A few months ago, my daughter badly sprained her ankle (level 3 sprain), tearing at least one ligament. She did this by landing badly after jumping a hurdle during the physical part of the selection procedure to join the police. She was in crutches and a cast for 6 weeks, and was signed off work for 8 (in her work she does a lot of standing and walking around).

We've just received a letter from SUVA.

Nach unseren Unterlagen hat sich kein Unfallereignis im Sinne von Artikel des Bundesgesetz 4 ... zugetragen. Auch sind die Voraussetzungen zur Übernahme des Schadenfalles als unfallähnliche Körperschädigung nicht erfüllt.

Wir empfehlen Ihnen, den Fall Ihrer Krankenversicherungen zu melden un legen Ihnen dafür end Brieffdoppel bei.

Article 4 says:

In Artikel 4 des Bundesgesetzes über den Allgemeinen Teil des Sozialversicherungsrechts heisst es: «Unfall ist die plötzliche, nicht beabsichtigte schädigende Einwirkung eines ungewöhnlichen äusseren Faktors auf den menschlichen Körper, die eine Beeinträchtigung der körperlichen, geistigen oder psychischen Gesundheit oder den Tod zur Folge hat.» Für einen rechtmässigen Unfall muss jedes Kriterium dieser Definition erfüllt sein.

I'm trying to figure out how a sprain incurred while doing an obstacle course is not an accident... Strange thing is, we had cause to call SUVA earlier, and they said there was no issue. Maybe they have got incorrect information?

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Down with racism. Long live miscegenation!

I'd call SUVA and have them explain it to you. Perhaps after further deliberation, they'll alter their decision.

It doesn't make any sense to me either.

If that’s not an accident I don’t know what is.

My daughter will call them tomorrow. Most odd.

I duffed my ankle playing footie in the park a few years ago and it was counted as an accident. You have to fill in a form detailing exactly what happened and who was involved, though. Maybe in your daughter’s case the police don‘t want to be seen to be somehow involved, or implicated with dodgy hurdles?

Did she had prior, chronic problems with the ankle/ligaments? That is the only option I see how it could not be an accident.

But even then, torn ligaments are by default considered as accidents and it is on the insurance to proof otherwise.
Art. 6 UVG https://www.admin.ch/opc/de/classifi.../index.html#a6
And also https://www.beobachter.ch/geld/versi...all-oder-nicht


The worst which can happen is that the regular health insurance says it was an accident, and you have to pay all medical costs until both insurance found an agreement in court.

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On Strike - ChatGPT knows more than I, so use it (or doesn't it?)

Ask the piglets on the selection process to send a letter maybe ?

The decision could hinge on "external" or on "unusual". My guess would be on the former as no additional factors appear to have been involved when the incident occured.

That said, you may want to enquire with the police corps. When doing the military entry test you're subject to, and insured according to, military law. Police is the civil version of military so equivalent rules may apply.

I had my knee 'lock' while sleeping and had to do a surgery to remove part of the ligament and it counted as an accident. The doctor and hospital told me it isn't an accident but when I pressed my risk insurance provider they said it is and covered everything.


Push and push hard, sometimes they might say no automatically to weed out the fake claims. A true case will persist.

My layman's summary understanding is that an accident is an injury caused by an unexpected external event.

So for example, if you are in a gym, attempt to lift a heavy weight, and manage tear a muscle, that might not be considered an accident, on grounds that there isn't an unexpected external factor. It was rather expected that the weight be heavy and your unexpected weakness is internal.

On the other hand, if you slip while performing a gymnastic maneuver, or if you bicycle skids on loose rocks, these are unexpected events. Injuries stemming from such events are much harder for accident insurance companies to dispute.

So while I wouldn't recommend disingenuity when filling out an accident report, I would recommend being careful to explain any such external event which led to the injury, even if it might seem too obvious to mention.

Keep in mind that insurance companies are in business to make money, not to pay claims.
If they can weasel out, they will. They need to be pushed. Be relentless, but keep your cool.
The squeaky wheel ...

Normally in Switzerland the rules are very clear. And if it gets passed back to your health insurance they will fight it out directly with the accident insurance...



either way, your daughter should be covered... definitely call SWICA and I'm sure they will know how to fix the problem...

So we called SUVA. They claim that as it was done during sport, it isn't an accident, it's an injury, so not covered.

The only issue with it getting passed to Swica, is that then I'll have to pay the excess - 2500CHF. Which would be irritating somewhat.

I think we'll go down the appeal process ourselves, quoting the law. There was nothing pre-existing.

Something lost in translation. What German term was used for "injury"?


PS: The issue seems to be the "extraordinary/unusual" part of the accident definition:
https://www.koordination.ch/de/onlin...egriff/#c16958
Reading the federal court rulings is just plain legal bonkers. No wonder they added certain injuries on the default list of Art. 6 UVG.

Odd, I've hurt myself skiing and motorcycling, and SUVA covered both!

Tom

Might I ask:

Aside from the issue of meeting the franchise and Selbstbehalt, is there any other advantage to having an injury classified as an accident rather than an illness?

(As a dilettante Hausfrau, accident and illness are the same insurer.)

Verletzung.

For you, probably nothing. My accident insurance gives me private care - but my health insurance is public.

Not much of an issue for a non-working person which has health and accident insurance from the same company.

SUVA is general ward (same as basic insurance) but it has some special occupational and physical rehabilitation centers.

SUVA is the largest accident insurance company (mandatory for some high risk professions) other accident insurance might offer privat care.

Not 100% sure, but I think for accidents the insurance at time of the event has to bear all costs until full recovery, whereas with illness it is simply your current insurance provider at time of treatment.

Also, in case there is a long term disability and loss of function the insured paycheck is higher and the payout earlier in case of an accident.

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On Strike - ChatGPT knows more than I, so use it (or doesn't it?)

I suppose they are inferring that it was self inflicted as a sports injury.

Could you have a claim against the Police for the injury. Had they prepared her for this? i.e. warm up and milder exercises first

But why wouldn't a sports injury be an accident?

My skiig injuries were always cosidered accidents, motorcycle injuries as well.

Tom