Inability to work: right to sickness benefit

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If you are unable to work, you are entitled to sickness benefit

Unfortunately, not every illness is over after a few days of rest. Symptoms such as back pain or depression often last for weeks. Employees who have been ill for more than six weeks are entitled to sickness benefit. The amount depends on the income before the incapacity to work begins.

Claims after six weeks Illnesses such as depression or painful back pain are usually not over after a few days, but usually last for weeks or even months. Employees must continue to be paid by the employer for six weeks after a sick leave. After this period, the health insurance company must step in, with 70 percent of the gross salary. Manuela-Andrea Pohl from the Association of Replacement Funds (vdek) in Berlin said: "Insured persons are entitled to sickness benefit if their illness makes them unable to work."

The doctor makes the decision The doctor makes the decision about when a person is unable to work. Dirk Lullies from the Association of Private Health Insurance (PKV) in Berlin said that being unable to work means that someone can do less than 50 percent of their current job. In addition, the cause must actually be an illness and not an accident, because then the accident insurance is responsible. According to Pohl, treatment in a hospital or in a preventive or rehabilitation facility could be another reason for sick pay.

Unemployed people are also entitled to sickness benefit As Ann Marini from the GKV umbrella organization in Berlin explained, the amount of sickness benefit depends on income before the onset of incapacity to work. According to this, it is 70 percent of the gross salary for employees, but a maximum of 90 percent of the previous net income. Those receiving unemployment benefit I received sickness benefit equal to the most recently received benefits and voluntarily insured self-employed persons could choose whether they would like to receive sickness benefit when taking out their insurance. However, this increases their contributions. In total, an insured person can receive sick pay of up to 78 weeks within three years. "This applies to each illness individually," says Pohl. It is calculated from the first day of the beginning of the incapacity to work.

Privately insured receive up to 100 percent According to similar guidelines, privately insured also receive their sick pay. Lullies said: "It can replace up to 100 percent of net earnings." The insurance company uses the average earnings of the past twelve months before the onset of illness. In addition, the entitlement does not necessarily end after 78 weeks, but may possibly continue to be paid until the actual end of the illness. Self-employed people could choose a tariff in which sickness benefit is paid not after the seventh week but after a few days. However, this would be more expensive and the insured would also have to tell their provider if their net income changes.

Pay attention to complete sick leave. Basically, you only have a claim if you follow certain rules. According to Pohl, it is often the little things that insured people ignore when it comes to sickness benefits. "Our tip: Always make sure that the sick leave is complete," she said. For example, the person who is on sick leave from Monday to Friday and has to extend it should do so on the last day of the sick leave, i.e. on Friday. This is because if the sick leave is renewed from Monday, the health insurers did not pay any money for the past weekend.

Important for the pension insurance certificates This not only reduces the sickness benefit itself, but "This is also noticeable afterwards with the pension insurance certificates", as Pohl explained. Sickness benefits would also pay pension and unemployment insurance contributions. In addition, it is important: "The employee should quickly send the copy of his sick leave that he receives from the doctor for his insurance." The earlier the insured person sends the document, the quicker the case can be processed.

Some without an automatic entitlement On the one hand, self-employed persons who have not opted for a corresponding tariff and also those who only work in a company for a few days or weeks have no automatic entitlement to sickness benefit. Pohl said that this included, for example, seasonal workers who signed contracts of less than ten weeks. However, you could also insure the possibility of sick pay for an additional charge, depending on the tariff, even before the seventh week.

Organ donors receive more money According to Pohl, nothing has actually changed in the legal basis for sick pay in recent years. However, since August 2012, people who donate an organ during their lifetime have been entitled to the recipient's health insurance paying them sickness benefit for the period after the donation. "Organ donors get even more money," said Pohl. In contrast to the usual 70 percent, donors received up to 100 percent of their salary in the event of a donation.

Health insurance funds often refuse help The statutory health insurance companies in Germany increasingly refuse to help their approximately 70 million members. Hundreds of thousands of health insurers received negative feedback from their insurance company in 2012 on benefits such as rehabilitation measures, aids or sick pay, the news agency “dpa” reported a few months ago, citing figures from the Medical Service of Health Insurance (MDK). In 16 percent of all health insurance reviews initiated by health insurers, experts came to the conclusion that the employees were healthy and could work again. (ad)

Image: Andrea Damm /

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