The following terms and definitions are taken from the general literature on Swiss social insurance and liability law and are intended as an aid to understanding. They do not claim to be complete and do not replace an assessment of the individual case. Seegarten Klinik accepts no liability for the independent use of the terms and definitions given here.
A
Declaration of assignment (Abtretungserklärung): with a declaration of assignment, a claim – i.e. a payment expected in the future – can be assigned to a third party, e.g. the social welfare authority, so that a debt the assignor owes to that third party is settled.
Adequacy (Adäquanz): see also causality. Damage is adequately caused by an accident if, in the ordinary course of events and according to general experience of life, the accident is capable of causing the damage that occurred. In accident insurance law, special adequacy criteria apply to the psychological consequences of an accident or whiplash, and these must be examined in each individual case.
Registration (Anmeldung): with both disability insurance (IV) and accident insurance (for the self-employed), you must register as soon as possible after becoming unable to work / after the accident. The forms can be found on your insurer's website.
Incapacity for work (Arbeitsunfähigkeit): the full or partial inability, due to impaired physical, mental or psychological health, to perform reasonable work in one's previous occupation or area of activity. If it lasts a long time, reasonable work in another occupation or area of activity is also taken into account (Art. 6 ATSG).
ATSG: Federal Act on the General Part of Social Insurance Law of 6 October 2000, SR 830.1.
B
Cash payment of the vested benefits (Barauszahlung der Freizügigkeitsleistung): insured persons can request a cash payment of the termination benefit if they leave Switzerland permanently; if they become self-employed and are no longer subject to compulsory occupational pension provision; or if the termination benefit is less than their annual contribution. For beneficiaries who are married or in a registered partnership, cash payment is only permitted with the written consent of the spouse or registered partner. (Art. 5 of the Federal Act on Vesting in Occupational Old Age, Survivors' and Invalidity Pension Plans, FZG, SR 831.42)
BVG pension (BVG-Rente): pension paid from occupational pension provision (2nd pillar, pension fund).
C
Case management (CM): case management is often initiated by an insurer when someone is unable to work. The case manager's task is to support the injured or sick person on the way back into the labour market. The aim is to prevent disability as far as possible or to minimise its effects.
Conditio sine qua non: the term relates to the question of whether an accident is naturally causally linked to the damage that occurred. A natural causal link exists if the event in question is a necessary condition for the damage, i.e. if the cause cannot be imagined away without the result also disappearing.
D
Direct damage (Direktschaden): a person who is personally affected by the harmful act claims their own direct damage and in principle has a direct claim against the person who caused it. A person who has suffered a financial loss only because the directly injured person can no longer provide a service is indirectly harmed and in principle has no claim.
E
Integration measures (Eingliederungsmassnahmen): various social insurers provide such measures, all aimed at enabling a person to work (again) or to resume their previous household activities. The measures can vary greatly and must be determined in each individual case.
Supplementary benefits (Ergänzungsleistungen): these consist of the annual supplementary benefit and the reimbursement of costs of illness and disability. They serve to secure a subsistence income. Entitlement must be assessed in each individual case. Persons living in Switzerland who receive an old-age (AHV) or disability (IV) pension that does not cover their basic needs are entitled.
Incapacity for gainful employment (Erwerbsunfähigkeit): exists in full or in part if, after damage to health and after all reasonable integration measures, a loss of earning capacity remains.
F
Reduction of holidays (Ferienkürzung): if an employee is absent for more than one month in a working year, e.g. because of illness or accident, the employer may reduce the holiday entitlement by 1/12 for each further full month of absence (Art. 329b OR).
Vested benefits (Freizügigkeitsleistung): insured persons who leave the pension fund before an insured event occurs are entitled to a termination benefit (Art. 2 para. 1 FZG). This is normally the case when an employment relationship ends. An insured event has occurred when a pension entitlement has arisen or been registered.
