Accident insurance - application for compensation in the event of an accident
Application process for accident compensation
Individuals who suffer from an accident that incurs liability may be entitled to accident compensation from Iceland Health.
Accident compensation is paid to those who meet the following criteria:
An individual is involved in an unexpected accident.
The individual is covered by accident insurance.
The accident is compensable according to accident insurance law (lögum um slysatryggingar almannatrygginga).
The accident is reported in a timely manner
Accident compensation can be:
For out-of-pocket costs for medical care.
Accident benefits due to incapacity for work.
Lump sum payment of disability or disability compensation for permanent personal injury
Death benefits due to fatal accident
Compensation other than compensation for permanent personal injury is paid two years back in time from the time all documents were received by Iceland Health.
Accident per diem payments are also paid if the accident resulted in the individual becoming unable to work.
If the employer pays wages during an accident, the payment goes to the employer.
If the employer does not pay wages during an accident's absence, the person who was injured will receive the accident per diem payment
Get the necessary data
Injury certificate
The certificate must be from the doctor or healthcare professional who was first consulted after the accident. It must include information about:
First arrivals due to the accident.
Period of inability to work.
Follow-up treatment.
If you went to Landspítali University Hospital, you can submit an emergency room register instead of an injury certificate (you can download from the Landspítali website).
Another
In the event of fatal accidents, a police report must be submitted, if available.
Due to maritime accidents, payslips must be submitted for the processing of accident pay to the fishing company in connection with the income guarantee of seafarers.
2. Report accidents
The employer or the injured person must report the accident to Iceland Health. The other person receives an email on the Ísland.is that the accident was reported, logs in with electronic ID and approves the accident as described or makes comments.
An individual has 1 year to report the accident, but Iceland Health may give a longer period in certain circumstances (see: Am I entitled to accident compensation?).
If the injured person is self-employed or if the accident occurred while doing housework, the injured person must report the accident.
In the case of a fatal accident, the employer or the family member of the deceased can report the accident.
3. Iceland Health review
Iceland Health reviews the application and its necessary supporting documents (see application processing times).
If Iceland Health needs more detailed documentation, they will contact you and ask for what is missing. This may delay the processing of the application.
If the requested documents are not received within the stipulated time, the case will be postponed, and the applicant will be notified thereof.
An application is made for reimbursement of medical expenses when an accident is reported. Invoices for the medical expenses must be submitted.
It does not require original invoices.
If the payment method does not appear on the invoice, a payment confirmation is also required.
Data can be sent electronically.
It is possible to apply for reimbursement of medical care due to an accident for up to five years from the date of the accident.
Costs that were paid by a trade union, insurance company or other parties are not reimbursed.
When an individual signs an application with Iceland Health, he/she confirms that all information is correct.
All information is treated as confidential.
Measures are taken to ensure the security of all data, and it is transmitted through secure web portals.
Case documents are stored in the secure operating environment of Iceland Health.
Further information on the processing of personal data by Iceland Health and data protection can be found in Iceland Health's privacy terms.
Iceland Health receives information from the following institutions:
Directorate of Labour: Information on periods of unemployment benefits and payments from the Maternity/Paternity Leave Fund.
The tax:
Information on wage payments/imputed remuneration.
Name and ID number of the employer.
Information on whether home insurance is valid.
Social Insurance Administration:
Information on disability or rehabilitation assessment (status).
Information on payments that may not be paid at the same time as accident insurance benefits (status).
Registers Iceland:
Information about name, ID number, and address.
Information about children and spouses.
In rare cases, it may be necessary to obtain information from the employer, sports clubs, or educational institutions about the accident if it is not available from the person who was injured.
Who will receive information about the application?
Iceland Health will share information about the outcome of the case with the employer, sports club, or educational institution.
It is only disputed whether the application has been approved, denied, or postponed.
