Go Back   English Forum Switzerland > Help & tips > Insurance  
Reply
 
Thread Tools Display Modes
  #1  
Old 25.01.2021, 20:58
Newbie 1st class
 
Join Date: Jan 2021
Location: Bern
Posts: 11
Groaned at 0 Times in 0 Posts
Thanked 4 Times in 2 Posts
JamesHolding has no particular reputation at present
Accident Insurance Dispute - Who pays?

So i've been having a bit of a headache with insurance regarding an accident I had over a year ago.

I tripped over and sprained my ankle badly, went to the doctors the same day, had xrays and was treated with a cast, etc for a lot of ligament damage. No dispute on that part being an accident and accident insurance paid for it.

Anyway my cast was removed 6 weeks later and I began walking; however, I still had pains. I did physio for a while and things improved but there was still an underlying pain that never went away. Physio and doctors put it down to shin splints and said it would go with time. So we closed my case and I continued to get on with life..
Pain didn't go away and 5months later (after corona lockdown) I got back to the doctors to figure out why it hadn't gotten better. They did more xrays, couldn't figure out the cause, other than a suggestion of arthritis and so gave me some pills that would hopefully help. The pills didnt work and so I was referred to an orthopaedic specialist who carried out a MRI and found that I had a piece of bone broken off inside my ankle and detached ligaments that would require surgery to resolve. How the doctors initially missed this, I don't know! I was booked in for my surgery under the assumption that this was all still part of my accident, as there had been no other incident within the period from the initial fall until the operation. I spoke to the accident insurance to confirm this was all ok and was given some forms to fill out regarding circumstances to make sure it was all ok. I filled them out, sent them back and waited. I didn't hear back for some time and so I contacted the accident insurance company to confirm everything was ok, to which I was told they were referring the case to their doctor and it could take some time to figure out and may even need to be assessed after the operation.. a bit useless but ok, I needed the surgery as it was affecting my quality of life and it couldn't be put off.

Post surgery (Surgeon told me there was no arthritis ) i heard nothing from my accident insurance despite all medical bills being sent to them. I called them as I needed to figure out my salary payments for work absence and was told that the accident insurance doctor had looked at the MRI results and said that there was ligament damage from an older injury and so were not sure on coverage. Other than maybe spraining my ankle as a kid playing sports over 15years ago, which never warranted treatment beyond resting a bit, there has been no other injury, illness or treatment to this ankle. I made the point that the MRI had been carried out almost a year after the accident and so, of course the damage would look old after so long. They tried to claim it was from an older injury and after disagreeing with them, they said they would reconsult their doctor about it.

Are the accident insurance able to get out of paying this, or is this a bluff on their part to try to dodge paying costs?
Reply With Quote
  #2  
Old 25.01.2021, 21:42
NotAllThere's Avatar
Modulo 2
 
Join Date: Oct 2008
Location: Baselland
Posts: 14,492
Groaned at 279 Times in 239 Posts
Thanked 21,725 Times in 8,815 Posts
NotAllThere has a reputation beyond reputeNotAllThere has a reputation beyond reputeNotAllThere has a reputation beyond reputeNotAllThere has a reputation beyond reputeNotAllThere has a reputation beyond reputeNotAllThere has a reputation beyond repute
Re: Accident Insurance Dispute - Who pays?

My daughter sprained her ankle badly while insured by SUVA. They disputed it saying it was preexisting.

I posted about it on here and a few people pointed the law, which states that sprained ankles are always covered by accident insurance. Read this thread https://www.englishforum.ch/family-m...-accident.html!

We think it was probably due to her employer's accident report, rather than deliberately trying to reject the claim.
Reply With Quote
The following 2 users would like to thank NotAllThere for this useful post:
  #3  
Old 29.01.2021, 13:52
Newbie 1st class
 
Join Date: Jan 2021
Location: Bern
Posts: 11
Groaned at 0 Times in 0 Posts
Thanked 4 Times in 2 Posts
JamesHolding has no particular reputation at present
Re: Accident Insurance Dispute - Who pays?

Thanks for the information! I looked through it all and to me it seems clear that the accident insurance company should be paying for this.
However, I spoke to them and they said they would not be covering it because on the xray from the day of the accident there was already an old injury on the xray. A loose piece of bone that needed removing in the operation apparently was already there before the day of the accident. From the information on that thread, it seems that the accident insurance act covers that but they didn't agree. They said that there must have been a older injury and that the accident insurance at that time should pay for it, not them. However, there was not one, or if there was, it was from childhood when I lived in the UK. I explained that I had zero pain before the day of the accident and nothing that had encouraged me to seek medical care and so old accident or not, the new accident had triggered my need for surgery.

Any advice on this? Do I have a way of fighting this?
Reply With Quote
  #4  
Old 29.01.2021, 14:24
Island Monkey's Avatar
Forum Legend
 
Join Date: Mar 2008
Location: Wallis
Posts: 6,169
Groaned at 106 Times in 71 Posts
Thanked 6,905 Times in 3,138 Posts
Island Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond repute
Re: Accident Insurance Dispute - Who pays?

