Mandatory accident insurance (LAI) explained simply

The Swiss Federal Law on Accident Insurance Act (LAI) provides for mandatory accident insurance. Employers are required to provide cover for their employees. Accident insurance in accordance with LAI can be taken out with a private insurer approved for this purpose, for example Zurich, a health insurance company or the Federal Accident Insurance Institution (SUVA). The Federal Accident Insurance Institution has an accident insurance monopoly for certain occupational groups for those companies mentioned in Art. 66 LAI. The above-mentioned companies must therefore take out their LAI insurance with the Federal Accident Insurance Institution. Although accident insurance is mandatory, not everyone is subject to its protection. Details of assumption can be found in the answer to question 3 below.

The compulsory accident insurance pursuant to LAI covers costs arising from occupational and non-occupational accidents or occupational illnesses. In general: An occupational accident (OA) occurs during working hours; non-occupational accidents (NOA) on the way to work or during leisure time. According to the 2020 accident statistics, recreational accidents account for as much as two-thirds of all reported accidents. Occupational illnesses are regarded as occupational accidents. The insurance coverage and benefits of the mandatory accident insurance are legally required. 

All employed persons in Switzerland are subject to mandatory accident insurance. Basically, the following applies:

• Do you work at least eight hours a week for the same employer?  
  In this case, you enjoy full insurance coverage for occupational accidents (OA) and non-occupational accidents (NOA).  
  
• You work less than eight hours or your part-time workload does not reach eight hours per week at any of your employers?   
  In this case, you are not insured for non-occupational accidents (NOA). Recreational accidents are handled by the mandatory health insurance. Accidents on your way to work, on the other hand, are insured – an exception – because in principle these are considered non-occupational accidents (NOA).   
  
• Are you unemployed?  
  In this case, you are insured with the LAI insurance of the Federal Accident Insurance Institution, as long as you meet the requirements for receiving unemployment benefit. You pay the premiums for accident insurance in full yourself – they are deducted directly from your daily unemployment benefit. 

Good to know: Mandatory accident insurance requirement does not apply to self-employed persons. They can join the accident insurance scheme voluntarily in accordance with LAI or cover parts of their accident risk via private accident insurance. The same applies to employee family members who are not subject to mandatory insurance. Zurich accident insurance for the self-employed offers you and your loved ones protection against the financial consequences of an accident. Those who do without voluntary insurance have mandatory cover from the health insurance company, for the treatment costs incurred in the event of an accident. However, accident coverage under mandatory health insurance does not include benefits for loss of wages and loss of income.

The premium for occupational accident insurance (OA) is paid in full by the employer. If you nevertheless find a deduction for accident insurance on your salary statement, this is the premium for non-occupational accident insurance (NOA). The employer is allowed to pass on up to 100 % of this premium to its staff. Nowadays, however, many employers also cover the NOA premium or a significant part of it. Self-employed people who take out voluntary insurance pay the premiums in full themselves. 

Which benefits are covered by accident insurance, and to what amount, is defined by law. The following is insured:  

• Medical expenses and reimbursements of costs  
  By law, appropriate and economical medical treatments are insured. This includes all treatment that is required for  for healing. Costs for medical treatment (e.g. doctor, dentist, medication, hospital accommodation in the general ward), home care, aids, rescue transport and medically prescribed stays at health resorts are covered. For medical expenses within Switzerland, the costs are insured for an unlimited period. Abroad, on the other hand, a maximum of twice the amount that would be incurred for the same treatment in Switzerland is insured.  
  
• Daily allowance  
  The employer is obliged under labor law to continue to pay wages to an employee with an inability to work due to an accident for a certain period of time. However, this obligation to continue to pay wages does not apply if the employee is mandatorily insured against the economic consequences of being unable to work through no fault of their own, and the insurance benefits amount to at least 80 % of his wages. If the benefits are lower, the employer must pay the difference (Art. 324b OR (Swiss Code of Obligations)). The amount of the LAI daily allowance is determined by the degree of the inability to work. In the event of a complete inability to work, the daily allowance is 80 % of the insured earnings from the third day after the accident.   
  
• Disability pension  
  The degree of disability is also decisive for the calculation of the LAI disability pension. In the event of total disability, the pension amounts to 80 % of the insured earnings. If the insured person is entitled to a pension from the disability insurance (IV) or to a pension from the old-age and survivors' insurance (OASI), they will be granted a so-called complementary pension from the accident insurance. This supplements the IV or AHV pension up to 90 % of his insured earnings.  
  
• Survivors' pension   
  If the insured person dies as a result of an accident, the family members receive a survivor's pension.  
  
• Allowance for physical and mental impairment  
  If an accident leaves behind a permanent physical, mental or psychological impairment, a one-time allowance for physical and mental impairment is paid out in the form of a lump-sum benefit.  
  
• Care allowance  
  A care allowance is paid to anyone who is permanently dependent on help from third parties to support them in their daily lives as a result of their disability. 

The insured earnings of the person affected by the accident are decisive for the calculation of the daily allowance or pension amount. According to the law, a maximum of CHF 148,200 per year, or CHF 406 per day, are insured. If the annual salary is higher, the difference can optionally be covered by supplementary accident insurance under private law (LAI supplementary insurance).  

Good to know: As an employer, you pay your employees at least 80 % of their wages during the first two days after an accident. From the third day onwards, the accident insurance covers the costs. In the event of a long-term inability to work, benefits are coordinated with the state pension scheme (OASI/IV (invalidity insurance)).

A reduction in benefits is possible if you as the insured person cause an accident through your own fault. This happens if you cause the accident through gross negligence, take a risk or expose yourself to unusual risks – for example, drive under the influence of alcohol or drugs or actively participate in a scuffle. 

You are insured as long as you are employed: Insurance coverage begins on the day on which your employment relationship starts or you are entitled to your salary for the first time. If no specific day is agreed for starting work, the protection begins when you first set off on your way to work. Unless the contract of employment provides for otherwise, mandatory insurance coverage for non-occupational accidents (NOA) ends 31 days after you leave the insured company.   

In the case of voluntary accident insurance, the duration depends on the contractual agreement.  

Good to know: Are you temporarily giving up your gainful employment or reducing it below eight hours per week? No problem. You can extend the existing insurance coverage for non-occupational accidents (NOA) under LAI for up to six months. This solution is referred to as insurance by special agreement. You can take out this insurance with the insurance company with which you were previously mandatorily insured for NOA by your employer. The premium amounts to CHF 40 per month. 

Yes, you are! For persons insured under LAI, accident insurance also applies abroad. If you often travel abroad, it may be worthwhile taking out private, supplementary accident insurance (UVG-Z (LAI supplementary insurance)). This is because mandatory accident insurance only covers medical treatment and transport costs abroad up to twice the amount of the costs that would be incurred in Switzerland.