Interrupted sickness benefits: 5 steps to protect yourself

Context

TL;DR

• A burnout results in Patrick taking a complete leave of absence from work
• The policy provides for a limit of 720 or 730 days
• The insurer stops payments after a few weeks
• The transitional period is generally between three and five months

Key facts

• Persona → Patrick, fictitious name, 55 years old
• Inability → complete, certified by his attending physician
• Benefits → daily allowances from the employer's sickness insurance
• Decision → resumption of the same activity with another employer
• Policy limit → 720 or 730 days
• Transitional period → as a rule, three to five months

Patrick, a fictitious name, is 55 years old and turned to the trade union over a problem related to his employment relationship. After suffering burnout, he was forced to take leave for treatment and rest. His attending physician certified that he was completely unable to work.

During his absence, he regularly received the daily allowances provided for by the employer's sickness insurance. Once the period of protection shielding the employee from dismissal had elapsed, however, his employer notified him of the termination of his employment.

The dismissal came as a complete shock. At least on the face of it, one certainty remained: if the insurance requirements continued to be met, the allowances would be paid up to the maximum limit provided for by the policy, indicated as 720 or 730 days. One month after the dismissal, however, a new communication arrived. The same insurer announced that payments would stop after a few weeks.

The reason lay in the opinion of the insurer's doctor, according to whom Patrick was able to perform the same activity for another employer. The insurer therefore concluded that he was fit for work again. The decision immediately raised a question, however: can a person who is still ill be expected to find new employment within a few weeks? The answer is no, at least not automatically.

The principle invoked by the Federal Supreme Court

Under Swiss law, the employee must mitigate the damage and, when the conditions allow, make use of their remaining ability to work. This obligation, however, cannot be assessed in the abstract. The insured person's specific situation must be considered, taking into account their age, health, education and training, professional background and the concrete prospects of reintegration into the labour market.

In the case described, Patrick was 55 years old, had gained experience mainly in the same sector and had medical documentation indicating that he was still completely unable to work. For these reasons, an immediate change was unrealistic. The Federal Supreme Court clarified that, when the insurer invites someone to change employers in order to fulfil the obligation to mitigate the damage, an adequate transitional period must be granted. This allows the person to adapt to the new situation and genuinely seek new employment. As a rule, case law places this period between three and five months, depending on the circumstances of the specific case.

The duration is therefore not separate from the insured person's personal situation. Age, health, education and training, experience and actual prospects of reintegration all help determine whether the time granted is adequate.

Operational details

The assessment must remain concrete

The point is not to categorically deny the duty to mitigate the loss. The source acknowledges it, but ties it to a condition: when circumstances allow, the worker must make use of the residual work capacity. This wording prevents the possibility of changing employers from being treated as an automatic process.

The difference is between being able to envisage an activity and being genuinely able to resume it. An insurer may consider that the same job is theoretically available with another employer. Swiss law, however, requires that conclusion to be assessed in relation to the insured person: age, training, professional experience, health, and actual prospects of reintegration must be taken into account in the assessment.

What this means for cross-border workers

For a cross-border worker who finds themselves in a similar situation, the practical issue concerns the relationship with the employer's sickness insurance, rather than a general rule on every aspect of cross-border work. If the worker is asked to look for a new job while on sick leave, the key issue is whether the request genuinely takes the individual situation into account and allows the time indicated by case law.

Patrick's case shows why the factors should not be considered in isolation. His age of 55, his experience concentrated in the same sector, and his complete incapacity for work, as shown by the medical documentation, combined to make an immediate change unrealistic. It does not follow that everyone is automatically entitled to the upper limit of the range. The duration must be determined on the basis of the concrete circumstances.

The timing distinction also matters. A notice period of a few weeks is not equivalent to the transitional period indicated by the Federal Supreme Court when the insurer asks the worker to change employers. For this reason, the communication must be read not only for its outcome, but also for the time granted and the medical reasoning supporting it. The assessment concerns not only the termination of the contract: it concerns the real possibility of adapting, seeking a new job, and using the residual capacity when conditions allow.

The principle does not eliminate the need to mitigate the loss, but it prevents that requirement from being applied without considering the person and the labor market into which they would have to reintegrate. This is the difference between a theoretical request and a request assessed in the specific case.

Key points

From notification to protection

When the insurance company announces the termination of benefits with short notice, the sequence indicated by the source is actionable and should not be postponed. The worker can act on two fronts: challenge the decision and protect themselves from the risk of being left without income while waiting for a response.

Five steps to take

1. Do not simply accept the notification. The termination of benefits must be challenged promptly, especially when the notice granted is only a few weeks.

2. Ask for the decision to be reassessed. The request must refer to the insured person's specific situation and not merely to the theoretical possibility of carrying out the same activity for another employer.

3. Provide the available medical documentation. In the case described, complete incapacity certified by the attending physician is an element that must be considered when assessing work capacity.

4. Check the transitional period granted. It is necessary to verify whether the time assigned genuinely allows the person to adapt to the new situation and concretely seek new employment, taking into account age, health, training and professional experience.

5. As a precautionary measure, it is advisable to register in parallel with the regional employment office, that is, for unemployment. This measure aims to avoid being left without income if the insurance company delays its response.

These steps do not replace an assessment of the case. They serve to ensure that a communication affecting daily allowances does not go unanswered and to keep open the review of the insurance requirements, medical documentation and transition period.

For a cross-border worker in a similar situation, the practical advice remains the same: act quickly when the insurance company interrupts benefits and do not confuse registering for unemployment with accepting the decision. The source identifies the trade union or a legal adviser as contacts to involve without delay.

A timely review makes it possible to identify the necessary steps and prevent the passage of time from compromising the possibility of asserting the principles established by law. For the precautionary step related to unemployment, consult disoccupazione frontalieri.

Source: ocst.ch