The reason is that the parties in question may be entitled to reimbursement of paid expenses and/or accident per diem payments if wages have been paid during sick leave due to the accident.
These parties never receive health or medical record information.
The Administration of Occupational Safety and Health and the Icelandic Transport Accident Investigation Board can obtain a copy of the application if they request a copy.
Tryggingastofnun receives information about benefit payments that are not paid at the same time as benefits from them.
If the employer notifies Iceland Health of the accident, it is possible to ask for information about which employee reported the accident.
Right to accident compensation
Accident compensation is paid to those who meet the following criteria:
The individual experienced an unexpected accident.
The individual is covered by accident insurance.
The accident is compensable under the law on accident insurance of social security.
The accident is reported in a timely manner.
Medical expenses are not reimbursed if they were paid by a health fund, insurance company, or another party.
If a refund is applied for with incorrect information, the applicant may be required to repay it with interest.
The applicant must have been involved in an unexpected accident.
An unexpected accident refers to an event that:
Is sudden and unexpected.
Causes injury to the body.
Happens without the will of the injured person.
Cannot be traced to the underlying diseases of the injured person.
There is a deviation from the course of events that could be expected.
A viewer can realize that has happened.
Accidents subject to compensation can be:
Accidents at work.
Accidents during vocational training.
Accidents during rescue work.
Accidents during sports activities.
Accidents while housework (if you apply for insurance on your tax return).
Accident insurance also applies to occupational diseases. Occupational diseases are illnesses that occur because of work or work environment.
Car accidents are not liable for compensation.
Work-related accidents
A work-related accident is considered liable for compensation if the person in question was at work at the time of the accident and was paid wages or calculated remuneration for the work. The injured person is at work if he/she is:
At the workplace during working hours (also applies to meal and coffee breaks).
In same-day missions for the workplace.
On same-day trips between workplace and home.
On longer trips if the employee is on pay during the trip.
Marine accidents
Marine accidents are liable for compensation if the person in question was paid wages for work or calculated remuneration for the work.
Accidents during housework
Accidents during housework may be liable for compensation if the insurance was checked on the appropriate tax return.
The accident insurance is valid from 1 June in the year in which the tax return is submitted until 31 May the following year. It is not possible to apply for accident insurance after the tax authorities have received your tax return.
The housework must have been carried out in Iceland in the insured person's home or summer cottage in which he/she is staying (including in garages, storage rooms, a designated garden, or driveways).
Household chores that are insured against accidents include:
Traditional household chores such as cooking and cleaning.
Care of the sick, elderly and children.
Maintenance projects and repairs.
Traditional gardening work.
Accident insurance does not cover accidents during daily activities (dressing, bathing, and eating) and accidents while travelling.
Accidents during sports
Athletes' accidents are covered if the injured person is 16 years of age or older, participates in sports activities and is injured during training, exhibitions, or competitions.
Sports activities mean that the person in question trains regularly with a sports club within the auspices of the National Olympic and Sports Association of Iceland (ÍSÍ).
Accidents during rescue work
Accidents during rescue work are insured against accidents if the injured person was working to rescue people from danger or to protect against other imminent major damage.
Accidents during vocational training
Accidents that occur during practical time or during work related to apprenticeship or other studies may be liable for compensation if the premise of an unexpected accident is met.
Occupational diseases
Illnesses caused by work or the work environment are also considered accident insured, even if they are not directly accidents. Compensation is applied for as if it were an accident.
Employees are insured against accidents if they:
Work and receive wages in Iceland.
Work on board a ship or aircraft, Icelandic or operated by Icelandic parties, and receive wages in Iceland.
Self-employed persons are insured against accidents if they:
Are employers in agriculture (spouses and their 13–17-year-old children are also insured).
Work independently in industries other than agriculture.
Vessel owners who are also crew members.
Students are insured against accidents if they are in:
Certified apprenticeship.
Internship in health sciences or other sciences (practical studies at a university).
