If you stay still, you get paid

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Are you one of the victims of an accident where the operating doctor attached the torn tendon to the accident, but the accident insurance claims it was a disease, not an accident?

If the accident insurance does not pay, the accident costs are at least paid by the health insurance company. This is just silly if you have a high exemption and therefore have to bear the bulk of the costs yourself.

What should we do? Tell the insurer to take over your franchise. They would later withdraw the objection. This is called comparison. If you have accident insurance in Visana through your employer, they will likely agree.

It can be thought of as a win-win situation. Because objections are associated with high costs for accident insurers. You should have an expert opinion drawn up by a supposedly independent coroner. It is cheaper for the insurer to provide a comparison to the customer. Something like: I’ll pay you the exemption; and you waive the objection.

Gopfried Stutz knows of five cases where the casualty insurer offered such a comparison – and that was always Visana.

Is this legal? Visana refers to the general section of social insurance law. It says: “Disputes about social security benefits can be resolved through comparison.”

Yet other casualty insurers don’t want to know anything about comparisons, as a survey by the Medinside industry portal shows.

Helsana is reported to have said, “We do not maintain such a practice.” “No deals are made on the backs of health insurance companies,” Sympany says. And at Swica he says: “After careful explanation, we decide what we have decided is right. So there is no need for comparison.”

Finally, Suva points out that cost optimization for the patient should not be the goal. It often does not end in medical and surgical costs. In the event of incapacity for work, daily allowance costs must be taken into account. Late effects and the risk of recurrence should not be ignored. With a comparison later possible claims are waived.

Independent social insurance experts are also skeptical. According to Ueli Kieser, a professor of social security law at the University of St. Gallen, the health insurance company will also have to agree to the comparison, as it will have to pay the medical costs. And, according to Martin Lorenzon, ombudsman for private insurance and Suva, comparisons in social security law are only allowed if it is unclear whether an accident has occurred. In any case, he admired Visana’s practice. She had never heard of it in her 13 years as ombudsman.

Source :Blick