{"id":9173,"date":"2022-06-17T09:41:29","date_gmt":"2022-06-17T07:41:29","guid":{"rendered":"https:\/\/news.save.ch\/?p=9173"},"modified":"2023-06-27T07:12:57","modified_gmt":"2023-06-27T05:12:57","slug":"unfall-oder-krankheit","status":null,"type":"post","link":"https:\/\/news.save.ch\/en\/unfall-oder-krankheit\/","title":{"rendered":"Accident or illness?"},"content":{"rendered":"
\"Accident
Image: depositphotos<\/figcaption><\/figure>\n

In the event of an accident or occupational illness, persons insured with Suva are entitled, among other things, to medical treatment and daily allowance or pension payments. In addition, they are supported in rehabilitation and reintegration.<\/p>\n

But time and again there are cases in which it is unclear which insurance company covers the treatment costs or daily allowances. Is it the accident insurance? Or possibly the health insurance? And what difference does it make to the injured or ill person who ultimately pays? The term \"accident\" is defined by law. If one of the specified factors is missing, an event is not classified as an accident, but as an illness.<\/p>\n

Difference between accident insurance and health insurance<\/h2>\n

Accident insurance provides benefits in the event of accidents, bodily injuries listed in the law and occupational diseases. If a case is taken over by the accident insurance, it settles the accident-related costs directly and without cost sharing by the insured person.<\/p>\n

In the case of health insurance, on the other hand, the injured person usually has to finance the costs in advance. Depending on the chosen deductible rate and the deductible for benefits, additional costs arise for the person affected.<\/p>\n

Whether a reported event constitutes an accident in the legal sense must be examined by Suva by law. Classifying a case correctly is not always easy, even for legal professionals. In their assessment, they follow the Federal Act on the General Part of Social Insurance Law (ATSG), the Accident Insurance Act (UVG), the Health Insurance Act (KVG) and the corresponding ordinances.<\/p>\n

Definition of accident<\/h2>\n

By legal definition, an accident is a sudden, unintentional harmful effect of an unusual external factor on the human body that results in impairment of physical, mental and psychological health or death. If one of these aspects is missing, the event is not classified as an accident, but as an illness.<\/p>\n

Examples \"No accident<\/h2>\n

For example, suppose Gabriel, a prospective recruit, cuts off his finger to avoid military service. Because Gabriel acted with intent, the event is not classified as an accident.<\/p>\n

Kathrin's case is also covered by the health insurance: The young woman has been suffering from extreme whistling in her ears since attending a rock concert. The accident insurance company's negative decision was based on the lack of a \"suddenness\" factor, since Kathrin had been exposed to the loud music for a long time.<\/p>\n

In the example of Ernesto, who is lifting a heavy box at the construction site and suddenly gets shot in the back, the unusual external factor is again missing. Lifting heavy boxes is part of the normal activities of a construction worker.<\/p>\n

Examples \"Accident<\/h2>\n

The following events, on the other hand, meet all the criteria of an accident:<\/p>\n