An accident can happen quickly, but asserting your rights with insurance companies can be a real obstacle course. The Temps Present program met Swiss policyholders who have been fighting for years to obtain fair compensation after an accident.
Many policyholders discover with bitterness the complexity of the accident insurance system in Switzerland. This is the case of Sergio, 62 years old, stretcher bearer in Geneva. After a fall down the stairs, he underwent surgery on his knee and shoulder.
The expert interpreted things as he saw fit, his report is a bunch of nonsense
But, after having requested the opinion of an expert, the insurance refused to cover his shoulder, arguing that it was pre-existing osteoarthritis. Sergio’s case then goes under the health insurance regime. With significant repercussions due to the deductible and co-pay. The bill amounts to 11,000 francs in Sergio’s case.
“The expert interpreted things as he saw fit, his report is a bunch of nonsense,” denounces Alexandre Lädermann, the surgeon who operated on Sergio. According to him, insurance plays on the confusion between natural aging and pre-existing pathological conditions.
Contested expert opinions
The Temps Present program was interested in this expert, because other policyholders, also examined by him, experienced the same disappointments as Sergio. According to several doctors and lawyers, Doctor D. would have a habit of delivering expert opinions biased in favor of insurance companies. Contacted, the sixty-year-old did not want to answer Temps Present’s questions, indicating by telephone that “the media court did not interest him”.
-Rachel, a teacher from Vaud, had an experience similar to that of Sergio. After breaking her leg, she suffered from neuropathic pain. But the expert commissioned by the insurance, again Doctor D., concludes that she can work again 100%. “He told me to stop pretending,” she testifies, revolted.
A system called into question
Under the Federal Dome, the question of these expertises will be debated. Is it fair for insurance companies to hire and therefore pay an expert directly? State Councilor Baptiste Hurni (PS/NE) tabled a motion to create a neutral center of expertise. “There is a suspicion of conflicts of interest which is sometimes verified,” he says.
For its part, the Swiss Insurance Association (ASA), umbrella of the sector, informed by letter that “we expect the experts to evaluate the facts in an impartial manner. The ASA sees no reason to question this. question and rejects this criticism as unfounded.”
A long-term fight
Faced with these difficulties, policyholders must be patient. Rachel obtained an AI pension after years of procedures. Sergio won his appeal to the Federal Court after four years.
Sabine Pirolt
