Accident insurance for physical exercise for the self-employed

Insurance Terms and Conditions in accordance with section 200 of the Workers’ Compensation Act

1 Conditions for Being Granted the Insurance

1.1

We grant off-working-hours insurance if the self-employed person has voluntary occupational accident insurance with Fennia.

1.2

The insurance enters into force as of the date when Fennia receives the insurance application, unless a later date has been agreed on.

1.3

Fennia is not obligated to grant off-working-hours insurance.

2 Persons Covered by the Insurance

The insured persons are the persons named in the policy document.

3 Scope of the Insurance

3.1

The insurance is valid during the self-employed person’s leisure time, during physical exercise.

Physical exercise is exercise taking place during off working hours, which supports the self-employed person’s well-being and ability to cope at work. The exercise can be instructed or it can be voluntary physical activity.

3.2

The insurance is valid both in and outside of Finland.

3.3

The insurance does not cover

a) competitions, matches or practices arranged by a sports federation or sports club which require sports accident insurance.

b) everyday physical activity or other leisure-time activities.

c) the following sports:

• downhill ice cross and roller derby
• alpine sports and off-piste skiing and snowboarding
• American football and rugby
• air sports
• ice-hockey and ice-skating
• martial arts (combat, contact or self-defence sports)
• scuba diving and freediving
• strength sports, such as weightlifting and powerlifting and crossfit
• mountain, ice and rock climbing, and wall climbing without the use of protective and safety gear

4 Annual Earnings as the Basis for Insurance Premiums and Compensation

4.1

The self-employed person’s annual earnings consist of the person’s reported income under section 112 of the Self-Employed Persons’ Pensions Act (YEL). The reported income confirmed by the pension company consists of the wages that would reasonably be paid if the self-employed person hired someone with the same level of skill to do the same work. If the self-employed person has several entrepreneurial activities, his or her earned income is calculated on the basis of the combined work input employed for these activities.

4.2

If the self-employed person’s reported income is defined as the maximum amount according to YEL, the annual earnings can be confirmed at a higher amount upon application in accordance with section 4.1.

4.3

The annual earnings used as the basis for the insurance premium for a self-employed person under the age of 18 are confirmed in accordance with section 4.1.

4.4

The insurance premium is based on the insured’s reported income under YEL and the accident and occupational disease risk of the work carried out by the insured. In order to determine the premium, Fennia has the right to receive information about the work carried out by the insured person, about the company’s line of business and about the insured person’s reported income under YEL.

4.5

The annual earnings used as the basis for compensating lost income and survivors’ pension are the valid reported income on the day of the accident but, for the situations mentioned in sections 4.2 and 4.3, the amount of confirmed annual earnings.

4.6

The insurance premium is defined annually in compliance with Fennia’s premium bases valid at the time. In accordance with Fennia’s premium bases, at least a minimum insurance premium for each calendar year is always charged on voluntary off-working-hours insurance for as long as the insurance is valid.

4.7

The reported income under YEL that is used as the basis for the insurance premium can be changed retroactively to correspond to the amount of reported income under YEL.

Fennia has the right, when necessary, to receive information about the self-employed person’s reported income under YEL directly from the policyholder’s pension company.

5. Policyholder's Obligation to Notify

5.1

The policyholder has the obligation to notify Fennia of all the necessary information pertaining to the insurance when taking out the insurance.

5.2

The policyholder must notify Fennia of any changes that take place while the insurance is valid within one month of the change taking place. If the notice concerning a change in the type of self-employed activities or work is made later than the aforementioned time limit, the change will enter into effect on the date when the notice of change was reported.

Changes in the amount of annual earnings are made on the same date as the change to the reported income under YEL, regardless of when Fennia received notice of the information.

5.3

The injured person shall, without delay, inform Fennia of changes affecting the compensation such as significant changes in his/her state of health, work capacity, work or earnings.

When an insured event takes place, Fennia must be notified in writing at the latest 30 days from when the incident occurred.

6 Insured Events and Restrictions

6.1

The insurance covers an accident during the self-employed person’s leisure time that occurred during physical exercise as mentioned in section 3.1. Accident refers to a sudden and unexpected event resulting from an external factor that causes injury or illness to the employee.

6.2

The insurance also covers other injuries and illnesses caused by an accident, such as skin abrasions caused by chafing (section 18 of the Workers’ Compensation Act) and the significant worsening of an injury or illness caused by the accident. The worsening of an injury or illness is not compensated if the accident only played a minor part in its worsening. A maximum of six months of compensation, starting from the time of the accident, is paid for the worsening of an illness or injury (Workers’ Compensation Act, section 19).

6.3

A general requirement for an accident being compensated is a probable medical causal connection between the accident and the injury or illness. In assessing the causal connection, particularly the medical findings and observations, how the accident happened and previous injuries and illnesses are taken into account.