G
Right to be heard (rechtliches Gehör): before issuing a decision, the competent authority must give the person concerned the opportunity to comment on the intended decision.
Expert opinion (Gutachten): to clarify an entitlement to benefits, usually when a pension claim is being examined, social insurers can commission a medical expert opinion. It establishes which occupational options are still open to the person from a medical point of view. It is therefore particularly important to give information about the health impairment that is as complete as possible.
H
Household assessment (Haushaltsabklärung): if someone works wholly or partly in the household, i.e. is not in 100% gainful employment, they may be entitled to a disability insurance pension if they can no longer carry out household tasks to the same extent as before. The extent of the loss is established by a household assessment, in which a disability insurance case officer visits the household and examines the specific circumstances.
Medical treatment (Heilbehandlung): is carried out with the aim of removing or reducing the health impairment. This means first diagnosing the impairment and then treating it. In health insurance it also includes preventive measures, and in accident insurance care measures that serve not to heal but solely to preserve the remaining capacity to work.
Helplessness (Hilflosigkeit): a person is considered helpless if, because of impaired health, they permanently need the help of others or personal supervision for everyday activities (Art. 9 ATSG).
Aids and appliances (Hilfsmittel): an object whose use can compensate for the loss of certain parts or functions of the human body. Which aids are paid for by the social insurers is set out in various lists (e.g. Art. 21 f. IVG).
I/J
Inter-institutional cooperation (Interinstitutionelle Zusammenarbeit, IIZ): a platform to improve cooperation between partner organisations in unemployment insurance, disability insurance, social welfare, public careers advice and other institutions. Further information at: http://www.iiz.ch.
Income with disability (Invalideneinkommen): the income that can still be earned taking the health impairment into account.
Disability (Invalidität): full or partial incapacity for gainful employment that is expected to be permanent or to last a long time. The term is not defined uniformly in Swiss social insurance law. Whether there is a disability, and to what extent, must be assessed in each individual case.
Degree of disability in disability insurance (Invaliditätsgrad): determined by comparing income without disability with income with disability. The loss of income as a percentage gives the degree of disability.
K
Causality (Kausalität): concerns the question of whether a particular situation, e.g. a loss of earnings, can legally be regarded as the consequence of a particular event, e.g. an accident.
Child's pension (Kinderrente): a pension paid for minor children in addition to a parent's pension.
Illness (Krankheit): any impairment of physical, mental or psychological health that is not the result of an accident and that requires medical examination or treatment or results in incapacity for work (Art. 3 para. 1 ATSG).
Coordinated salary (koordinierter Lohn, BVG): Art. 8 BVG: the part of the annual salary from CHF 22,155 up to and including CHF 75,960. If the coordinated salary is less than CHF 3,165 a year, it must be rounded up to this amount. If the annual salary falls temporarily because of illness, accident, unemployment or similar reasons, the previous coordinated salary remains valid at least for as long as the employer would be obliged to continue paying the salary under Article 324a OR. The insured person may, however, request that the coordinated salary be reduced.
Protection against dismissal (Kündigungsschutz): Art. 336c OR applies:
After the probationary period, the employer may not terminate the employment relationship:
1 a. while the other party is performing compulsory Swiss military service, civil protection service or Swiss civilian service, and, if the service lasts more than eleven days, during the four weeks before and after;
b. while the employee is wholly or partly unable to work through no fault of their own because of illness or accident, namely for 30 days in the first year of service, 90 days from the second to the fifth year of service and 180 days from the sixth year of service;
c. during an employee's pregnancy and in the 16 weeks after she gives birth;
d. while the employee, with the employer's consent, is taking part in an aid mission abroad ordered by the competent federal authority.
2 Notice of termination given during one of the protection periods set out in paragraph 1 is void; if, however, notice was given before such a period began but the notice period has not yet expired, it is interrupted and only continues after the protection period has ended.
