover continues to be granted under the insurance contract in effect at the time the accident occurred. According to the same rule, in the case of relapses from accidents, any additional benefits must be requested from the insurer who covered the first treatments. Here’s another potentially problematic scenario: an accident takes place during a period of residency and work abroad, and the relapse occurs after the worker returns and resumes professional activity in Switzerland. 
 

This situation can quickly become impossible for the policyholder, especially if this person has dependants. It becomes even more critical when the accident victim returns to Switzerland after a stay abroad and that his or her former insurer does not provide any further benefits after a certain time period. The injured person may then be required to pay all or part of his / her treatment, and may not be compensated for loss of income.

Overview 

796’696

The number of accidents recorded in Switzerland in 2014 that relied on compulsory accident insurance. This figure accounts for occupational accidents (268,154), non-occupational accidents (513,254) and the case of job seekers (15,288). 
(Source: Suva) 

1.82

Total costs for the processing fee dependent on accident insurance in 2013, in billions of francs.
(Source : Suva)

 
 
 
 

A liability becomes an asset

Kevin Hafner’s insurance issue has now become a case study. Outraged by the insurance company’s response, the father of the young Valais native decided to publicise the case, and several politicians took up the issue. In 2011, Christophe Darbellay, then a national adviser and President of the Christian Democratic Party, introduced a motion in Parliament demanding that accident insurance guarantee the payment of daily compensation in cases where the inability to work is due to a relapse or the delayed results of an injury when the policyholder was younger.
 
Although the motion introduced by the Valais representative was definitively adopted on 3 June 2014, accident insurers still do not compensate – in most cases – for delayed consequences of prior accidents, or do so to a limited extent. Therefore, it is important to specify this type of guarantee through complementary accident insurance purchased by the employer. Since this is not currently a legal requirement for insurance companies, they may refuse to grant this guarantee or charge a relatively high price for the guarantee. It may be interesting to call on the expertise of a broker or insurance consultant to purchase a guarantee under the best conditions. This benefit is important for workers. This additional social benefit granted by the employer is included in the list of benefits offered by their company.

 

 
Yvan Roux
Corporate Clients Director
Article published in august 2016