Accident insurance for the self-employed

Insurance Terms and Conditions in accordance with sections 188 and 200 of the Finnish Workers’ Compensation Act

1 Conditions for Being Granted The Insurance

1.1

An individual who has pension insurance under the Self-Employed Persons’ Pensions Act (YEL, 1272/2006) has the right to insure him- or herself in self-employed work and during off-working hours in the event of an accident.

1.2

The insurance can only be taken out with one insurance company such that it covers all of the self-employed activities that are insured by the self-employed person’s pension insurance.

1.3

The insurance takes effect as of the date when Fennia has verifiably received the insurance application, unless a later starting date has been agreed on.

1.4

This insurance does not cover self-employed agricultural work as referred to in the act on accident insurance for a farmer (873/2015), nor does it cover work carried out by grant recipients. The insurance is also not granted for professional sports. Professional athletes must be insured separately under the act on accident insurance and pension provision for athletes (276/2009).

2 Persons Covered by The Insurance

The insured persons are persons mentioned by name in the policy document.

3 Scope of The Insurance

3.1

The insurance is valid during the self-employed person’s work time and leisure time.

3.2

The insurance is valid both in and outside of Finland.

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 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 from the policyholder.

4.4

The annual earnings used as the basis for compensating lost income and survivors’ pension is the valid reported income under YEL on the day of the accident or the amount of confirmed annual earnings per section 4.2.

4.5

The insurance premium is determined 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 occupational accident insurance and off-working-hours insurance for as long as the insurance is valid.

4.6

The reported income under YEL that is used as the basis for the insurance premium and compensation can be changed retroactively as of the date on which the change occurred so that it corresponds 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 The Policyholder’s Disclosure Obligation

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 report to Fennia any changes that take place while the insurance is valid without delay; however, no later than one month after the change takes 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 party 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.

5.4

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

Accident refers to a sudden and unexpected event resulting from an external factor that causes injury or illness to the employee.

6.2

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.

The self-employed person’s working hours

6.3

Occupational accident insurance covers a work-related accident that happened to the employee at work, in the area where work is carried out or outside the area where work is carried out, in accordance with sections 21–25 of the Workers’ Compensation Act.

The area where the self-employed person’s work is carried out is considered to be the area where the self-employed person carries out his or her self-employed work at any given time. The area where work is carried out is not, however, the self-employed person’s residence or other areas that are mainly used for private purposes.

Training for the self-employed person is considered to be only training related to his or her self-employed activities. Regulations concerning recreational events are not applied to the self-employed.

When the self-employed person performs work in his or her residence, the regulations concerning remote work contained in section 25 of the Workers’ Compensation Act are applied. In such cases, the insurance does not cover accidents that happen in the area where the work is carried out, during the commute between the residence and place of work or while on an eating or recreational break.

6.4

Occupational accident insurance also covers other injuries and illnesses caused by an accident, such as skin abrasions caused by chafing (Workers’ Compensation Act, section 18) 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).

6.5

Occupational accident insurance also covers the sudden soreness of a muscle or tendon (work movement soreness) that was not the result of an accident, but occurred as the person was performing a single strenuous work movement. Compensation is not paid if the soreness is caused by a previous injury or illness or by tissue damage that could only occur as the result of an accident. A maximum of six weeks of compensation is paid for soreness (Workers’ Compensation Act, section 33).

6.6

Occupational accident insurance also covers occupational diseases, meaning an illness that was likely primarily caused by exposure to a physical, chemical or biological agent at work, in the area where the work is carried out or in training (Workers’ Compensation Act, sections 26 to 30).

6.7

Occupational accident insurance also covers abuse or damage caused deliberately by another person, according to the conditions laid down in legislation (Workers’ Compensation Act, section 34). The insurance also covers mental shock resulting from an accident at the workplace, according to the conditions laid down in legislation (Workers' Compensation Act, section 35).

The self-employed person’s off-working hours

6.8

The insurance covers an accident during leisure time that did not occur under the circumstances referred to in sections 21–25 of the Workers’ Compensation Act.

6.9

Off-working-hours insurance also covers other injuries and illnesses caused by an accident, such as skin abrasions caused by chafing (Workers’ Compensation Act, section 18) 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).

6.10 Off-working-hours 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)

6.11 Off-working-hours 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 accident insurance for a farmer

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 party 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 party shall be reimbursed, at most, the client charge as provided in the Act on Client Charges in Social and Health Care Services.

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) is the annual earnings for the insurance and the so-called short term daily allowance rule (Workers’ Compensation Act, section 58) does not apply to the daily allowance.

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 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 party’s remaining ability to acquire earnings for him/herself in such available work that can reasonably be considered possible for the injured party to be able to perform is taken into account. In this case, the injured party’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.

7.5 Deductions made to compensation paid on off-working hours insurance

Compensation paid to the injured 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 grant power of attorney to Fennia, authorising Fennia to file for compensation for the medical costs in accordance with the Health Insurance Act.

A calculated deduction of the daily allowance and of 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 the table in section 202 of the Workers’ Compensation Act.

A benefit paid to the injured party by virtue of another act for the same accident is deducted for the same period from the rehabilitation allowance to be paid from the industrial injuries pension and during the period of industrial injuries pension. Benefits that are deducted are partial disability pension, cash rehabilitation benefit, disability pension and the subsequent old-age pension and daily allowance according to the Health Insurance Act. Correspondingly, survivors’ pension paid by virtue of another act for the same accident is deducted from survivors’ pension paid to the beneficiary.

8 Termination of The Insurance

8.1

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

The insurance is terminated on the last day of the company’s compulsory occupational accident insurance, if the policyholder terminates it in connection with an insurance transfer procedure.

8.2

The insurance ends at the same time as pension insurance referred to in the Self-Employed Persons’ Pensions act ends. The insurance can be terminated retroactively. If the entrepreneurial activities of a self-employed person who is just starting out do not continue for a period of four months, the insurance ends as the self-employed activities end. Fennia informs the policyholder of the decision to terminate the insurance.

8.3

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.

8.4

If it becomes known that the insured has a similar insurance that has commenced previously for the same work with another company, Fennia’s insurance shall be cancelled retroactively from its starting date.

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.

40 421 30