Long-term leave: HR and insurance processes (coordination of daily sickness benefits, accident insurance, disability insurance)

Long-term leave: HR and insurance processes (coordination of daily sickness benefits, accident insurance, disability insurance)

A long-term shutdown is a governance issue for an SME: business continuity, costs, labor law, data confidentiality, and coordination between insurers. When the situation isn't managed effectively, gaps in compensation, inconsistent decisions, or a deterioration of the working relationship can arise.

This guide offers a simple method for managers, CFOs, and HR professionals: clarify the scenario (illness or accident), activate the appropriate support channels (daily sickness benefits, disability insurance, etc.), document the necessary paperwork, and then track the case with return-to-work milestones. You will leave with a checklist, two mini case studies, and 10 questions to ask.

Long-term leave: clarifying the framework and responsibilities

Illness: maintaining salary and the role of the daily sickness allowance

The first thing to do is check if daily sickness allowance (IJM) insurance exists and what it actually covers. SECO reminds us that the law does not mandate IJM insurance, but it is often included in the employment contract.

When a daily sickness benefit (IJM) exists, the policy and the general terms and conditions of insurance (GTC) are binding. SECO indicates that in practice, "most" IJMs entitle the employee to 80% of their salary for 720 or 730 days within a 900-day period, with variations depending on the contract.

When no daily sickness benefits exist, SECO reminds us of the legal minimum: the employer pays the full salary for a period determined per year of service (at least three weeks in the first year), and the payment of the salary is 100% from the first day (without a waiting period).

Steering decision (management/CFO): model the actual scenario (shortage, supplements, out-of-pocket expenses) based on contractual rules, no assumptions.

Accident: LAA relay and SME attention points

In the event of an accident, mandatory accident insurance (LAA) takes over from income. The CFST Guide outlines a key operational point: in the event of total disability, the daily allowance corresponds to 80% of the insured earnings and is paid for every calendar day starting from the third day following the day of the accident.

Two points often create financial discrepancies:

• Insured earnings ceiling: the official memorandum 6.05 specifies that the maximum amount of insured earnings in LAA is 148,200 francs per year, or 406 francs per day.

• Part-time work: if the weekly working time with the same employer is less than eight hours, the compulsory coverage does not cover non-occupational accidents.

Employment law: protection against termination (reference point)

The SECO aide-mémoire reproduces art. 336c CO: after the probationary period, the employer cannot terminate during a period of incapacity for work due to illness or accident (not attributable to fault) for 30 days during the first year of service, 90 days from the second to the fifth, and 180 days from the sixth.

Methodological point: this benchmark is used to secure your decisions (organization, job alternatives, communication), not to "manage by the calendar".

Manageable HR processes: manage, document, monitor

Managing: a case manager and a streamlined decision-making process

Designate a case manager (often from HR) and a streamlined process:

• Direction: organizational arbitration.

• CFO/finance: cost scenario (shortage, supplements).

• Manager: actual position and possible adaptations.

• Broker/insurer: reporting rules and required documents.

Documentation: a single file, useful to both the insurer and the company

SECO reminds employees that, at the employer's request, they must provide a medical certificate specifying whether the employee is totally or partially incapacitated; in the case of partial incapacity, the degree must be specified. The certificate must not contain a diagnosis.

Regarding data protection, the PFPDT recalls the principle of proportionality (art. 328b CO): the employer only processes the data necessary for the execution of the contract.

Follow-up: Capacity-oriented checkpoints and return to work

Each checkpoint must produce a written decision:

• capacity (total/partial) and functional limitations,

• job adaptations

• next steps with the insurer (IJM/LAA) and, if necessary, with the AI.

Mini case study 1 (illness + IJM)

A small business has a collective daily sickness benefit. An employee is on extended leave and the case is becoming confusing.

Management: HR extracts from the IJM policy the waiting period, duration and coordination; finance calculates the remaining cost.

Documentation: successive certificates (without diagnosis), description of actual position, log of decisions.

Follow-up: as soon as partial capacity is mentioned, formalize a gradual recovery plan (authorized tasks, control points, success criteria).

