Occupational accident insurance for the self-employed

Insurance terms and conditions in accordance with section 188 of the Finnish Workers’ Compensation Act

1 Conditions for being granted the insurance

1.1

A person who has pension insurance under the Self-Employed Persons’ Pensions Act (YEL, 1272/2006) has the right to insure themself for accidents that occur during self-employed work.

1.2

A self-employed person under the age of 18 has the right to insure themself if they fulfil the requirements for self-employment provided in the Self-Employed Persons’ Pensions Act section 3.

1.3

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.

1.4

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

1.5

This insurance does not cover self-employed agricultural work referred to in the Occupational Accident and Disease Act for Farmers (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 athletes’ accident and pension cover (276/2009).

2 Persons covered by the insurance

The insured persons are the 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 working hours.

3.2

The insurance is valid in Finland. Work abroad is subject to section 14 of the Workers’ Compensation Act.

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 and confirmed income under section 112 of the Self-Employed Persons’ Pensions Act (YEL). The reported income confirmed by the pension institution is the salary that would reasonably be paid if the self-employed person hired someone with the same level of skills to do the same work. If the self-employed person is engaged in several entrepreneurial activities, their earned income is calculated on the basis of the combined work input used 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, by application, be confirmed at a higher amount in accordance with section 4.1.

4.3

The annual earnings of 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 confirmed 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 from the policyholder 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 the survivors’ pension are the income under YEL valid on the day of the accident or, in cases according to sections 4.2 and 4.3, the amount of the confirmed annual earnings.

4.6

The insurance premium is determined annually in accordance with Fennia’s payment criteria valid at the time. In accordance with Fennia’s payment criteria, at least a minimum insurance premium, specific to the calendar year, is always charged for the validity of the voluntary occupational accident insurance for the self-employed.

4.7

The reported income under YEL that is used as the basis for the insurance premium can be changed retroactively as of the date on which the change occurred so that it corresponds to the amount of the reported income in accordance with the Self-Employed Persons’ Pensions Act (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 disclosure obligation

5.1

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

5.2

The policyholder must report, without delay, to Fennia any changes that take place while the insurance is valid, but no later than one month after the change. If the change concerning the type of the entrepreneurial activities or work as a self-employed person is reported later than stated above, the change will be valid as of the reporting date. Any changes to the annual earnings are made to this insurance as of the same date as when the change in the reported income under YEL was made, irrespective of when Fennia received the information.

5.3

The injured person must, without delay, inform Fennia of any changes affecting the compensation, such as significant changes in their state of health, work ability, work or earnings.

5.4

Fennia must be notified of an insured event in writing no later than 30 days from the date of the incident.

6 Insured events and limitations

6.1

The insurance covers a work-related accident that occurred to the employee at work, in the area where work is carried out or outside the area where work is carried out, as provided in sections 21–25 of the Workers’ Compensation Act.

The area where work is carried out is considered to include the area where the self-employed person carries out their self-employed work at any given time. However, the area where work is carried out does not include 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 include only training related to their self-employed work. Regulations concerning recreational events do not apply to the self-employed person.

When the self-employed person performs work at their residence, the regulations concerning remote work provided in section 25 of the Workers’ Compensation Act apply. In that case, the insurance does not cover accidents that occur in the area where work is carried out, during the commute between the residence and place of work or during a lunch or recreational break.

6.2

An accident refers to a sudden and unexpected event resulting from an external factor that causes injury or illness to the person performing work.

6.3

The 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 covered if the accident only played a minor part in its worsening. Compensation for the worsening of an illness or injury is paid for six months, at a maximum (Workers’ Compensation Act, section 19).

6.4

The 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).

6.5

The 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 work is carried out or in training (Workers’ Compensation Act, sections 26 to 30).

6.6

The insurance also covers damage caused by abuse or other deliberate act 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 work, according to the conditions laid down in legislation (Workers’ Compensation Act, section 35).

6.7

A general requirement for an accident to be covered is a probable medical causal connection between the accident and the injury or illness. When assessing the causal connection, the medical findings and observations, how the accident happened and previous injuries and illnesses are taken into account, in particular.

7 Compensation

7.1

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

7.2 Compensation for medical care

Compensation under the insurance is paid for unavoidable expenses resulting from necessary medical care (Workers’ Compensation Act, sections 36–37).

Necessary travel expenses arising from travel to the nearest place of treatment for medical care, or to a place specified in a payment commitment, are covered. For journeys made using a private vehicle, the compensation is half of the tax free rate-per-kilometre compensation confirmed by the Tax Administration annually.

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

Compensation for costs, such as the costs of medical treatment, pharmaceuticals, travel and additional home care, must be applied for from Fennia within one year of the costs arising.

7.3 Compensation for loss of income

The basis for compensation for loss of income (daily allowance, rehabilitation allowance and industrial injuries pension) is the annual earnings stated in the insurance, and the provision on short-term daily allowance (Workers’ Compensation Act, section 197) does not apply.

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

7.4 Assessment of the self-employed person’s impaired work ability

If an accident mainly prevents the person from performing self-employed work, the daily allowance is paid according to full incapacity for work. If an accident considerably limits the performance of self-employed work, the daily allowance paid is half of the daily allowance paid for full incapacity for work.

When assessing the impairment of work ability, the injured person’s remaining ability to obtain earnings for themselves by performing such available work that can reasonably be considered possible for them to perform is taken into consideration. In that case, the injured person’s education, previous activity, age, place of residence and other comparable factors are taken into account. For the self-employed person, 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 the industrial injuries pension that is granted until further notice.

8 Termination of the insurance policy

8.1

The policyholder may terminate the insurance policy. The termination must be made in writing. The insurance policy ends, at the earliest, when Fennia receives the termination notification.

The insurance policy 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 policy is terminated on the same date as the pension insurance referred to in the Self-Employed Persons’ Pensions Act. The insurance policy can be terminated retroactively. If the entrepreneurial activities of a self-employed person who is just starting their business do not continue within a period of four months, the insurance policy is terminated when the self-employed activities end. Fennia informs the policyholder of the termination of the insurance policy by issuing a decision.

8.3

Fennia has the right to terminate the insurance policy 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 unfounded financial gain for themself or someone else.

The insurance policy is terminated within 30 days of the submission of the written notice of termination. However, the insurance policy is not terminated if the policyholder has paid the due premium before the end of the period of notice.

8.4

If it becomes known that the insured has a similar insurance policy that has commenced earlier for the same work with another company, Fennia’s insurance policy is cancelled retroactively as of its starting date.

9 Appeals

Decisions issued by Fennia under this insurance can be appealed against in writing with 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). When taking out an insurance policy, section 4 subsection 1, section 5 subsection 1, section 5 a, as well as section 7 subsection 1 of the Insurance Contracts Act (543/1994) also apply.

40 422 30