4.2.Reporting a new event

Once registered (reported), the company can report an event to the insurer with just a minimum set of data, even if the event date is still missing. This allows the company to report the event promptly and receive the claim number (insurance case ID)

back from the insurer.

Procedure

Select the appropriate employee from the Employee list and open a new case via HR - KLE Case Management. Select “New Accident / New Disease” from the menu at the top and fill in the data in the “General” menu. If an incorrect incident date was reported by mistake, it cannot be corrected retroactively. In this case, discuss the procedure for rectifying the error with the insurer.

Field description

Work hours	Irregular - regular This is also explained in menu One-time setup - Salary type man-agement / Salary type assignment	An hourly wage earner is usual-ly set to irregular. However, if s/he has individually agreed weekly working hours, ‘regular’ must be selected so that the contractually agreed wage, and not the actual wage bill for the last 12 months, is reported. Monthly wage earners are set to regular.
No incapacity to work	Not activated by default = Accident with incapacity to work	Must be set to inactive if it is a minor accident without incapacity to work.
Test case	Cases marked as test cases can also be deleted after transmission.	Can be used for training and testing purposes. No claim is opened for an insurer.
Sync with Direct	Case is synchronized with SwissSalary Direct.	SwissSalary Direct Self-service Portal must be set up

Field description specific to illness

General	Explanation - Action	Information
Type	Select the appropriate type	If maternity coverage is included in the KTG policy, the birth of the child and the mother’s absence from work can be reported using the maternity notification form.
Start	Onset date of the illness	The start date of the illness cannot be changed retroactively.

Field description specifically for accidents

General	Explanation - Action	Information
Incident Date Type	Under review – approximately – exactly; select the appropriate situation	Depending on whether the date of the incident is known at the time of reporting, if the status is “under investigation,” it is not possible to create a story, provide an accident description, or report a work disability.
Incident Date	Enter the date of the accident, or leave it blank if it is not yet known	If the incident type is “exact” or “approximate,” a date is required.
Type of Accident	Select the appropriate type	Accident work, Accident at Leisure, Occupationa Disease, Case of Death at work, Case of Death at Leisure, Relapse at work, Relapse at Leisure
No incapacity to work	Not enabled by default = Claim involving inability to work	Must be set to “inactive” if the accident is minor and does not result in an inability to work
Relapse Date	a new, later date following the initial incident date	Required only when a relapse is reported
Recurrence Case with the Same Employer	Select the appropriate case	List of all cases reported by the employee
Relapse After Changing Employers	In the event of a relapse, the insurance provider that was already responsible for covering the initial case must cover the costs.	In the event of a relapse, the insurance provider that was already responsible for covering the initial case must cover the costs.

If SwissSalary Direct is used, the checkbox “KLE Sync Enabled” can be selected in the SwissSalary Direct setup within SwissSalary. To use this feature effectively, the KLE option must be enabled for employees on the SwissSalary Direct side. This allows employees to record accidents or illnesses on their SwissSalary Direct dashboard. These are then synchronized to SwissSalary and can be transmitted from there to the insurer. As soon as the claim number is available in SwissSalary, it is synchronized to SwissSalary Direct during the next synchronization. If the claim is initially recorded in SwissSalary, the “Synchronize with Direct” checkbox can be selected directly on the KLE case. This allows the case to be sent to the employee’s SwissSalary Direct portal before it is transmitted to the insurance company, so that the employee can make corrections and/or additions.

Synchronization of a case without an exact incident date is only possible once. The next synchronization attempt will result in the error message: “Incident date type must not be ‘under investigation/uncertain’ in KLE Case.” This ensures that the exact date of the incident is actually sent along with the accident description.

After the initial report, the insurer may request other parts. They are marked in red and have a deadline. These parts are stories that the insurer dynamically requests from the company over the course of the case.

Missing information must be filled in via different stories and re-submitted.

While parts have not yet been transmitted, they can be deleted via ‘Manage’ in case stories. If an incorrect incident date or wrong incapacity to perform duties has already been reported, stories may no longer be deleted.

=> For more information on stories, see chapter Overview of all KLE cases stories and KLE case stories in detai