This is of no help to you, sorry..... but the separate Swiss accident/Health insurance system is bull shit! There should be one insurance covering everything, and the employer should make a contribution, that would stop these disputes.
Reply With Quote
The following 2 users would like to thank Island Monkey for this useful post:
This user groans at Island Monkey for this post:
  #5  
Old 29.01.2021, 15:34
Newbie 1st class
 
Join Date: Jan 2021
Location: Bern
Posts: 11
Groaned at 0 Times in 0 Posts
Thanked 4 Times in 2 Posts
JamesHolding has no particular reputation at present
Re: Accident Insurance Dispute - Who pays?

I completely agree, the bureaucracy and complications placed on someone that is already dealing with sickness/injury etc is ridiculous and shows little regard for the people at all. Overcomplicating things that should be made as simple as possible seems to be a running theme here.
Reply With Quote
This user would like to thank JamesHolding for this useful post:
  #6  
Old 29.01.2021, 15:43
aSwissInTheUS's Avatar
Forum Legend
 
Join Date: Nov 2007
Location: Zurich area
Posts: 12,778
Groaned at 99 Times in 88 Posts
Thanked 19,576 Times in 8,681 Posts
aSwissInTheUS has a reputation beyond reputeaSwissInTheUS has a reputation beyond reputeaSwissInTheUS has a reputation beyond reputeaSwissInTheUS has a reputation beyond reputeaSwissInTheUS has a reputation beyond reputeaSwissInTheUS has a reputation beyond repute
Re: Accident Insurance Dispute - Who pays?

Quote:
View Post
This is of no help to you, sorry..... but the separate Swiss accident/Health insurance system is bull shit! There should be one insurance covering everything, and the employer should make a contribution, that would stop these disputes.
Still better than the German accidence insurance bullshit where it depends how far you deviate from the most direct commuting route between your workplace and your home if your health insurance or the more generous workplace insurance has to pay.
Reply With Quote
This user would like to thank aSwissInTheUS for this useful post:
  #7  
Old 29.01.2021, 15:44
Forum Legend
 
Join Date: Aug 2015
Location: Basle
Posts: 2,800
Groaned at 72 Times in 57 Posts
Thanked 1,949 Times in 1,129 Posts
Landers has a reputation beyond reputeLanders has a reputation beyond reputeLanders has a reputation beyond reputeLanders has a reputation beyond reputeLanders has a reputation beyond repute
Re: Accident Insurance Dispute - Who pays?

Do you have a report from your own doctor which clearly contradicts what the insurance says?
Reply With Quote
The following 2 users would like to thank Landers for this useful post:
  #8  
Old 29.01.2021, 16:01
st2lemans's Avatar
Forum Legend
 
Join Date: Dec 2010
Location: Lugano
Posts: 32,223
Groaned at 2,454 Times in 1,776 Posts
Thanked 39,317 Times in 18,533 Posts
st2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond repute
Re: Accident Insurance Dispute - Who pays?

Quote:
View Post
This is of no help to you, sorry..... but the separate Swiss accident/Health insurance system is bull shit! There should be one insurance covering everything, and the employer should make a contribution, that would stop these disputes.
a) Not everyone has an employer.

b) Employer accident has no deductable, non employer accident insurance does.

Tom
Reply With Quote
The following 3 users would like to thank st2lemans for this useful post:
  #9  
Old 02.02.2021, 18:01
Newbie 1st class
 
Join Date: Jan 2021
Location: Bern
Posts: 11
Groaned at 0 Times in 0 Posts
Thanked 4 Times in 2 Posts
JamesHolding has no particular reputation at present
Re: Accident Insurance Dispute - Who pays?

Quote:
View Post
Do you have a report from your own doctor which clearly contradicts what the insurance says?
I'm not sure. Initially the doctors who looked at me, thought it was calcium build up on my ligaments in the x ray, but when the specialist saw it, they said it was a piece of broken bone instead.. the initial doctors weren't that helpful at solving the problem or diagnosing it, so i'm wondering if their report has added to the problem with insurance. I have contacted the ombudsman for insurance and asked for all documents relating to my case from the accident insurance. Just waiting to hear back from them so that we can figure out how to deal with this..
Reply With Quote
The following 3 users would like to thank JamesHolding for this useful post:
Reply

Tags
accident insurance, dispute, health insurance, medical bills, payment




Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
I bumped my head and need to see a doctor - who pays: accident or health insurance? coolbeanz Insurance 11 24.11.2020 12:24
Accident on maternity leave /accident insurance question swissviking Insurance 14 09.01.2020 23:05
Kindergarten accident - who pays? SwissMorgs Family matters/health 14 03.06.2019 02:03
Who pays? - accident before living in CH. Island Monkey Insurance 4 24.02.2014 19:08
You MUST pay first, before insurance pays? xomflower1 Insurance 17 02.09.2009 16:13


All times are GMT +2. The time now is 22:23.


Powered by vBulletin® Version 3.8.4
Copyright ©2000 - 2022, Jelsoft Enterprises Ltd.
LinkBacks Enabled by vBSEO 3.1.0