Relapse and Late Sequelae (Rückfall und Spätfolgen)

Concept

A relapse occurs where an accident injury that was regarded as healed, or whose treatment had been completed, again requires treatment or again leads to incapacity for work. Late sequelae are health impairments that first appear a considerable time after the accident and are attributable to its consequences, such as post-traumatic arthrosis years after a joint injury. Both situations require a natural and adequate causal link between the original accident and the new complaint; the longer the interval, the higher the evidentiary requirements tend to be in practice.

Liability in Switzerland

Under Art. 11 UVV the benefits of mandatory accident insurance are also granted for relapses and late sequelae; for recipients of disability pensions this applies only under the conditions of Art. 21 UVG, which restricts medical treatment after the pension has been fixed to specified cases. The accident insurer that covered the original accident remains responsible – even where the insured person has since changed employer or insurer or is no longer insured. The burden of proving the causal link rests with the insured person to the standard of the balance of probabilities; where the case was closed without a pension, a fresh notification is required. An example from practice: UVG supplementary contracts close the gap for relapses and late sequelae of earlier accidents that were not or are no longer insured by paying up to 80 % of the UVG salary plus any additionally insured daily benefit for six months.

Private Accident Insurance and Practice

In German and Austrian private accident insurance, account is taken of later deterioration only within time limits: the disability must occur and be claimed within the contractual periods, and reassessment of the degree of disability is, as a matter of market practice, possible annually for up to three years after the accident – up to five years for children and up to four years in Austrian tariffs; late sequelae arising thereafter do not trigger an additional capital benefit, and Swiss collective wordings expressly state that once the disability lump sum has been paid there is neither top-up nor recovery. For claims practice this means that case closures in social insurance always remain subject to relapse and must be reserved accordingly, whereas settlements in private accident insurance have final effect.