Accident Insurance
The statutory accident insurance covers accidents at work, accidents on the way to work and occupational diseases. It is financed by the employer alone.
At a glance
Legal basis
Insurer
The competent employers’ liability insurance association
Covered
Accident at work · accident on the way · occupational disease (Section 8 SGB VII)
Contributions
Borne by the employer alone
Injury pension
From a 20 per cent reduction in earning capacity beyond the 26th week (Section 56 SGB VII)
Occupational diseases
Only if listed in Annex 1 to the Occupational Diseases Ordinance
What the accident insurance covers
The statutory accident insurance is responsible for damage arising from an accident at work or on the way to work, and for occupational diseases. Unlike the other branches it is financed by the employer alone; the party liable is the competent employers’ liability insurance association.
An accident at work requires, under Section 8(1) SGB VII, an event limited in time and acting on the body from outside which causes damage to health. Subsection 2 also covers the direct route to and from the place of work.
Why the route is so often disputed
What is protected is the direct route. Anyone who interrupts it – for shopping, a detour or a private errand – leaves the insurance cover for the duration of the interruption. That is what is most frequently litigated in practice.
Injury pension for lasting damage
Where damage is lasting or earning capacity is reduced, there is a claim to a pension from the accident insurance, the injury pension. It comes in addition to possible claims from the statutory pension insurance.
The condition under Section 56 SGB VII is that earning capacity is reduced by at least 20 per cent beyond the 26th week after the insured event. The extent of the reduction is the real point of dispute – it is determined by expert opinion and is open to judicial review.
Occupational diseases
Occupational diseases are illnesses listed in the schedule of occupational diseases – Annex 1 to the Occupational Diseases Ordinance. Where such an illness occurs, claims likewise arise against the competent liability insurance association.
What has to be shown is not only the illness but also the connection with the occupational exposure. Where latency periods are long this takes effort; documenting earlier activities decides the case. The question of the degree of disability and of participation benefits frequently arises at the same time.
Frequently asked questions about accident insurance
Is the route to the nursery covered?
Taking children into the care of others on the way to work is separately protected. The details of the detour matter.
What if the accident was not reported?
The claim does not lapse automatically. Without a prompt report, however, proving what happened becomes considerably harder – witnesses and the emergency doctor’s report are then decisive.
Can I also sue my employer?
Only in narrow exceptional cases. The statutory accident insurance generally replaces the employer’s liability.
