Two possible assessments
Incapacity can stop someone using the tools of their trade without ruling out every form of work. Depending on the policy and legal regime, the insurer may first consider usual tasks and then assess earning capacity in suitable alternative work when a return to the usual occupation is no longer possible. Groupe Mutuel group terms illustrate the distinction. They do not necessarily describe your individual policy. Ask which definition applies, when and on what medical and occupational evidence.
Workshop and desk work
A self-employed cabinetmaker cannot operate machinery, but design work might be compatible with some restrictions. That does not mean technical drawing can immediately bring in the same earnings. The cabinetmaker explains the actual work, tasks, hours and earnings and asks how the insurer considers suitable alternative work. A certificate giving a percentage of incapacity in the workshop does not, by itself, determine what is due if the policy changes the basis of assessment.
Separate ability, earnings and duration
Ask which adjustments are considered reasonable, whether there is a transition period and how potential or actual earnings are assessed. Clarify the treatment of phased return and benefits from another scheme. Check the minimum incapacity threshold, waiting period, remaining benefit days and exclusions. Do not assume this insurer's assessment and any separate disability insurance assessment are identical.
Keep records that reflect what happened
Record the dates of tasks you cannot perform, can do with adjustments and have actually resumed. Report changes as the policy requires. Obtain a written calculation before including a payment in your budget. Workshop costs can continue even if potential earnings are assessed differently. Separate business and household costs and do not commit to retraining expenditure assuming insurance will finance it.
Ask which assumption changes payment
Present one scenario with part-time adapted tasks and another without any billable work. Ask the insurer to distinguish earnings actually received from earnings it considers achievable, and explain how it treats a transition or job-search period. For a self-employed worker, a new role does not mean expenses from the former activity stop. Put continuing bills and confirmed receipts on separate lines and test how long you can fund a gap before relying on either estimate.
Sources & further reading
OFSP / FOPH — Assurance facultative d’indemnités journalières