Coordination IJM, LAA, AI: building a relay scenario

Performance dashboard (qualitative)

Subject	IJM (disease)	LAA (accident)	AI (rehabilitation)
Purpose	Covering a loss of earnings according to the contract	Covering loss of earnings and consequences of an accident	Preventing/treating the risk of disability, supporting rehabilitation
Trigger	Certified incapacity + police	Accident recognized + disability	Communication (detection) or request
SME Decision	Deficiency, coordination, out-of-pocket expenses	Ceiling, non-professional, supplements	When to communicate, when to submit, collaboration plan
Critical Pieces	Consistent certificates + actual position	Declaration + qualification	Capacity-oriented dossier + action plan

AI: Activate early, without confusing "communication" and "demand"

Memo 4.12 describes early detection: rapid contact with AI and decision on the appropriateness of a request.

Communication for early detection is not a request for benefits, and the AI does not grant any benefits during the detection phase.

Employers can report a case, after informing the insured person beforehand.

If an application is submitted, the early intervention phase lasts for a maximum of twelve months.

Mini case study 2 (accident + "part-time" friction point)

An employee works less than eight hours per week. Accident outside of work, extended leave.

Risk: below eight hours, the mandatory coverage does not cover non-occupational accidents.

Decision: immediately verify coverage and secure compensation relay before discussing job adjustments.

Guidelines and checklist

1. Clarify the scenario

• Illness or accident? If accident: work-related or non-work-related?

• Which insurance policies can be used (daily sickness benefits, accident insurance, supplementary insurance)?

1. Securing the financial transfer

• IJM: review policy and CGA (waiting period, duration, coordination).

• LAA: check the maximum insured gain and any additional benefits.

1. Establish governance of the case

• Case manager, single timeline, short decision-making process.

• Internal communication plan (who knows what, at what level).

Box: What needs to be documented

• Contract, regulations, applicable collective bargaining agreement/collective agreement

• IJM Police + CGA and internal summary

• LAA policy (professional/non-professional, insurer, supplements)

• Successive medical certificates (without diagnosis)

• Description of the job actually held

• Journal of exchanges and decisions

• Adaptation proposals and responses

• Letters/requests for documents from insurers

1. Manage sensitive data properly

• Apply proportionality: keep and share only what is necessary.

• The PFPDT specifies that the employer does not have to consult medical data when admitting to an IJM; they must go to the insurer's medical advisor/medical service.

1. Decide if an AI contact is relevant

• In case of risk of chronicity, consider early detection communication (by informing the insured person).

Common mistakes and how to avoid them

1. "We have an IJM, so it's covered."

Correction: summary of a page of the police/CGA (deficiency, duration, coordination, parts).

1. Allowing medical data to circulate

Correction: limit access and content (capacity, duration, restrictions), while respecting proportionality.

1. Confusing AI communication and AI demand

Correction: use early detection as a channel for collaboration, then decide if a request is necessary.

1. Forget about LAA discrepancies (ceiling, non-professional part-time work)

Correction: check the insured earnings ceiling and the eight-hour rule as soon as the file is opened.

Questions to ask your insurer/broker

1. What are, in our IJM, the waiting period, the maximum duration and the coordination rule (and where is this written)?

2. What is the compensation rate and what salary components are included?

3. What are the requirements for certificates (format, frequency, medical checks)?

4. Who reports the case and within what timeframe, and what documents are required for the initial submission?

5. How does the insurer handle cases of partial capacity (gradual return)?

6. Under the LAA (Accident Insurance Act), does the coverage correctly include non-occupational accidents according to working hours?

7. Under the LAA (Accident Insurance Act), what is the maximum insured gain applied and do we have supplementary coverage beyond that?

8. What monitoring reports can the insurer share, and at what frequency?

9. How is the practical coordination with the AI done (exchanges, documents, steps)?

10. What data protection limits must we respect in exchanges?

Conclusion

A long-term leave of absence is managed when the scenario is clear (illness/accident), the relevant support mechanisms are in place (daily sickness benefits/accident insurance/disability insurance), and the case is properly documented. The next useful step is to formalize your internal protocol (roles, documents, decision-making process) and compare it with your actual policies.