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Old 19.05.2019, 01:14
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Accident Insurance problem abroad

I am currently in Canada and have a groin hernia from lifting weights. My employment only lasted until April so im pretty sure that my employer won't cover my accident that happened 2 days ago.

I didn't know I had to switch the accident insurance to my private health insurance until now.

Because its illegal not to have accident insurance, would the health insurance company just go back and add on the accident insurance for May's premium? Or am I completely screwed?

My second question is, does accident insurance cover hernia surgeries abroad? or would I have to fly back to Switzerland to have it covered? The information on my contract states that they cover up to double the costs of what it is in Switzerland... but I'm unsure if a hernia is a medical emergency.
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Old 19.05.2019, 01:33
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Re: Accident Insurance problem abroad

It is only mandatory if you are employed, otherwise it is your free choice to take out an accident insurance or not. Also no new accident insurance would pay for this since it is considered a pre-existing thing.

However is this really an accident and not just a medical issue for your health insurance?
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Old 19.05.2019, 02:15
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Re: Accident Insurance problem abroad

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I am currently in Canada and have a groin hernia from lifting weights. My employment only lasted until April so im pretty sure that my employer won't cover my accident that happened 2 days ago.
.
There is usually a grace period of about 30 days after your employment ends. Check with the insurance company. Also probably get accident insurance added to your health insurance.
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Old 19.05.2019, 08:17
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Re: Accident Insurance problem abroad

The idea that it was not an accident but rather a normal health issue made worse by lifting weights is worth pursuing -any accident insurance company might well make this argument. Did you ever have any pain prior to going to the gym.............?
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Old 19.05.2019, 09:00
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Re: Accident Insurance problem abroad

1. Accident insurance is mandatory Art. 1a Abs. 2 Lit. b KVG
https://www.admin.ch/opc/de/classifi...index.html#a1a
It is either covered by your regular basic health insurance (which cannot exclude existing conditions) or when you are working a certain hours per week through your employer. Art. 8 UVG https://www.admin.ch/opc/de/classifi...038/index.html

2. If you get the mandatory coverage through your employer you are covered up to 31 days after the last paid day of employment (with some exceptions). Art. 3 Abs. 2 UVG

3. It is most likely not an accident but an injury covered by health insurance. See https://www.englishforum.ch/family-m...-accident.html

4. If you can travel and the injury does not have to fixed ASAP I doubt they will pay for a surgery abroad.

5. How proceed? Find out if it is an accident, and after that if the responsible insurance would cover a treatment abroad.
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Old 19.05.2019, 09:24
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Re: Accident Insurance problem abroad

When I had an inguinal hernia, the doctor explained that it needed fixing, but it wasn't an emergency. You can survive with a hernia indefinitely (if not comfortably). It only becomes a medical emergency (and indeed a very serious one), if the hernia becomes strangulated.

TL/DR - have the surgery when you get home. Subject to the advice of your consulting doctor.
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Old 19.05.2019, 11:24
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Re: Accident Insurance problem abroad

OP, you're probably still covered. Mind, private service providers (especially in North America) often cost more than is covered (costs can't be more than twice the cost in CH), you'd probably need a travel and accident insurance for that.

In addition you can extend coverage by up to 6 months (for 45.- a month) by getting what's called an "Abredeversicherung" in German from your current accident insurer, this must have been done before the 31 days grace period has run out.

Last edited by Urs Max; 19.05.2019 at 11:36.
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Old 19.05.2019, 20:19
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Re: Accident Insurance problem abroad

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The idea that it was not an accident but rather a normal health issue made worse by lifting weights is worth pursuing -any accident insurance company might well make this argument. Did you ever have any pain prior to going to the gym.............?
Never had any pain there before. Honestly the day before I was ripping up my dad's outdoor deck as well as working out the morning before.... so it could have been one of the two.
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Old 19.05.2019, 20:21
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Re: Accident Insurance problem abroad

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1. Accident insurance is mandatory Art. 1a Abs. 2 Lit. b KVG
https://www.admin.ch/opc/de/classifi...index.html#a1a
It is either covered by your regular basic health insurance (which cannot exclude existing conditions) or when you are working a certain hours per week through your employer. Art. 8 UVG https://www.admin.ch/opc/de/classifi...038/index.html

2. If you get the mandatory coverage through your employer you are covered up to 31 days after the last paid day of employment (with some exceptions). Art. 3 Abs. 2 UVG

3. It is most likely not an accident but an injury covered by health insurance. See https://www.englishforum.ch/family-m...-accident.html

4. If you can travel and the injury does not have to fixed ASAP I doubt they will pay for a surgery abroad.

5. How proceed? Find out if it is an accident, and after that if the responsible insurance would cover a treatment abroad.
Thanks for the info.

I didn't mention this but I was also ripping up my dad's outdoor deck the day before I noticed it and easily could've triggered this. Is this considered an accident?
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Old 19.05.2019, 21:45
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Re: Accident Insurance problem abroad

Was there an unexpected external event which caused the injury? If so, it is likely to be called an accident. If not, then not. If you slip, or something heavy shifts and puts more weight than you expected onto you, you may have an external event which caused the injury. On the other hand, if the barbell just had a lot of plates on it, it isn't really unexpected that it be heavy.

Do you have private-level health insurance? Was your employer's accident insurance basic, or did it include private-level care?

Obviously you'll need to pay any remaining franchise (deductible) for the year, if you use your health insurance, but otherwise, at least within Switzerland, the question of who pays only really matters if the coverages are at different levels - it can be expensive to request private level care because your accident insurance is private level, only to find that it is not an accident and your basic level health insurance only pays part.

The relevant insurance companies will have protocols for sorting out who pays when things are in doubt, especially for treatment in Switzerland. If you wait to get it closed up here, then you probably shouldn't worry about insurance too much, beyond the bit about the care level.
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Old 20.05.2019, 08:08
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Re: Accident Insurance problem abroad

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There is usually a grace period of about 30 days after your employment ends. Check with the insurance company. Also probably get accident insurance added to your health insurance.
Min period of 1 month max 6 months depending on employer.
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Old 20.05.2019, 15:11
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Re: Accident Insurance problem abroad

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Never had any pain there before. Honestly the day before I was ripping up my dad's outdoor deck as well as working out the morning before.... so it could have been one of the two.
It'll still count as illness, not accident. Hernias seem to be one of the things where the health insurance companies in CH have a set designation. To get a different answer you'd probably have to go to court.

I had a similar hernia situation 4-5 years back. I popped the hernia after failing on a heavy back squat (125kg, if memory serves) - but my employee insurance summarily rejected it as an accident and made me submit it as an illness. (Bummer. Had a big deductible for illnesses, none for accidents ... )
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