What to know about mandatory accident insurance (UVG)

The mandatory accident insurance (UVG) provides comprehensive coverage. All employees are insured against occupational accidents (OA) and, if they work more than 8 hours per week, also against non-occupational accidents (NOA).

The benefits range from covering care costs (usually without any contribution from the injured person) to a daily allowance of 80% of the insured salary (the maximum insured income is CHF 148,200) for up to two years, followed by a lifelong pension. Compared to sickness benefits, these coverages are excellent!

So far, so good. However, these benefits also have their gaps and pitfalls. For example, the daily allowance is limited to around CHF 118,500 (80% of CHF 148,200), which may be too low depending on salary and cost of living. Another drawback is that only the standard hospital ward is covered. While this may not be a big issue within Switzerland, it can be crucial for good treatment abroad.

Importantly, besides covering treatment costs, the daily allowance and pension payments also play a crucial role. Problems may arise if gross negligence (commonly traffic violations such as speeding or not wearing a seatbelt) or a risk-taking behavior (actions where the insured exposes themselves to a significant danger without reasonable precautions, e.g., extreme sports) are involved. In cases of gross negligence, the daily allowance (paid during the first two years after the accident) is usually reduced, but the long-term pension (starting from the third year after the accident) is not affected. However, in cases of risk-taking, both the daily allowance and the long-term pension can be reduced. How quickly a situation can be classified as risk-taking is illustrated by the following case:

In one case, an insured person jumped into the Rhine from a tree about four meters high. The water at that point was murky and not deep enough, causing the person to hit their head on the riverbed. Since then, they have suffered from tetraplegia (paralysis of both arms and legs). Beyond the severe human and health impact, the insurance reduced the long-term pension by 50% because the insured took an unreasonable risk. This ruling was upheld by the Swiss Federal Supreme Court.

Although the insured person's lack of caution can certainly be debated, a lifelong reduction (in this case, halving) of the pension in addition to the tetraplegia seems quite harsh for their behavior. Most people occasionally find themselves in situations that, in hindsight, could be classified as taking a risky gamble (for example, while skiing). For this reason, we strongly recommend our clients to take out a so-called “difference coverage” insurance. This coverage waives benefit reductions in cases of gross negligence and risky behavior (or pays the difference if the mandatory accident insurance reduces benefits). This additional insurance is especially advisable as it is very affordable.