Others who are insured against accidents in the event of an accident:
Athletes if the accident was during sports.
Rescue team members if the accident was during a rescue.
Those who are injured while doing housework and ticked the appropriate box on their tax return.
As a rule, all accidents must be reported within one year. If it is difficult to get the employer's signature on the notification, assistance can be sought from the police.
If more than a year has passed from the date of the accident until the accident is reported, but less than ten years, a report may be considered as long as:
The circumstances of the accident are quite clear.
The delay does not complicate data collection on issues that matter.
It is possible to assess the causal relationship between the accident and the damage to the health of the injured person.
What do accident compensations pay?
If the accident is eligible for compensation, a determination is made regarding the following categories of benefits:
Out-of-pocket expenses for medical care.
Daily accident allowance for incapacity.
Lump-sum disability or personal injury compensation for permanent bodily injury.
Death benefits in the event of a fatal accident.
Benefits other than those for permanent bodily injury are paid retroactively for 2 years from the date all necessary documents required for a decision were received by the Health Insurance Authority.
Paid costs due to the accident will be reimbursed. Reimbursement must be applied for, and payment is made in accordance with the agreements of Iceland Health.
Medical care
Medicines and packaging
Dental repairs due to damage to healthy or well-repaired teeth. Payments for repairs of poorer teeth are based on the estimated cost if they had been healthy.
Prosthetic limbs, braces, orthopaedic shoes, and similar aids due to the direct consequences of the accident.
Ambulance transport. First after an accident as well as later if necessary. Repeated trips for treatment are not refunded.
Physiotherapy
Travel expenses within Iceland. Necessary travel is paid for in the event of an accident. The cost of accommodation is non-refundable.
If the injured person is unable to work due to an accident for at least 10 days, he/she will be paid accident per diem benefits.
If the employer pays wages during an accident's absence, the accident per diem payments are paid to the employer.
Payments can be made for up to 52 weeks for each accident. It is permissible to pay longer if the medical experiments have not been completed, it is uncertain whether the injury will be permanent, and there is a likelihood of averting or reducing the harm with longer payment of per diem benefits.
Pensioners with Tryggingastofnun may experience a reduction in pension payments due to the payment of per diem benefits.
Payments may not exceed 3/4 of the income from the employment that the beneficiary had at the time of the accident at the time of the accident. Payments are made from the 8th day of absence from work.
A supplement is paid if the injured person has dependent children or pays child support.
Applies to accidents that occurred in 2022 and later.
If the injured person suffered permanent bodily injury because of the accident, he/she can request an assessment of permanent injury.
The assessment is done when stability is achieved, and no further improvement is expected.
Damages are calculated according to the rules of the Tort Act and are paid as a lump sum.
No damages are paid unless the assessment is 10% or higher.
Applies to accidents that occurred before 2022.
If the injured person suffered permanent damage because of the accident, he/she can request an assessment of permanent medical disability.
The assessment is carried out when stability is achieved, and no further improvement is expected.
The disability benefits are paid in a lump sum, and it is equivalent to a percentage of the monthly disability pension for a certain number of years.
The ratio is based on the percentage level of the disability assessment and the number of years depending on the nature of the accident.
Less than 10% disability
No compensation is paid for permanent medical disability unless the assessment is 10% or higher for one or more compensable accidents from the Social Security Accident Insurance.
Death benefits are paid if an accident causes death within 2 years from the date of the accident.
If the deceased had a spouse, the spouse receives a lump sum, otherwise the payment is divided equally between the deceased's children if they are alive, but otherwise to the deceased's estate.
If the deceased had a dependent child who is 16 years of age or older and is at least 33% disabled, the child will receive death benefits. The amount is based on how much the child was supported by the deceased.
It is possible to apply for a child pension from Tryggingastofnun due to the death of a parent.
Inquiries and data are accepted at Iceland Health service and call center and through Data submission of individuals.
Service provider
Iceland Health