Incident note

Fill in the following fields with your data in order to complete the incident note.

Employer & policy

Employer

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Policy details

Please fill in at least 1 of these fields.

   
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Contact person

   
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Insured person

Contact details

   
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Employment details

   
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Salary details

   
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Additional information

Other social insurance benefits

Is the insured person receiving a pension or daily allowance?

   
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Accident report

Details of accident

   
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Until when did the insuree work in the company before the accident occured?

   
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Circumstances of accident

Characters remaining:

   
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Incapacity to work

Incapacity to work



   
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Resumption of work


   
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Injury

Main injury

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Treatment

First treating physician


   
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Subsequent treating physician


   
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Send and Print

          
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Under "Open PDF document" and "Download PDF", the claim number will only be visible after transmission of the data to the insurance provider.

Submit attachment

Submit attachment

Documents can only be sent after successful submission of the incident report.

Help for use

Do you have any questions about the software?

Sunet help desk 041 455 43 12
Mon-Fri: 8:00 - 12:00 and 13:00 - 17:00


Do you have any questions about Visana’s processing of claims? Forgotten policy no.?

Accident section:
Visana AIA/UVG Benefits Centre 031 357 87 87
(Mon-Fri 08:00 to 17:00)

Daily allowance section:
Visana Daily Allowance Centre 031 357 88 00
(Mon-Fri 08:00 to 17:00)

Version: 26200