Report an accident

In simple terms: An accident is something that happens unexpectedly and unintentionally. An external factor is always the cause of injury.

Legal definition: An accident is defined as any sudden, unintentional, harmful effect of an unusual external factor on the human body. This effect leads to impairment of physical, mental or psychological health or even to death. If any one of these aspects is missing, the event is classified as an illness or disease rather than an accident.

Certain injuries are described as 'physical injuries deemed equivalent to an accident'. This is the case for injuries that weren't caused primarily by wear and tear or a medical condition. They are:

• broken bones
• dislocated joints
• torn meniscus
• torn muscles
• strained muscles
• ruptured tendons
• ligament injuries
• eardrum injuries
  

If you are stung by a wasp, bee or hornet, or bitten by a spider or tick, this is classed as an accident. Bites from midges, mosquitoes and gnats, bedbugs, fleas and lice, on the other hand, do not count as accidents.

Employees: If you work at least eight hours per week for the same employer then you're automatically insured against occupational and non-occupational accidents through your employer. Your employer's insurance will cover the costs if you have an accident. You can exclude accident cover from your health insurance and pay lower premiums in return.

If you work for less than eight hours a week, occupational accidents, including ones that happen on the way to work, are covered by your employer. You will need to include cover for non-occupational accidents in your basic insurance.

Retirees, children and homemakers: People in this group need to take out accident cover as part of their general health insurance. Their health insurance provider will then pay if they have an accident.

• Yes, if your health insurer is assuming the costs.
• No, if your employer's accident insurance is paying the costs.

You can simply give your doctor your CSS client number. If the accident claim isn't being handled by your own health insurance provider, ask your employer.

You simply mention any damage to the teeth in the accident notification form. Your dentist will provide us with the details of the dental damage.

We need the accident report to clarify the circumstances leading to the accident and your employment situation. It enables us to determine which insurance is responsible for the medical costs and to process the bill quickly. If a third party was involved in the accident, we investigate whether recourse is possible.

Recourse is possible if a third party or company is at fault for the accident. Common examples include traffic accidents, skiing accidents and damage caused by defective products.

If we seek recourse, the liability claim becomes subject to a limitation period. That's why it's important to submit 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).