3 If the employment relationship is to end on a fixed date, such as the end of a month or working week, and this does not coincide with the end of the continued notice period, the notice period is extended to the next such date.
L
Reduction of benefits (Leistungskürzung): social insurance benefits can be reduced, either because the conditions are no longer met or as a sanction, e.g. for breach of the duty to cooperate – in which case a warning and reflection procedure must first be carried out. In both cases, the conditions for admissibility must be examined carefully.
Continued payment of salary (Lohnfortzahlung): if an employee becomes unable to work because of illness or accident, they are entitled to continued payment of their salary for a certain time. The amount and duration depend on the length of employment and the employment contract.
LSE (Swiss Earnings Structure Survey, Schweizerische Lohnstrukturerhebung): every two years, the composition (amount and circumstances) of salaries paid in Switzerland is recorded in a statistical survey. The LSE provides information on average salaries in individual sectors, broken down by gender and level of responsibility. If an insured person's income cannot be proven specifically because they no longer work in the sector concerned, the LSE is used to assess earning potential – for example, to determine the degree of disability. Its correct application must be examined in each individual case.
M
Warning and reflection procedure (Mahn- und Bedenkzeitverfahren): if an insured person refuses to carry out a measure ordered by the insurer, the insurer's benefits can be reduced or stopped. Beforehand, however, the insured person must be informed of the consequences of continued refusal and given the opportunity to change their position.
Relevant salary (massgebender Lohn, BVG): under Art. 5 para. 2 sentence 1 AHVG, the relevant salary is any remuneration for work performed as an employee for a fixed or indefinite period.
N
Natural causality / natural causal link (natürliche Kausalität): concerns the question of whether an accident is a necessary condition for the damage. If the cause cannot be imagined away without the result also disappearing, there is a natural causal link. For bodily injury, the medical facts are decisive.
Non-occupational accident insurance (Nichtberufsunfallversicherung): if a person works 8 hours or more a week for the same employer, the employer must also insure them against non-occupational accidents.
Non-employment (Nichterwerbstätigkeit): for persons not in gainful employment, disability is determined by the degree to which they are unable to carry out their previous area of activity.
O
Compulsory occupational pension provision (obligatorische berufliche Vorsorge): employees earning more than CHF 18,990 a year are subject to compulsory insurance for the risks of death and disability from 1 January after their 17th birthday, and also for old age from 1 January after their 24th birthday (Art. 7 para. 1 BVG).
P
Psychiatric comorbidity (psychiatrische Komorbidität): a mental illness accompanying another (underlying) illness. One of the criteria in the question of whether, in the sense of case law, a pain disorder can be overcome or not.
Q
Quota privilege (Quotenvorrecht): an injured person may have a claim against both the social insurer and the liable person. The liability claim may then be paid only in part – because the claim for damages cannot be recovered (e.g. for lack of solvency) or because the damages are reduced or capped. Under the principle of quota privilege, the injured person's liability claim takes precedence over the social insurer's.
R
RAD (regional medical service, Regionaler Ärztlicher Dienst): the internal medical assessment service of disability insurance.
Reformatio in peius / in melius: the pair of terms means that the appealing party may be awarded more than it applied for (reformatio in melius), or that the contested decision may be changed to its disadvantage (reformatio in peius).
Recourse (Regress): recourse by, for example, a social insurer against the liable person or their liability insurer. Payments made by the social insurer to the injured person can be reclaimed from the liable person / liability insurer.
Review of a pension (Revision der Rente): review of a pension that has been awarded, to check whether the facts are still the same as when it was awarded.
Repayment of social welfare (Rückerstattung von Sozialhilfe): social welfare received must be repaid as soon as the former recipient's financial situation has improved enough for repayment to be reasonable. The conditions must be assessed in each individual case on the basis of the specific circumstances.
Repayment of benefits received unlawfully (Rückerstattung zu Unrecht bezogener Leistungen): anyone who has received social insurance benefits unlawfully must repay them. Whether the claim for repayment actually exists and can be enforced must be examined in each individual case.
