Cross-border workers: how are cross-border workers insured against accidents (LAA), supplementary LAA coverage, and loss of earnings due to illness?

Introduction

Cross-border workers have become a key HR governance issue: they face the same business continuity requirements, but with more complex administrative processes (residence abroad, cross-border healthcare, multiple points of contact). For an SME, the risk isn't just "being insured," it's about managing it effectively: who files claims, to whom, with what documentation, and how to avoid gaps in coverage between accidents (LAA), supplementary benefits (LAA-supplementary), and illness (loss of earnings).

In this article, you will be able to make concrete decisions: what coverage applies to a cross-border worker employed in Switzerland, which options are truly HR policy choices, and how to structure a simple “manage, document, monitor” method.

1. Cross-border workers and insurance in Switzerland: the basic principle to remember

1.1 What remains unchanged: a cross-border worker is an employee “who works in Switzerland”

The starting point, regarding accidents, is very clear: mandatory accident insurance (LAA) applies to employees working in Switzerland. The official AHV/IV summary reiterates that, according to the LAA, accident insurance is mandatory for all employees working in Switzerland, in order to cover health damage and compensate for lost earnings due to an accident or occupational disease. (AHV-IV, “Mandatory Accident Insurance LAA”, status as of January 1, 2025)

Pilot study conclusion: for a cross-border worker employed in Switzerland, the question is not “is he entitled to LAA?”, but “how is the coverage organized (insurer, scope, premiums) and how to make it work in case management”.

1.2 What can create confusion: illness (LAMal) vs accident (LAA)

Health insurance for cross-border workers is governed by specific rules (requirement, right of option depending on the country), which differ from those of the Federal Law on Accident Insurance (LAA). The Federal Office of Public Health (FOPH) indicates that people domiciled abroad who work in Switzerland must, in principle, take out health insurance in Switzerland, with exceptions depending on the country/nationality. (FOPH, “Health Insurance: Cross-border Workers in Switzerland”)

Governance benchmark: in business, mentally separating the “LAA accident” and “illness” flows avoids reporting errors and delays in care.

2. Accident insurance (LAA): who insures what for a cross-border worker?

2.1 Mandatory LAA: Role of the employer and scope of coverage

Suva reiterates the operational principle: in accordance with the Federal Law on Accident Insurance (LAA), all workers in Switzerland are required to have accident and occupational disease insurance through their employer. (Suva, “Accident Insurance according to the LAA”)

In SME management, this means: the employer chooses the competent accident insurer (Suva or other accident insurer depending on the sector), maintains the affiliation and manages the claim declaration.

2.2 Workplace accidents and non-workplace accidents: the threshold that changes the HR game

Two practical points are crucial for both cross-border workers and residents:

• If a person works at least 8 hours per week for the same company, they are also insured against non-occupational accidents. (Suva, “Accident Insurance according to the LAA”)

• For less than 8 hours per week, non-occupational accidents are not covered by the employer; the SME information on admin.ch clarifies this and indicates that the individual must then take out their own insurance for this risk (often through mandatory health insurance). ( kmu.admin.ch , “AAP and AANP Accident Insurance”)

HR decision: For cross-border part-time workers, the risk of "bad habits" is high (commuting, leisure activities). Your process must identify the threshold and trigger clear communication with the employee.

2.3 LAA bonuses: what is borne by the company vs. the employee

Also from admin.ch , a useful point of reference for budgetary governance: non-occupational accident insurance premiums (AANP) are paid by the employee, the employer advances them and then deducts them from the salary. ( kmu.admin.ch , “Accident Insurance AAP and AANP”)

CFO involvement: properly allocate charges and document the withholding policy, including for cross-border workers who often compare with practices in their country of residence.

