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Specifically, what amount must the accident insurance pay to the insured if the IV attributes a helplessness compensation for moderate helplessness to non-accident-related causes?

March 3, 2025

Liability and Insurance Law

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Accident insurance and settlement with IV helpless compensation

In your case, where the IV attributes the helplessness compensation for moderate helplessness to non-accident-related causes, the accident insurance considers this according to the legal regulations as follows:

According to Art. 36 para. 1 UVG, helplessness compensations are not reduced if the health impairment is only partially the result of an accident (Art. 36 para. 1 UVG). This means that the accident insurance cannot reduce the helplessness compensation, even if the helplessness is partially attributed to non-accident-related causes.

The amount of the helplessness compensation is based on the degree of helplessness. In the case of moderate helplessness, it amounts to four times the maximum amount of the insured daily earnings according to Art. 38 para. 1 UVV (Art. 38 para. 1 UVV). This maximum amount is legally defined, and the exact sum would be calculated based on the individual insured daily earnings.

If non-accident-related causes play a role, Art. 38 para. 5 UVV stipulates that the accident insurance can claim from the IV the amount of the helplessness compensation that it would provide to the insured without an accident (Art. 38 para. 5 UVV). This ensures that the accident insurance secures the amount that the IV would have to pay due to non-accident-related causes.

In summary, the accident insurance must pay the full amount of the helplessness compensation for moderate helplessness, which is four times the maximum amount of the insured daily earnings, but can claim the corresponding amount from the IV.

Sources

Art. 36 Abs. 1 UVG

1 The care services and cost reimbursements as well as daily allowances and disability compensations will not be reduced if the health damage is only partially a result of an accident.

Art. 36 Abs. 2 UVG

2 The disability pensions, integrity compensations, and survivor's pensions will be appropriately reduced if the health damage or death is only partially a result of an accident. Health damages prior to the accident that did not lead to a reduction in earning capacity will not be taken into account.

Art. 36 Abs. 1 UVG

1 The care services and cost reimbursements as well as daily allowances and disability compensations will not be reduced if the health damage is only partially a result of an accident.

Art. 36 Abs. 2 UVG

2 The disability pensions, integrity compensations, and survivor's pensions will be appropriately reduced if the health damage or death is only partially a result of an accident. Health damages prior to the accident that did not lead to a reduction in earning capacity will not be taken into account.

Art. 38 Abs. 1 UVV

1 The monthly helplessness compensation amounts to six times the maximum insured daily wage in cases of severe helplessness, four times in cases of moderate helplessness, and double in cases of mild helplessness.

Art. 38 Abs. 5 UVV

5 The insurer can claim the amount of the helplessness compensation from the AHV or the IV for helplessness that is only partially attributable to an accident, which these insurances would pay to the insured if he had not suffered an accident.

Art. 38 Abs. 1 UVV

1 The monthly helplessness compensation amounts to six times the maximum insured daily wage in cases of severe helplessness, four times in cases of moderate helplessness, and double in cases of mild helplessness.

Art. 38 Abs. 5 UVV

5 The insurer can claim the amount of the helplessness compensation from the AHV or the IV for helplessness that is only partially attributable to an accident, which these insurances would pay to the insured if he had not suffered an accident.

Art. 39k Abs. 1 IVV

1 If the insured person is entitled to a disability compensation from the IV and later becomes entitled to a disability compensation from the accident insurance, the compensation office transfers the disability compensation from the IV to the liable accident insurer. Disability compensations for minors are transferred by the Central Compensation Office.

Art. 39k Abs. 2 IVV

2 If the insured person is entitled to a disability compensation from the accident insurance and this is later increased for reasons unrelated to the accident, the compensation office transfers the amount of the disability compensation that the IV would pay to the insured person if they had not suffered an accident, to the liable accident insurer. Disability compensations for minors are transferred by the Central Compensation Office.

Art. 39k Abs. 1 IVV

1 If the insured person is entitled to a disability compensation from the IV and later becomes entitled to a disability compensation from the accident insurance, the compensation office transfers the disability compensation from the IV to the liable accident insurer. Disability compensations for minors are transferred by the Central Compensation Office.

Art. 39k Abs. 2 IVV

2 If the insured person is entitled to a disability compensation from the accident insurance and this is later increased for reasons unrelated to the accident, the compensation office transfers the amount of the disability compensation that the IV would pay to the insured person if they had not suffered an accident, to the liable accident insurer. Disability compensations for minors are transferred by the Central Compensation Office.


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