Accident? The essentials in brief.
Accident notification, medical expenses, recourse and co-payment – find out everything you need to know if you have an accident.
Why is it important to report an accident?
We're not familiar with either the circumstances leading to the accident, or your professional situation. And it isn’t always possible for us to tell from a bill what sort of injury has been suffered. In the case of accidents involving third parties, we also need information about the other people involved. That way, we can establish whose insurance will cover the related medical costs.
The sooner you let us know these details, the faster we can process your bill and transfer the money to you.
Employees – your employer pays
If you work for the same employer for at least 8 hours a week, you are automatically insured by them for occupational and non-occupational accidents. In that case, you can exclude accident cover from your health insurance and get a premium discount of up to 7% on your basic insurance.
If your employer’s accident insurance is liable, it will often cover property damage in addition to medical costs. You may even be eligible for a daily indemnity or an annuity (if you're temporarily or permanently unable to work).
Retirees, children and homemakers – health insurance pays
If you don't work or work less than 8 hours a week, you must take out accident cover with your health insurer. All you need to do is include accident cover in your basic insurance.
Then your health insurance will assume the medical expenses if you have an accident. An exhaustive list of benefits is set out in the Federal Health Insurance Act and its ordinances.
Recourse: when a third party is to blame
Even if a third party is liable, we're required to pay benefits in advance and will cover the medical costs that fall within the scope of the insured benefits. We will then reclaim these benefits from the liable third party’s insurer. This procedure is known as recourse.
As a general rule, we can always seek recourse if a third party (or company) is to blame for the accident.
Most common examples of recourse:
- Road traffic accidents (cars, motorcycles, bicycles, etc.)
- Skiing and snowboard accidents
- Faulty products (including foodstuffs)
- Animals (dogs, horses, etc.)
- Defects in work (structures, roads, open-air swimming pools, etc.)
Liability claims have limitation periods
That’s why it’s important to assert your claims in plenty of time. Ask your liability insurer to issue a written waiver of the limitation period for follow-up treatment, relapses and delayed effects (e.g. for children with dental damage).
Frequently asked questions
This means, for example, that we’ve received a bill from your doctor in which they mention that the treatment is accident-related. Or your dentist has informed us of dental damage. We need more information from you about how the accident occurred.
You can simply give your doctor your CSS client number. This is the number we work with unless recourse is involved.
If the costs are assumed by your employer's accident insurance, no co-payment will be charged. However, general health insurance companies are required to charge a co-payment under the Federal Health Insurance Act.
This example explains the recourse process:
Person A is hit by a car and injured. Injured person A is insured with CSS, so we pay their treatment costs in advance.
Driver B is at fault and liable through their mandatory motor liability insurance. The costs are then reclaimed from the motor liability insurance of driver B (= person who caused the accident). This reclaiming of costs from the insurer of the person who caused the accident is known as recourse.
Yes. You can reclaim the co-payment directly from the liability insurance which covers the person who caused the accident. You can also ask them to refund expenses (such as the cleaning or replacement of clothing, glasses, and transport costs), as well as loss of earnings.
Send that person's liability insurer the benefit statement(s) you have received from your health insurance. They show the co-payments that you have made.