2.4 Coverage continuity and potential “gaps”: the point of vigilance

Certain situations (end of contract, interruption of activity) can lead to a lapse in coverage. Suva publishes a brochure dedicated to the effects, duration, termination of mandatory accident insurance, and the possibility of extension (contractual insurance) to avoid such an interruption. (Suva, “Effects, Duration and Extension of Mandatory Accident Insurance – Contractual Insurance”, PDF)

HR decision: as soon as a cross-border worker leaves the workforce, secure the end of coverage and communication, because care may take place abroad but coverage remains linked to the LAA claim.

3. Supplementary LAA (LAAC): Why cross-border workers are putting it under strain

3.1 What it is, in simple governance terms

The mandatory LAA (Accident Insurance Act) is a legal requirement. Supplementary LAA (often called LAAC in the market) is a group insurance policy that aims to expand the scope of benefits beyond the mandatory requirements, according to the contract. An insurer like AXA presents it as an extension of LAA coverage for employees. (AXA, “LAAC: Supplementary Accident Insurance for Your Employees”)

Key steering point: here, we move away from the “mandatory” logic towards a “HR policy” logic (attractiveness, harmonization of benefits, protection of managers, etc.) and above all “inter-insurer coherence”.

3.2 The classic trap: believing that the LAAC replaces the LAA

Some supplementary insurance terms and conditions explicitly state the relationship: the supplementary insurance covers accidents (occupational and non-occupational) that must be compensated by the basic accident insurance (LAA). (Sympany, “Supplementary Accident Insurance”, terms/AVB, PDF)

In other words: LAAC is conceived as something “above” the LAA base, not as a parallel circuit.

Governance decision: verify alignment of scopes (who is insured, where, when), and document coordination with claims management.

3.3 Cross-border workers: three reasons for being particularly rigorous

1. Care pathways potentially cross-border, therefore more supporting documents to consolidate.

2. Increased number of contacts (accident insurer, HR, sometimes health insurance fund at home).

3. Coverage expectations are often heterogeneous (executives, jobs involving travel, etc.).

MAGE Method: manage by scenarios and by parts, rather than by promises.

4. Loss of earnings due to illness: what is “owed”, what is “insured” and what is “chosen”

4.1 The legal framework for sick leave: maintenance of salary by the employer

Admin.ch (SECO/SME Portal) reiterates a key point: in case of illness, the employer must continue to pay the employee for a certain period; the minimum duration of 3 weeks during the first year of service is established by case law (and subsequent periods are determined using recognized scales). ( kmu.admin.ch , “Loss of Earnings Insurance”)

For a cross-border worker, this reference point does not change because of their residence: it is the employment relationship in Switzerland that governs the logic of maintaining their salary.

4.2 Daily sickness allowance insurance (loss of earnings due to illness): a management tool

The same SME portal indicates that employers can cover this risk with health insurance funds or other insurance companies, and that half of the premiums can be charged to employees. ( kmu.admin.ch , “Loss of Earnings Insurance”)

CFO/HR decision: define a policy (waiting period, compensation duration, rates, staff categories) and document it. For cross-border workers, the key is clarity: who pays what and when does the transition from salary to compensation occur?

4.3 Coordination between accident and illness: avoiding the wrong channel

A work stoppage following an event can be classified as either an “accident” or an “illness” depending on the classification and causality. Your governance must address this.

• an initial triage (presumed accident vs. illness)

• Follow-up if the qualification changes

• traceability of decisions and documents

Without invented figures, the essential thing is the method: the speed of declaration and the quality of the file often make the difference.

5. Two mini case studies (border workers)

Case 1: Part-time cross-border worker, leisure accident and grey area

Situation: A cross-border worker works less than 8 hours per week. She has a leisure accident on the weekend, then takes time off work.

Management: According to the official rule, non-occupational accidents are not covered by employer insurance below the threshold. ( kmu.admin.ch , “AAP and AANP Accident Insurance”)

Decisions:

• document the contractual and actual working hours

• direct the employee towards the appropriate coverage (often through health insurance)

• Trace HR communications to avoid future disputes (expectations, deadlines, supporting documents)

Case 2: Cross-border worker/executive, workplace accident, then discussions on additional benefits

Situation: A cross-border manager is injured while on a business trip. The case is covered by the LAA (Law on Accident Insurance). The company has a LAAC (Law on Accident Insurance) for certain job levels.

