Accident insurance or health insurance?

Some time back I made a few rashmoves during a sports match and woke up the next morning with a slipped disk. I gave the doctor bills to my boss' accountant to pass on to sort out an accident insurance claim.

Recently the accountant gave me a letter from the accident insurance company which says they won't cover the bills and that I should claim at my health insurance company. That is not great because I have a 2500 deductible on my health insurance policy. Plus, as far as I am concerned the slipped disk was caused by an accident.

So the question is: who decides if something is an accident or a health problem?

Hi there,

Whether or not an injury is classified as an accident for insurance purposes depends on the cause of the injury.

If the injury is unintentional (on your part), caused by an extraordinary external factor and takes effect immediately when the incident occurs, then it is generally categorized as an accident.

Accidents outside of the workplace are covered by the non-occupational accident insurance which you receive from your employer or from your health insurance provider (if you are unemployed or employed less than 8 hours per week at one employer). Occupational accidents are covered by your employer's accident insurance regardless of your work hours.

If the injury results from everyday activities or only takes effect some time after an incident occurs, then it is categorized as an illness. Illnesses are covered by health insurance.

As you pointed out, a deductible and coinsurance payment apply to health insurance claims - including accident insurance claims from your health insurance provider. Compulsory health insurance and accident insurance from health insurance providers do not cover loss of income resulting from injuries. The accident insurance which you receive from your employer does.

Best regards from Moneyguru

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