Relapse (Rückfall): the recurrence of health consequences of an accident that had already healed. In principle, this revives the claims under accident insurance.
S
Damage and damages (Schaden und Schadenersatz): in liability law, damage always means a reduction in assets, whether through additional costs or lost income. For the liable person to have to compensate the damage, it must be naturally and adequately caused by the accident, and the other conditions of liability law must be met. All of this must be assessed in each individual case.
Social welfare (Sozialhilfe): if a person cannot support themselves from their own resources, or these are not available quickly enough, they are entitled to public social welfare. The exact circumstances and the amount of the entitlement are assessed by the competent social welfare authority after registration.
T
Part-time employment (Teilerwerbstätigkeit): for part-time workers, disability insurance assesses the pension entitlement or degree of disability separately – for the employed part by comparing incomes (income with vs without disability), and for the rest by a household assessment.
Fixed-term pension (terminierte Rente): a pension awarded for a limited period.
U
Overcompensation (Überentschädigung): the social insurance benefits theoretically owed exceed the insured earnings. The benefits may be reduced accordingly.
UKS (accident-like bodily injury, unfallähnliche Körperschädigung): for precisely defined bodily injuries, there is an entitlement to benefits from compulsory accident insurance (Art. 9 Accident Insurance Ordinance, UVV, SR 832.202).
Accident (Unfall): for the social insurance definition of an accident to be met, the following conditions must be fulfilled: suddenness, involuntariness, unusualness, external factor.
Accident daily allowance (Unfalltaggeld): in the event of incapacity for work after an accident, compulsory accident insurance pays 80% of insured earnings until no significant improvement in health can be expected from further medical treatment.
Capacity of judgement (Urteilsfähigkeit): the ability to assess the consequences of a particular course of action and to act accordingly. The fact that someone has this ability does not mean that they actually made the relevant considerations. If they should have done so, there may be negligence.
V
Income without disability (Valideneinkommen): the income that could be earned without the health impairment.
Limitation (Verjährung): claims that are not asserted in time can become time-barred after a certain period, which means they can no longer be enforced in court.
Employability (Vermittlungsfähigkeit): a term from unemployment insurance. The insured person is able to accept and carry out work to the extent sought.
Insured earnings (versicherter Verdienst): income that must be replaced by a particular insurance if it is lost. The amount of insured earnings must be determined in each individual case.
Insurance cover after the end of employment (Versicherungsschutz nach Ende des Arbeitsverhältnisses): cover under the employer's daily sickness allowance insurance and accident insurance ends some time after the employment relationship ends. If no new employment begins in the meantime, you are entitled to transfer to individual insurance (daily sickness allowance) or to continue accident insurance voluntarily. The insurer concerned will provide details.
Advance benefits (Vorleistung): if, after a loss of earnings due to illness or accident, it is not clear which insurer is actually liable, another insurer may provide advance benefits until the liability has been clarified (Art. 70 para. 1 ATSG). Benefits provided in this way may have to be repaid once the claim has been clarified.
W
Waiting period (Wartefrist): entitlement to benefits from certain social insurances only arises after a certain period – e.g. a disability insurance pension only once the disability has lasted at least one year.
Owner's liability for structures (Werkeigentümerhaftung): liability of the owner of a building or structure for damage suffered by others as a result of defective construction or maintenance. The exact circumstances must be assessed in each individual case.
Reconsideration (Wiedererwägung): incorrect decisions that are not yet final can be reconsidered by the authority that issued them, meaning that the authority withdraws its decision and decides again.
X/Y/Z
Chance (Zufall): in non-contractual liability law, chance is a cause that is independent of human behaviour. Unlike force majeure, chance does not break the adequate causal link.
Reasonableness (Zumutbarkeit): whether a particular activity or an ordered measure is reasonable must be assessed by an objective standard and in the specific individual case.