All,

I am having an issue where I suffered what in every country I have lived in was considered a work accident.

Basically, the accident insurance (provided by my employer) has decided that it is not an accident but a sickness hence my medical insurance should take the hit. Problem is, by them taking the heat the following happens:

a) My health insurance premium goes up
b) I have to pay for the whole excess

Since I had to attend physio, the costs is going to be extremely high. Now, should I seek legal assistance? Should my employer take ownership (since they asked me to carry out the job) and cover the costs? They are saying that since the Accident insurance has decided (with a medical certificate advising it was "cas d'accident") that is not, they are saying I should make the payments.

on top of that, I am really close to get a pursuit because of this.

I sincerily believe it is gone mad!!!

Switzerland does not stop surprising me!!!

Has this happened to anyone else?

I think nobody can seriously tell you weather or not you should get legal help without more information from your side. I can understand that you do not want to give it on a public forum, I would not do so either.

Do you have a good relationship with your physio? Ask him, he might be the most knowledgeable in that area...

Did you get in touch with the insurance Ombudsman ?
They will do some mediation to find a solution.

MrVertigo,

Thanks a million for the information.

I can defenitely answer yes to all their questions

I will give that a go and see what the outcome is.

Thanks everyone!! (specially you, MrVertigo)

I've had my own insurance-related nightmares in Switzerland involving insurers battling over whether or not something was an accident. (See thread.)

The legal definition of an accident is very strict, and a key component is that there has to be some sudden external factor that causes an injury essentially instantaneously. This is in the Swiss legal definition of an accident (which I have on some form buried in amongst my files, but don't have in front of me right now).

What this means is that there are many types of injuries that aren't necessarily illnesses, but won't be covered by accident insurance. Examples include repetitive strain injuries, muscle or tendon damage due to overuse, back problems, etc.

The bad news is that unless there really was a specific "accident" involving falling, a collision with something, etc., accident insurance will not pay your medial bills. Even though it is paid for by your employer, accident insurance is really only for accidents, and has nothing to do with illnesses arising from your work.

In my case I had a knee injury due to twisting it while skiing (so it wasn't even work-related), but the insurances spent a lot of time arguing whether my knee problems were due to overuse or an accident. This involved people from both insurance companies examining MRIs and medical records, detailed medical history questionnaires, etc. In the end the accident insurance paid, but it took ages and ages to figure it out, and it required them preparing a legal document stating that they agreed that medical bills for the work on my knee were related to the accident and not due to ongoing health problems.

If you really do think that your health problems are due to a specific accident, you should request a re-evaluation by the accident insurance company. (Read my experiences here.) You will have to meet with someone in person and describe your accident in an absurd amount of detail (things like: where was your left hand? where was your right hand? what was the lighting like?) You will also have to provide all medical records. The accident insurance company might overturn their decision (as they did in my case) if it really is due to a sudden external factor.

If your illness is deemed to be not an accident but a work-related health problem, this is something you need to discuss with your employer directly. And you'll have to use your regular health-insurance.

I hope this helps.

Heather

Woa!! Heather, I am sorry for what you had to go through.

Thanks for the information.

I was also looking to see whether the company should take any responsability. Does anyone know?

Without knowing what happened, very difficult to say.

b) yes, that's a general problem with that kind of issue
a) why? We don't have a bonus/malus system in Switzerland. Incidents don't have any influence on the premiums.

Peter

Hi Peter,

the problem appears when it gets handed over to the medical insurance it is not considered an accident any more.

The Insurance company is now saying that although the pain was caused by an external agent, the weight of the external object has to be between 60-100 Kg (WTH!!!???)

I have not seen a lamer excuse (and I worked for an insirance company back in the UK and seen a few bad excuses).

Do insurance premiums go up based on medical history?

I thought that they couldn't, i.e. that insurance rates are purely based on the services provided/covered and not the type of medical cover needed, with factoring in the excess and payment schedule.

I'm guessing yes, based on the OP's comment, but that's news to me.

Unless, the OP is refering to taking a lower premium so that more is covered by the insurance. In this case, yes, the premiums would (obviously) go up.

If they don't they should.
It appears to me that some people seem to be down the doctors every other week with problems and put on meditation.
Then there are people like me that haven't even been to a doctor since 1992, have taken no subscription drugs; antibiotics or medicine for 30 plus years.
Perhaps I have just been lucky, but my Health Insurance is CH 205 per month and is my biggest expenditure after my rent.

Sure there are time wasters, but that kind of system penalises people who have a genuine reason to go more frequently.

Totally agree; it really is a difficult one.

As I said, I have been very lucky that I have not been ill and I have to admit that it is often difficult to be sympathetic to employees that always seem to have illnesess and problems; a lot probably self inflicted due to bad diet, unhekthy living; too much alcohol and drugs.

Yes. You have been lucky. And long may it continue. But you'll be glad of the current system if you do develop any conditions as you get older. Anyway people with a max excess such as myself don't go down to the doctors unless really necessary. People who want to do that pay considerably higher premiums, so I'm not quite sure what your beef is here.

I like the idea of subscription drugs though.

The above exposition appears quite knowledgeable, and I know nothing about Swiss insurance law. I studied EEC (as it then was) insurance law and US insurance law at universities. A quick Googling suggests that your answer may be incomplete in one respect, perhaps not germane here:

"Les maladies professionnelles reconnues en Suisse sont, à de rares exceptions près, celles qui figurent dans la liste des Substances nocives et des maladies dues à certains travaux de l'Ordonnance sur l'assurance-accidents; ..." http://www.bfs.admin.ch/bfs/portal/f...ment.97054.pdf

If this were my case I would want to see what those listed industrial illnesses are: http://www.admin.ch/ch/f/rs/c832_202.html A quick look suggests that this concerns mainly substances nocives such as amiante (asbestos) and certains travaux. But the Ordinance is worth reading and, if there is doubt and considerable money involved, consulting an expert would be sensible.

If the employee has been seconded from an affiliated firm in another country, that other country's law may also apply. I once instituted simultaneous complaints before the labour commissions of the UK and of New York State on behalf of an aggrieved seconded worker and the firm increased its redundancy settlement offer dramatically.

I had a long, drawn-out (3 years') litigation with AXA France over a hotel accident where I filed suit against their insured in Florida and against AXA in the Tribunal d'Instance du 9e Arr. in Paris. I was about to file a further suit in London on the eve of the statute of limitations expiring when they settled. My medical consultant was the leading British surgeon, theirs was a tired, typically uninterested and inexpert insurance doctor in an unkempt third-floor surgery in out-of-the-way Paris. (The Paris suit was because they failed to pay the British surgeon his £650 and stopped responding to correspondence. They admitted liability before the judge and even then didn't pay the judgment until I sent notice that I was going to register the French judgment at the Royal Courts of Justice and attach their 2% shareholding in Legal & General.)

So much for insurance companies.

I am not giving advice here, just providing library references and sharing my disdain for insurers. In my experience the best chances for a quick and reasonable outcome are where both insurance policies in question are with the same insurer. Probably not possible where health insurance is involved.