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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

Federal Act of March 20, 1981, on Accident Insurance (UVG) > Third Title: Insurance Benefits > Chapter 3: Reduction and Denial of Insurance Benefits for Special Reasons > Concurrence of Various Causes of Damage

Art. 36 para. 1 UVG

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

Art. 36 para. 2 UVG

2 Disability pensions, integrity compensations, and survivor pensions will be appropriately reduced if the health impairment or death is only partially a consequence of an accident. Health impairments before the accident that have not led to a reduction in earning capacity will not be taken into account.

Federal Act of March 20, 1981, on Accident Insurance (UVG) > Third Title: Insurance Benefits > Chapter 3: Reduction and Denial of Insurance Benefits for Special Reasons > Concurrence of Various Causes of Damage

Art. 36 para. 1 UVG

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

Art. 36 para. 2 UVG

2 Disability pensions, integrity compensations, and survivor pensions will be appropriately reduced if the health impairment or death is only partially a consequence of an accident. Health impairments before the accident that have not led to a reduction in earning capacity will not be taken into account.

Regulation of December 20, 1982, on Accident Insurance (UVV) > Third Title: Insurance Benefits > Chapter 2: Cash Benefits > Section 5: Compensation for Inability to Help > Amount

Art. 38 para. 1 UVV

1 The monthly compensation for inability to help amounts to six times the maximum daily wage for those with severe inability, four times for those with moderate inability, and double for those with mild inability.

Art. 38 para. 5 UVV

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

Art. 38 para. 2 UVV

2 Inability to help is considered severe if the insured is completely helpless. This is the case if he is regularly dependent on the help of others in a significant way for all daily activities and furthermore requires constant care or personal supervision.

Art. 38 para. 3 UVV

3 Inability to help is considered moderate if the insured is regularly dependent in a significant way on the help of others in most daily activities despite the provision of aids:a. or b. is regularly dependent in a significant way on the help of others in at least two daily activities and furthermore requires constant personal supervision.

Art. 38 para. 4 UVV

4 Inability to help is considered mild if the insured is regularly dependent in a significant way on the help of others in at least two daily activities despite the provision of aids:a. or b. requires constant personal supervision or c. requires constant and particularly intensive care due to the disability or d. can only maintain social contacts thanks to regular and significant services from others due to a severe sensory impairment or a serious physical disability.

Regulation of December 20, 1982, on Accident Insurance (UVV) > Third Title: Insurance Benefits > Chapter 2: Cash Benefits > Section 5: Compensation for Inability to Help > Amount

Art. 38 para. 1 UVV

1 The monthly compensation for inability to help amounts to six times the maximum daily wage for those with severe inability, four times for those with moderate inability, and double for those with mild inability.

Art. 38 para. 5 UVV

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

Art. 38 para. 2 UVV

2 Inability to help is considered severe if the insured is completely helpless. This is the case if he is regularly dependent on the help of others in a significant way for all daily activities and furthermore requires constant care or personal supervision.

Art. 38 para. 3 UVV

3 Inability to help is considered moderate if the insured is regularly dependent in a significant way on the help of others in most daily activities despite the provision of aids:a. or b. is regularly dependent in a significant way on the help of others in at least two daily activities and furthermore requires constant personal supervision.

Art. 38 para. 4 UVV

4 Inability to help is considered mild if the insured is regularly dependent in a significant way on the help of others in at least two daily activities despite the provision of aids:a. or b. requires constant personal supervision or c. requires constant and particularly intensive care due to the disability or d. can only maintain social contacts thanks to regular and significant services from others due to a severe sensory impairment or a serious physical disability.

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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