The monetary benefits paid in the event of an accident are: daily allowance, disability pension, integrity and helplessness allowance, and surviving dependants’ pension. The monetary benefits paid under accident insurance are calculated on the basis of the insured income.
The monetary benefits paid under accident insurance are calculated on the basis of the insured income. This is the salary on which AHV pension contributions are based, with certain additional components. The maximum insured income (see Art. 22 para. 1 of the Accident Insurance Ordinance/UVV, SR 832.202) is set in such a way as to ensure that, in general, the full income is insured for 92–96% of all people subject to compulsory insurance.
Daily allowances are based on the last salary received before the accident. Pensions are based on the salary received for the year preceding the accident. Integrity and helplessness allowances are calculated on the basis of the maximum insured income.
Persons who are wholly or partly unfit for work as a result of an accident can claim a daily allowance. This is paid for each calendar day from the third day after the day of the accident. It amounts to 80% of the insured income for complete incapacity, and correspondingly less for partial incapacity. The entitlement to a daily allowance ends when the person regains full capacity for work, is granted a disability pension, or dies. Daily allowances for persons who have an accident while unemployed are equivalent to unemployment benefits.
If persons become disabled as the result of an accident – i.e. if their ability to work is likely to be impaired permanently or for a prolonged period – they can claim a disability pension. The entitlement begins when continued medical treatment is not expected to result in any significant improvement in their health and any IV rehabilitation measures have been completed. The degree of disability is calculated by comparing the insured person’s potential earnings with and without the impairment.
The disability pension amounts to 80% of insured income for complete incapacity and correspondingly less for partial incapacity. For insured persons entitled to an AHV or IV pension, accident insurance pays a supplementary pension corresponding to the difference between 90% of the insured income and the AHV/IV pension. However, the total amount paid will not exceed the accident-related disability pension envisaged for complete or partial incapacity.
Entitlement to a pension ceases when the person regains full capacity for work, or upon receipt of a lump-sum benefit, a pension buyout, or the person’s death.
Persons who suffer a substantial, permanent loss of physical or mental integrity as a result of an accident (e.g. loss of a kidney or leg, tetraplegia or blindness) are entitled to an appropriate integrity allowance. This takes the form of a lump sum settlement, based on the severity of the impairment. Impairments below 5% are not deemed to be material. The percentage impairment is multiplied by the maximum insured income to determine the integrity allowance payable.
Persons who, as a result of disability, permanently require assistance with day-to-day tasks, or personal supervision, can claim a helplessness allowance. This is calculated according to the degree of helplessness (mild, moderate or severe).
Surviving dependants’ pension
If an insured person dies as a result of an accident, the surviving spouse (under certain conditions) and children can claim surviving dependants’ pensions. An ex-spouse eligible for maintenance payments from the accident victim will be treated as equivalent to a widow or widower.
Surviving dependants’ pensions are calculated as a percentage of the insured income, amounting to 40% for widows and widowers, 15% for children having lost one parent, and 25% for orphans – up to a maximum of 70% for all surviving dependants. For an ex-spouse, the pension amounts to 20% of the insured income, but it must not exceed the maintenance payable.
For surviving dependants entitled to an AHV or IV pension, accident insurance pays a supplementary pension (cf. “Disability pension” above).
In certain cases, the widow or ex-wife will be paid a lump sum instead of a pension.
In general, a surviving spouse’s entitlement ceases upon remarriage, death or a pension buyout. Children’s entitlement normally ceases when they reach the age of 18 or complete their education, but at the latest when they reach the age of 25.
Last modification 15.05.2020