Leisure Time Accident
If you are injured in an accident during leisure time, your insurance policy is of utmost importance. Leisure time accident insurance is often included in family and home contents insurance policies. As terms differ between both insurance companies and policies it is vital to read the policy terms carefully to fully realise your rights to compensation.
Leisure Time Accident
Leisure time accident insurance policies commonly cover daily allowances for incapacity to work, compensation for loss of amenity (also known as medical disability) as well as partial reimbursement of medical costs.
Insurance policy terms frequently contain limitations such as compensation reductions due to age and a requirement of a minimum threshold evaluation for loss of amenity/medical disability (often 15%). Please note that traffic accidents are traditionally excluded in leisure time accident policies.
Some collective wage agreements/union contracts stipulate that employers must purchase leisure time accident insurance for their employees. This generally applies to government and municipal employees. If you have purchased a general accident insurance policy, it covers both leisure time accidents along with workplace accidents.
Leisure Time Accident
If you have chosen to purchase social security accident insurance on your tax return, it covers accidents that occur while performing housework and maintenance on your home, summer house or under similar circumstances.
Leisure time accidents can also be covered by liability insurance if a third party is directly or indirectly responsible for the accident occurring. Such insurance policies traditionally lead to more extensive rights to compensation.
An unprovoked assault can under certain circumstances be classified as an accident during leisure time and therefore create a right for compensation from leisure time accident insurance policies.
Here to help
It is of vital importance to report all accidents to the relevant insurance company as soon as possible to ensure that your right to compensation is not lost.
Fortis will provide you with a comprehensive assessment of your case free of charge.
Examples of cases
Leisure time accident
38-year-old / Knee injury
Contacted Fortis for an assessment two weeks after the accident. Fortis assisted the client in reporting the accident on the grounds of both leisure time accident insurance and the employer’s accident insurance, as the client had around the clock coverage due to their wage agreement/union contract. Fortis took care of all case elements, communications with all liable parties as well as data collection and analysis.
Less than a year after the client’s first meeting all necessary data had been gathered and Fortis had an impartial assessor assess the extent and the severity of the damages suffered in the accident.
The results of the assessment arrived eight weeks after the assessment meeting, resulting in 9% loss of amenity/medical disability. The total compensation amounted to approx. 2.800.000 kr.
58-year-old / Fracture of the upper arm
Contacted Fortis for an assessment eleven months after the accident. Fortis assisted the client in reporting the accident on the grounds of both leisure time accident insurance and the employer’s accident insurance, as the client had around the clock coverage due to their wage agreement/union contract. Fortis took care of all case elements, communications with all liable parties, arranging the reimbursement of medical expenses as well as data collection and analysis.
Six months after the client’s first meeting all necessary data had been gathered and Fortis had an impartial assessor assess the extent and the severity of the damages suffered in the accident.
The results of the assessment arrived six weeks after the assessment meeting, resulting in 5% loss of amenity/medical disability. The total compensation amounted to approx. 850.000 kr.
We kindly ask you to keep in mind that each case is unique and that numerous variables affect the outcome of a case and by extension the amount compensated, such as the terms of the relevant insurance policy and the result of an evaluation of medical disability. For accidents based on tort law the average income of the injured person before the accident is also an important variable.
The General Process of a Personal Injury Case
Reporting the accident
It is of vital importance to report your accident to the relevant insurance company as soon as possible to ensure that the right to compensation does not expire. We at Fortis will report the accident on your behalf or assist you with filling out the correct form.
The necessary data varies across case types, but for personal injury cases the main case data is data that proves and documents the accident and the injury; such as police reports, doctor’s reports and medical records, records from physical therapists, psychologists, dentists and other parties that assist the injured person in recovery. We at Fortis will take care of the data collection on your behalf.
Assessment of injuries
When all the necessary data has been collected it is time to commission an impartial third-party assessor to assess the extent and the severity of the injuries suffered in the accident. As a general rule the assessment is not conducted until at least one year has elapsed from the accident’s occurrence. We at Fortis will guide you every step of the way during the assessment period of the case.
We use our decades of experience to make a claim for monetary compensation based on the result of the assessment. In the vast majority of cases the insurance company agrees to settle the case based on the assessment. Should the claim for compensation be disputed or the settlement unsatisfactory we can take the insurance company and other liable parties to court at your discretion.
Questions and Answers
Injured persons can suffer a permanent loss of their capacity to earn income (also known as financial disability). The loss of earning prospects can include e.g. a reduction in pay due to a change in work position, line of work or workplace or the reduction of capability to handle strain or stress or working overtime. Permanent loss of earning capacity is assessed in percentages and is assessed on an individual basis. When conducting the assessment, the assessors consider mental and physical abilities, age, education, work experience, residence and other personal aspects of the injured person. This differs from the evaluation for the permanent loss of amenities or disability, which are decided on an impersonal basis. The evaluation for permanent loss of earning capacity is only conducted for accidents which are compensated for under tort law, e.g. traffic accidents or work accidents at sea.
Permanent loss of amenities involves compensation for non-economic loss (also known as medical disability). Loss of amenities is evaluated on a point-based system and does not look to personalised matters, such as age, education, work experience or special talents. All persons are evaluated on the same scale and will receive the same compensation for the same injury and the same symptoms. The point-based system can be found in a chart published by the government which contains instructions on the points certain injuries or symptoms amount to. As an example, the loss of the little finger amounts to 5-7 points with no regard to whether the injured person is a world-class pianist, a lawyer or a craftsman.
The point of stabilisation is the point in time in which no further improvements can be expected from the injured person’s condition or health. In other words, the health condition is stable with no expected changes for the worse or the better.
For traffic accidents or accidents covered by tort law the injured person may have the right to claim compensation for temporary loss of earnings for time spent away from work due to the accident. The compensation covers days away from work in which they do not receive sick pay from their employer and until either they can return to work, or when further improvements to their health cannot be expected. The injured person may also possess a right to compensation for temporary loss of income from the Icelandic Health Insurance (Sjúkratryggingar Íslands).
When the right for compensation from the insurance company lapses, the injured person may possess the right to compensation from their union or pension fund. If the accident is a leisure time accident or an accident at work, they may also possess a right to claim a daily allowance for the incapacity to work.
Am I entitled to compensation?