The cash benefits paid in the event of an accident are daily benefits, disability pensions, lump-sum disability compensation, attendance allowances and survivors’ pensions. The cash benefits paid under accident insurance are calculated on the basis of the insured person’s insured income.
The cash benefits paid under accident insurance are calculated on the basis of the insured person’s insured income. This is the income on which their basic AHV/AHS pension insurance contributions are based, plus certain additional components. The maximum insured income (see Art. 22 Para 1 of the Ordinance on Accident Insurance [UVV/OLAA]; SR 832.202) is set to ensure that 92–96% of all people subject to the mandatory insurance requirement will be insured for their full income.
Daily benefits are calculated on the basis of the last pay received before the accident; pensions are calculated on the basis of pay received for the year preceding the accident. Disability and attendance allowances for all insured people are calculated on the basis of the statutory maximum insured income.
An insured person who is unfit for work or only partially fit for work as the result of an accident can claim daily benefits. These are paid for each calendar day from the third day after the accident occurs. Daily benefits are 80% of the insured income for a person who is 100% unfit for work, and correspondingly less for partial incapacity. Entitlement to daily benefits ceases once the insured person is fully fit for work again, once they start receiving a disability pension, or upon their death. Daily benefits for people who have an accident while unemployed are equivalent to their employment benefit.
If an insured person becomes disabled as the result of an accident – in other words if their ability to work is likely to be impaired permanently or for a prolonged period – they can claim a disability pension. They are eligible to claim if continued medical treatment is not expected to result in any significant improvement in their health and any rehabilitation measures under IV/IS disability insurance have been completed. The degree of disability is calculated by comparing the insured person’s potential income with and without the reduction in capacity to earn a living.
The disability pension amounts to 80% of insured earnings for 100% incapacity and correspondingly less for partial disability. Accident insurance pays insured people who are entitled to an AHV/AVS basic pension or IV/IS disability pension a supplementary pension corresponding to the difference between 90% of their insured income and their basic or disability pension; however, it will not pay more than the maximum amount of accident-related disability pension for the degree of full or partial disability.
Entitlement to a pension ceases once the insured person is fully fit for work again, full lump sum compensation is paid out, the pension is bought out, or upon their death.
Lump-sum disability compensation
An insured person suffering material, permanent impairment of their physical or mental integrity (for example the loss of a kidney or leg, quadriplegia or complete blindness) is entitled to appropriate compensation. This disability compensation is paid as a lump sum in accordance with the severity of the impairment, subject to a minimum level of materiality of 5 per cent. The applicable percentage impairment is multiplied by the statutory maximum insured income to calculate the amount of lump-sum disability compensation due.
Insured people whose disability or invalidity means they require long-term help with day-to-day tasks from another person or personal supervision can claim an attendance allowance on the basis of the degree to which their autonomy is impaired (slight, moderate or serious).
If an insured person dies as the result of an accident the surviving spouse (under certain conditions) and children may claim a survivor’s pension. An ex-spouse who was receiving alimony or maintenance from the deceased will be treated the same as a widow or widower.
A survivor’s pension is calculated as a percentage of the normal insured income as follows: 40% of the insured income for widows and widowers, 15% for surviving children with one living parent, and 25% for surviving orphans – to a maximum of 70% of the insured income for all survivors. A survivor’s pension for a divorced ex-spouse comes to 20% of the insured income, but may not exceed the alimony or maintenance they were due.
If the survivors are entitled to a basic AHV/AVS or IV/IS disability pension, they are paid a supplementary pension by the accident insurance company (please also see the section on disability pensions).
In certain cases the widow or divorced wife of the deceased will be paid a lump sum instead of a pension.
A surviving spouse basically ceases to be entitled upon their remarriage or death or if the pension is bought out; children’s entitlement normally ends when they reach age 18 or when they complete their education, but at the latest once they reach age 25.
Last modification 05.07.2018