LAA Relapse: In the context of accident insurance (LAA), when does a relapse occur?

Introduction

In the context of mandatory accident insurance in Switzerland (LAA), the concept of relapse is not simply a common term: it relates to how a new disability resulting from a previously insured accident is recognized and compensated. For SMEs, a poor understanding of this mechanism can lead to payment delays, unjustified denials, or financial losses. After reading this, you will be able to decide: how to document a relapse case, which legal rules apply, and how to structure your internal claims management to effectively handle this risk.

1. The framework of accident insurance (LAA) in Switzerland

1.1. Compulsory accident insurance

Under the Federal Law on Accident Insurance (LAA) , all dependent employees working in Switzerland must be insured against accidents and occupational diseases through an approved insurer or Suva. This insurance covers necessary medical care and compensates for lost earnings due to incapacity for work following an accident.

1.2. Objective of the services

Accident Insurance Act (LAA) benefits include reimbursement of medical expenses, daily allowances in case of incapacity for work, disability pensions, and survivor benefits. It is a coverage designed to protect both the employee and the company against the direct financial consequences of an accident.

2. How LAA treats relapses and sequelae

2.1. Lack of a single legal definition of “relapse”

The LAA (Accident Insurance Act) does not formally define a relapse in its main text as a separate case from the initial accident. However, in social insurance practice, a relapse is often distinguished from a late consequence of an already covered accident, when the condition reappears or worsens after a period of improvement.

2.2. Case Law and Practice

According to sources specializing in social insurance law, when symptoms reappear or delayed after-effects emerge, they are generally not considered a new accident , but rather a relapse or delayed consequence of the original case. This means that the insurer continues to review the case based on the original file, rather than initiating a new, separate procedure.

2.3. Life Insurer's Liability

Case law and official rulings indicate that the insurer responsible for a covered accident is obligated for life to pay the stipulated benefits, including in cases of relapse or long-term consequences . This includes treatment costs and daily allowances in the event of incapacity for work, subject to certain contractual terms.

3. Practical relapse scenarios

3.1. Case study: relapse related to the initial accident

An employee who fractured his wrist was prescribed a period of disability. After apparent recovery and a return to work, he experienced recurring pain related to an orthopedic complication recognized as a consequence of the initial accident. In this scenario, the accident insurance company (LAA) analyzes whether the current problems are a delayed consequence of the already insured accident. If so, the claim is treated as a continuation of the original case rather than a new accident.

3.2. Case study: late after-effects of a previous accident

An insured person who had an accident in their youth (before mandatory insurance coverage began) later develops long-term effects related to that event. A recent legislative amendment in Switzerland aims to guarantee the payment of daily allowances by the Accident Insurance Act (LAA) even for late-onset long-term effects of previously uninsured accidents , under certain conditions of the new legal framework.

4. Internal management and documentation

4.1. Recommended Internal Process

For each case of potential relapse, a clear procedure must be defined:

• Immediate notification to the insurer as soon as a relapse is suspected.

• Collection of all medical certificates and specialist reports.

• Medical evaluation to establish the causal link with the initial accident.

• Formal monitoring of the case until the insurer's final decision.

4.2. What needs to be documented

Box:

• Initial medical certificate and documentation of recovery.

• Clinical evidence of recurrent symptoms.

• Specialist medical opinions indicating causality.

• Detailed chronology of events with clear dates.

5. Guidelines and actionable checklist

| Step | Objective | Required component |

| Identification | Detecting potential relapse | Medical timeline |

| Causal link | Demonstrate connection to the initial accident | Specialized certificates |

| Complete file | Provide a solid file to the insurer | All reports |

| Communication | Follow-up with the insurer | Contact notes |

| Archiving | Retention for audit | Structured file |

6. Common mistakes and how to avoid them

Error: to consider any subsequent incapacity as new.

Solution: structure the causal analysis and demonstrate that it is indeed a relapse.

Error: Incomplete documentation.

Solution: systematically apply a medical and administrative checklist.

Error: Declaration deadline not met.

Solution: notify the insurer as soon as symptoms appear.

7. Questions to ask your insurer/broker (10)

1. How do you define a relapse in LAA practice?

2. What elements are sufficient to establish a causal link with the initial accident?

3. What medical evidence do you require?

4. Is there a time limit for declaring a relapse?

5. How do you treat late-onset sequelae?

6. Does a relapse affect the calculation of daily allowances?

7. What internal procedure do you recommend to speed up treatment?

8. How do you communicate your decisions (timeframe and format)?

9. Is there an impact on future bonuses?

10. Are there any recommended supplementary insurance plans?

Conclusion

A relapse in accident insurance is not simply a repetition of an accident: it is a concept that depends on a rigorous causal analysis , precise medical documentation , and structured contractual monitoring . For SMEs, structuring your internal processes around this typical case of social risk reduces uncertainty, optimizes benefit management decisions, and improves your relationship with the insurer.