Insurances of the person

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Personal accident insurance

Type of coverage

Private accident insurance is a voluntary insurance that covers costs incurred for accidents.

The costs may include those incurred for the treatment of accidents, and compensation may be paid for temporary or permanent handicap or death. It may be possible to extend the police by adding various other covers or compensation types, such as a per diem. The market also offers policies with individual cover types, such as insurance for bone fractures.

Among the costs compensated by the accident insurance include doctor’s fees, medicines as well as examination and treatment expenses. The private accident insurance will compensate costs that are not compensable on the basis of legislation. For any treatment expenses, the Kela reimbursement must be sought first.  Certain policies also cover physical therapy expenses among treatment costs.

Granting and validity

To grant a private accident insurance policy, the insurance company may request that the applicant give their health data, i.e., fill in the health declaration.  Earlier trauma or illness may cause the policy to include exclusions, or a total refusal of the insurance.

The validity of a private accident insurance is also limited in terms of the circumstances where the policy is in force. The policy is not necessarily in force in risky or professional sports. It may be possible to extend the validity of the policy to also cover the damages caused by the above activities. The sports-related so-called “licence insurance policies” (sports accident insurances) are in force only in the type of sport in question at each given moment. The individuals in question should learn more about compensation amounts related to sports accident insurances and assess whether such supplementary cover is needed.

The private accident insurance may be in force in free time only, or both during working hours and the leisure. A policy that is in force all the time is called full-time accident insurance.

Compensated events

For the accident-related expenses to be compensated, the unexpected accident must be sudden, caused by an external factor and cause a bodily injury, taken place without the insured person’s intention. The event deemed to constitute an accident must also have a medical causal relationship to the bodily injury. The accident must thus be sudden and caused by an external factor. For example, if a trauma or injury is caused by mere reaching for something or the person’s other effort or movement, it is not necessarily compensable. It is possible to extend the accident insurance in which case the policy also compensates for certain muscle strains and soreness caused by movement or exertion.

Any costs other than those defined to be caused by compensable events will not be reimbursed.  For example, an insurance which will not cover illness-related symptoms, will not compensate for the need for treatment caused by degenerative changes. This will be the case even if the degeneration did not cause any symptoms before the accident and it had only emerged in connection with the accident and the accident had worsened the symptoms.

Accident caused by the insured person’s other illness or defect are not compensated. For example, if an epileptic person falls as a consequence of the seizure, hurting themselves, this is not an accident compensated on the basis of the private accident insurance. On the other hand, trauma essentially influenced by an illness or defect independent of the accident, will not be compensated or will only be partly compensated to the extent that they are caused by the accident and not by another illness or defect. For example, if a degenerative cause has delayed the recovery of the accident trauma, the treatment expenses will be compensated only for the period of time the recovery from the trauma would have lasted, had there been no degenerative influence.

Notification of loss made by the insured

The notification of loss must be filed with the insurance company within one year of the insured event. This should be kept in mind, especially if the person is covered by several insurance policies which may pay compensation.  For example, certain unions have taken accident insurances for their members.

The compensation for treatment expenses can be paid from one insurance at the time, but it is possible to have the compensation for permanent handicap from several policies.