6.4

The insurance does not cover

a) an occupational disease or the significant worsening of some other injury or illness compensated as an occupational disease (Workers’ Compensation Act, sections 26–30)

b) the sudden soreness of a muscle or tendon that was not the result of an accident, but occurred as the person was performing a single strenuous work movement (Workers’ Compensation Act, section 33)

c) abuse or damage caused intentionally by another person (Workers’ Compensation Act, section 34)

6.5

The insurance also does not cover

a) damage as referred to in the Patient Injuries Act

b) an accident that entitles the injured party to compensation according to this act by virtue of another act

c) an accident that entitles the injured party to compensation for a work-related accident or occupational disease according to the act on occupational accidents and diseases for farmers

d) a motor vehicle accident as referred to in the Finnish motor liability insurance act or a similar act of a state belonging to the European economic area

e) a rail traffic accident as referred to in the Finnish act on liability for rail traffic (113/1999) or a similar act of a state belonging to the European economic area

7 Compensation

7.1

Compensation paid under the insurance is determined based on the provisions of the Workers’ Compensation Act.

7.2 Indemnity for medical treatment

Compensation under the insurance is paid for unavoidable expenses resulting from necessary medical treatment (Workers’ Compensation Act, Sections 36-37).

Necessary travel expenses arising from hospital treatment are compensated to the nearest place of treatment or to one specified in a commitment to pay. For journeys made in a private vehicle, half of the tax-free rate-per-kilometre compensation confirmed by the Tax Administration shall be reimbursed.

Fennia has the right to direct the injured person to a treatment facility of its choosing using a commitment to pay. If treatment is provided in a treatment facility other than the one indicated in the commitment to pay or if Fennia has not provided a commitment to pay, the injured person shall be reimbursed, at most, the client charge as provided in the Act on Client Charges in Social and Health Care Services.

Compensation paid to the injured party by virtue of the Health Insurance Act for the same accident is deducted from the indemnity for medical treatment. In order for this to take place, the injured party must present power of attorney authorizing Fennia to file for compensation for the medical costs in accordance with the Health Insurance Act.

Compensation for medical treatment, pharmaceutical, travel and additional home maintenance costs must be applied for from Fennia within one year of the costs arising.

7.3 Compensation for lost income

The basis for compensation for lost income (daily allowance, rehabilitation allowance and industrial injuries pension) under the insurance is the annual earnings for the insurance (Workers’ Compensation Act, section 58).

No other party than the company taking out the insurance is entitled to recover the earnings paid during sick leave or any other benefit from the compensation for lost income paid in accordance with this policy.

7.4 Deductions made from compensation for lost income

A calculated deduction from the daily allowance and from the rehabilitation allowance paid for the daily allowance period is made for the period during which the injured party is entitled to daily allowance based on the Health Insurance Act for the same accident. The deduction is made in accordance with section 202 of the Workers’ Compensation Act.

Daily allowance according to the Health Insurance Act that is paid to the injured party for the same period, as well as disability pension paid by virtue of another act and subsequent old-age pension are deducted from the rehabilitation allowance paid for industrial injuries pension and the period of industrial injuries pension. Correspondingly, survivors’ pension paid by virtue of another act for the same accident is deducted from survivors’ pension paid to the beneficiary.

7.5 Assessment of the impaired work ability of the self-employed person

If an accident mostly prevents the carrying out of self-employed work, daily allowance is paid in accordance with full disability. If an accident considerably limits the carrying out of self-employed work, half of the daily allowance paid in accordance with full disability is paid.

When assessing a deterioration in work ability, the injured person’s remaining ability to acquire earnings for him/herself in such available work that can reasonably be considered possible for the injured person to be able to perform is taken into account. In this case, the injured person’s education, previous activity, age, place of residence and other comparable factors will be taken into account. For the self-employed, the valid reported income under YEL after the accident is also taken into account.

If the reported income has not been reduced after the accident, the self-employed person is not entitled to industrial injuries pension that is granted for the time being.

8 Termination of the Insurance

8.1

The policyholder may terminate a permanent insurance during the insurance period.

The termination must be done in writing. The insurance expires at the earliest when Fennia receives the termination notification.

8.2

The insurance ends at the same time as the voluntary occupational accident insurance that was taken out for the insured person ends.

8.3

This insurance is terminated on the last day of the voluntary occupational accident insurance, if the policyholder terminates it in connection with an insurance transfer procedure.

8.4

The insurance is considered to have ended as of the date on which the policyholder has been declared bankrupt or when a bailiff has issued an impediment certificate as referred to in the Enforcement Code, Chapter 3, Section 95, indicating an impediment for lack of means or unknown whereabouts of the policyholder.

8.5

Fennia has the right to terminate the insurance if the policyholder has neglected to pay a due insurance premium, or if the policyholder has deliberately provided wrong or incomplete information required for processing a compensation matter or for determining an insurance premium in order to achieve unauthorised financial gain for him/herself or for someone else.

The insurance ends within 30 days of the written notice of termination being sent. However, the insurance does not end if the policyholder has paid the due premium before the close of the period of notice.

9 Appeals

Decisions issued by Fennia under this insurance policy can be appealed in writing to the Accident Appeal Board, in accordance with the instructions for appeal that are attached to the decision.

10 Applicable law

This insurance policy is subject to the Finnish Workers’ Compensation Act (459/2015). Upon taking out the insurance the policy is subject to the Insurance Contracts Act (543/1994), section 4 b, paragraph 1; section 5, paragraph 1; section 5 a, and section 7, paragraph 1.