Piloting:

• Report the accident claim immediately

• Check LAAC eligibility (insured population, conditions)

• Structure a single “LAA + supplements” file to limit exchanges and speed up the decision (medical documents, accident report, employer certificates)

What needs to be documented

List of parts and information to be standardized (accident, LAAC, illness):

• employment contract and rate/hourly rate (useful for the AANP scope)

• Accident report (facts, location, witnesses if relevant), internal HSE report if available

• Medical certificates, chronology of incapacity, return-to-work dates

• Exchanges with the insurer (emails, letters, decisions), follow-up log

• For illness: proof of incapacity and internal rules for maintaining salary, then switch to daily sickness insurance if applicable

• For contract termination: information on the continuity/termination of LAA coverage and renewal options, if applicable

Guidelines and checklist

Objective: a simple “pilot, document, monitor” method for cross-border workers.

Moment of decision to be made. Key control. Trace to be kept.

Cross-border onboarding: Explain who is responsible for what (accident vs. illness); Clarify the LAA vs. illness channel; HR note, acknowledgment of receipt

LAA settings: Verify AAP/AANP according to threshold. At least 8 hours/week for ANP via employer. Contract, timesheet.

LAAC choices: Define populations and objectives; LAA consistency + internal policy supplement, list of insured persons

Sickness policy: Organizing continued salary and daily sickness benefits. Written and known rules. Internal directive.

Claim filed quickly, complete file, timeline + medical records, tracking log

Offboarding: Avoid accidental cover gaps. End of LAA, possible options. Exit check.

Common mistakes and how to avoid them

1. Confusing accident and illness at the time of reporting

How to avoid: establish an HR triage with factual criteria (sudden event, link to work, circumstances) and document the initial decision.

2. Forgetting the threshold for accessing non-occupational accident insurance through the employer

How to avoid: automate a “less than 8 hours” check in onboarding and rate changes.

3. Having a LAAC without HR doctrine (who, why, how)

How to avoid: writing a governance memo: objectives, populations, LAA articulation, disaster recovery process.

4. Underestimating the need for evidence when care is received abroad

How to avoid: standardizing a parts list and medical timeline format.

5. Failure to formalize the policy regarding loss of earnings due to illness and its allocation of premiums.

How to avoid: clarify the framework (maintenance of salary, coverage via insurance, possible participation of staff) and integrate it into the regulations.

Questions to ask your insurer/broker (10)

1. For our cross-border workers, do you confirm the LAA scope and the competent insurer according to our sector?

2. What minimum documents expedite the LAA decision in a cross-border case?

3. How do you handle cases where the classification changes between accident and illness?

4. What is your recommended internal process for reporting and tracking an LAA claim?

5. How exactly does our LAAC relate to the LAA (triggers, exclusions, population)?

6. For the LAAC, what are the limits and points of attention in the event of treatment abroad?

7. In the event of loss of earnings due to illness, which clauses must be aligned with our salary maintenance policy?

8. What documentation do you expect to justify an incapacity and a partial return to work?

9. What timeframes and communication channels do you provide (portal, contact person, escalation)?

10. Can you audit our portfolio to identify borderline grey areas (rates, ANP, supplements, illness)?

Conclusion

For cross-border workers employed in Switzerland, accident insurance (LAA) is a mandatory core benefit managed by the employer, with a key focus on coverage for non-occupational accidents based on working hours. Supplementary accident insurance and loss of earnings due to illness then fall under governance decisions: defining a policy, documenting it, and monitoring cases using a consistent methodology.

Next step (soft): map your cross-border populations (rates, functions, mobility), review your LAA/LAAC contracts and formalize a claims checklist, to gain clarity, consistency and responsiveness.