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I work in Switzerland, so I'm legally required to have accident insurance. I had a bicycle accident about three months ago and sustained a few injuries, including an ongoing rotator cuff problem for which an orthopedic surgeon prescribed physical therapy.

Recently I got a letter from my accident insurance company saying they'd sent my MRIs to some other doctor, a doctor whom I've never seen, and this doctor ruled that I couldn't possibly have any ongoing effects from the accident. Therefore, said the accident insurance, as of date XYZ they would no longer pay for medical care.

I have two questions about this:

  1. Is this actually legal in Switzerland, to let such a decision be made by a doctor who's never seen the patient?
  2. The insurance company talked as if the outside doctor's diagnosis was not merely legal, but in fact legally required. Is it?

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