Occupational disease

What is an occupational disease?

An occupational disease (Berufskrankheit) is an illness caused by your work. Unlike a work-related accident, there is no sudden event. The illness often develops over months or years, for example as a result of noise, dust, chemicals or certain movements.

Legally, an occupational disease is an illness within the meaning of Art. 3 of the Federal Act on the General Part of Social Insurance Law (ATSG) that the Accident Insurance Act (UVG) treats in the same way as a work-related accident. This has an important consequence: it is not your health insurer that pays, but your employer’s compulsory accident insurance, with the same benefits as for an accident.

The UVG provides two routes to recognition:

• Listed occupational disease: the illness was caused exclusively or mainly by a substance or type of work listed in Annex 1 of the Ordinance on Accident Insurance (UVV).
• Other occupational disease: the illness is not on the list, but it has been proven to have been caused exclusively or predominantly by your work. The requirements for proof are higher here.

How it works

Annex 1 UVV consists of two parts. The first lists harmful substances, for example certain metals, solvents and dusts. The second lists work-related illnesses together with the types of work that cause them:

The occupational disease is deemed to have begun as soon as you first need medical treatment or are unable to work. From that point, the accident insurer pays as for a work-related accident: medical treatment without a deductible or retention fee, a daily allowance of 80% of insured earnings from the third day and a pension in the event of permanent invalidity.

Your employer’s accident insurer is responsible. Businesses that produce, use on a large scale or store substances that can cause occupational diseases are compulsorily insured with Suva (Art. 66 para. 1 let. f UVG).

Legal basis

Art. 9 UVG governs occupational diseases. Para. 1 defines them by reference to the Federal Council’s list, para. 2 extends them to other illnesses with an exclusively or predominantly occupational cause, and para. 3 treats them in the same way as a work-related accident from their onset. Under Art. 14 UVV, the list is set out in Annex 1 UVV. The benefits follow from Art. 6 para. 1 UVG, which treats work-related accidents, non-work-related accidents and occupational diseases in the same way, and from Art. 10 (medical treatment) and Art. 16–17 UVG (daily allowance). Under Art. 91 para. 1 UVG, the employer pays the premium.

For the distinction from health insurance, Art. 64 para. 2 ATSG applies: for medical treatment, accident insurance takes precedence over health insurance. If responsibility is disputed, health insurance must pay benefits in kind and daily allowances in advance under Art. 70 ATSG and later recovers the money from the responsible insurer.

Example: respiratory problems in the bakery

Reto, 52, has worked as a baker for 25 years with an annual salary of CHF 65,000. He has a deductible of CHF 2,500. Because of persistent respiratory problems, he needs tests and treatment costing CHF 4,000 and is unable to work for four weeks.

What this means for you

• Report it early: if you suspect a link with your work, inform your employer and tell your doctor. Your employer reports the case to its accident insurer.
• Collect evidence: note which substances or types of work you were exposed to and for how long.
• Inform your health insurer: if the accident insurer recognises the case, it is responsible from the onset. Clarify with your health insurer how it will settle the deductible and retention fee you have already paid.
• Check your insurance: you compare the premiums and models of basic health insurance in the premium calculator and the insurers under Health insurers. Suspend accident cover shows whether you can suspend the accident cover with your health insurer.
• Long-term consequences: if your ability to work remains limited, also register with invalidity insurance. More on accident insurance under UVG.

Common mistakes

• Only involving your health insurer. You then pay the deductible and retention fee, even though the accident insurer might be responsible.
• Not mentioning the link with your work. Without a hint, nobody checks whether it is an occupational disease.
• Thinking every work-related strain is an occupational disease. Outside the list, the occupational cause must be exclusive or predominant.
• Overlooking self-employment. Self-employed people are not compulsorily insured under the UVG; without voluntary insurance, the health insurer pays as for any illness.