Crans-Montana: the most important insurance questions after the fire disaster

In the event of accidents, insurance cover is provided in Switzerland – either through compulsory accident insurance in accordance with the Accident Insurance Act (UVG) or, if compulsory accident insurance in accordance with the UVG does not apply, through compulsory health insurance (OKP/KVG) with accident cover.

Employees are compulsorily insured under the UVG. Anyone who works at least 8 hours per week for the same employer is also insured against non-occupational accidents (NBU) – i.e. including accidents during leisure time. The insurance covers medical expenses and, depending on the case, daily allowances and disability and survivor benefits. In addition, supplementary UVG insurance policies – if available – may trigger further benefits.

Those who are not insured under UVG, such as young people, or who do not have NBU cover if they work less than 8 hours per week, are covered by OKP with accident cover. Accident cover is compulsory in these cases. OKP covers all medical expenses in accordance with KVG, whereby franchise and excess must be taken into account.

For guests from abroad, the cost coverage depends on the respective insurance coverage in their country.

With the European Health Insurance Card (EHIC), guests who are EU/EFTA/UK nationals are entitled to medically necessary care in Switzerland.  Billing is carried out in accordance with Swiss rules on the provision of benefits, and the costs are then claimed from the foreign insurance provider.

No definitive statement can be made for persons from other countries. They will, of course, receive medical care – but the question of how the costs will be billed later depends on their respective health or travel insurance policies or individual coverage. If they have no insurance, they are personally liable. Persons entering Switzerland on a Schengen visa require private health insurance with a minimum cover of EUR 30,000.

Whether there is liability and who is liable is part of the ongoing investigations – a criminal investigation has already been initiated. In connection with the organiser of the New Year's Eve party, this involves questions of fire safety, escape and rescue routes, and compliance with other regulations. The owner of the building or flat may also be liable if it turns out that the property was unsuitable for use as a bar and disco. Civil liability may exist regardless of the outcome of the criminal investigation.

State liability on the part of the municipality of Crans-Montana or the canton of Valais may also be an issue if the periodic fire safety inspections were not carried out as required or if the canton neglected its monitoring duties.

According to media reports, the bar ‘Le Constellation’ has public liability insurance with AXA, and the municipality of Crans-Montana has municipal liability insurance – also with AXA. It has not yet been reported whether there is also building liability insurance (for the condominium owner or for the entire property). If liability is affirmed, the coverage amounts of the corresponding liability insurance policies will be exhausted, and thereafter the liable parties will also be held accountable with their own assets.

Important from the point of view of those affected is that medical care is guaranteed regardless of the outcome of the liability issue. Only later can the social insurance providers, who are obliged to pay in advance, examine recourse options – depending on the results of the investigations and legal assessment – i.e. reclaim all or part of the costs from liable third parties. If the liability substrate is insufficient, the social insurance providers will have to defer or write off their recourse claims in favour of the directly injured parties on the basis of their priority of coverage.

Those affected are generally unaware of this. For damages not covered by social insurance providers (e.g. uncovered medical costs, visiting costs, urgent transport and travel costs or costs for legal advice), a victim assistance application can be submitted in accordance with the Victim Assistance Act (Victim Assistance Switzerland). Funeral and repatriation costs are covered by the canton of Valais (Crans-Montana fire disaster – measures to help victims).

Building insurance in Switzerland is organised on the basis of a dual system comprising cantonal building insurers and the private insurance industry. The canton of Valais is one of the so-called GUSTAVO cantons. These are cantons that rely on a private-sector solution, regardless of whether or not there is a cantonal insurance obligation, as is the case in the canton of Valais, for example.

Even in cantons without compulsory building insurance, insurance penetration is very high. One reason for this is that mortgages are generally only granted if sufficient building insurance has been taken out. This also applies to supplementary building and contents insurance (e.g. inventory, movable property) and business interruption cover.

In the canton of Valais – and therefore also in Crans-Montana – fire protection is governed by the fire protection regulations applicable throughout Switzerland. The obligation to comply with these regulations lies with the owners and operators. The competent authorities are responsible for approvals, inspections and enforcement.

In Valais, cantonal specialist agencies (including the Office cantonal du feu) provide concrete support to municipalities and planners. At the municipal level in Crans-Montana, the responsible safety officer and the municipal fire protection authorities (e.g. Commission du feu/fire brigade) are responsible for implementation and periodic inspections in accordance with cantonal regulations.

Since 2018, a project to revise these fire safety regulations has been underway under the leadership of the Association of Cantonal Fire Insurers (VKF), in which the SIA is also involved. However, particularly in light of the fire disaster, the adjustments appear to have unintentionally weakened the level of protection. The SIA is therefore calling for a genuine halt to this revision process.

Private insurers, on the other hand, are not licensing or supervisory authorities. Their contribution lies primarily in risk consulting (risk engineering) and contractual incentives in policies (e.g. premiums, deductibles, conditions).

Also relevant in this context: in individual cantons with cantonal building insurance, certain prevention or enforcement tasks in fire protection can be performed by the cantonal building insurers on behalf of the authorities. However, competence, supervision and ultimate responsibility remain with the authorities. This is merely an organisational arrangement, so there should be no difference in the scope of supervision.

In addition to the insured persons, insurers make their expertise available to the competent authorities and partners – for example, when it comes to coordinating services or practical handling.

The SIA also supports discussions in which all relevant parties work together to find solutions to the outstanding issues relating to the fire disaster in Crans-Montana.

The priority is to clarify how social insurers (UVG/KVG) will deal with the costs of medical care and the associated expenses for relatives (e.g. transport costs, accommodation, etc.) that are not included in the catalogue of benefits. A social insurance coordination group initiated by the Federal Office of Public Health could help to avoid unequal treatment. Due to the social insurance providers' obligation to pay in advance, the discussion of liability is a secondary issue.

From a liability law perspective, discussions should begin as soon as the facts of the case allow. It is important to conduct an independent investigation of the events, as the findings from the criminal proceedings will be used to assess civil liability.