Incapacity to work entitled to sickness benefit

In the event of incapacity for work sickness benefit

01/18/2014

Unfortunately, not every illness is over after a few days of rest. Complaints like backache or depression often take weeks. Workers who are ill for more than six weeks are entitled to sickness benefit. Its amount depends on the income before the beginning of the incapacity to work.

Claim after six weeks
Diseases such as depression or painful back problems are usually not over after a few days, but usually last weeks or even months. For employees, after a sick leave the salary must continue to be paid by the employer for six weeks. After this period, the health insurance has to step in, with 70 percent of the gross salary. Manuela-Andrea Pohl from the Verband der Ersatzkassen (vdek) in Berlin explained: „Insured persons are entitled to sickness benefit if their illness makes them unable to work.“

Decision is made by the doctor
The decision on when a person is incapacitated, the doctor meet. Dirk Lullies from the Private Health Insurance Association (PKV) in Berlin said that if someone could do less than 50% of their current job, they would be incapacitated for work. In addition, the cause must actually be a disease and not an accident, because then the accident insurance would be responsible. According to Pohl, treatment in a hospital or in a preventive or rehabilitation facility could be another reason for sickness benefit.

Unemployed people are also entitled to sickness benefit
As Ann Marini of the GKV-Spitzenverband in Berlin explained, the amount of sickness benefit depends on the income before the onset of incapacity for work. Accordingly, it amounts to 70 percent of the gross salary of employees, but no more than 90 percent of the previous net income. Unemployment benefit recipients I received sickness benefits equal to their most recently received benefits, and self-employed persons who were voluntarily insured could choose to take out sickness insurance when concluding their insurance. However, this increases their contributions. Overall, an insured person could receive up to 78 weeks of sick pay within three years. „This applies to each illness individually“, so Pohl. It is calculated from the first day of inability to work.

Private insured persons receive up to 100 percent
Under similar guidelines, privately insured persons receive their sickness benefit. Lullies explained: „It can replace up to 100 percent of net earnings.“ The insurance is based on the average earnings of the past twelve months before the illness began. In addition, the claim also does not necessarily end after 78 weeks, but could possibly continue to be paid until the actual end of the disease. The self-employed could choose a tariff, with which not only from the seventh week, but after few days sickness pay is paid. However, this would be more expensive and also the insured would 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 trivialities that left the insured out of the sick pay. „Our tip: always make sure that the sick leave is complete“, so her advice. For example, the person who has been sick leave from Monday to Friday and should extend it should do so on the last day of the sick leave, ie on Friday. This is because at a renewed sick leave from Monday the cashes paid no money for the past weekend.

Important for the pension insurance certificates
This not only reduces the sickness benefit itself, but „This is also reflected in the pension insurance certificates“, as Pohl explained. In fact, sickness benefits would also pay pension and unemployment insurance contributions. In addition, be important: „The employee should quickly send the breakdown of his sick leave he receives from the doctor for his insurance.“ The cashier could process the case the faster, the sooner the insured sent the receipt.

Some without automatic claim
On the one hand, self-employed persons who have not opted for a corresponding tariff, and even those who only work in a company for a few days or weeks, have no automatic entitlement to sickness benefit. Pohl explained that this included, for example, seasonal workers who sign contracts of less than ten weeks duration. However, they could co-insure the possibility of sickness benefit for a surcharge, depending on the tariff even before the seventh week.

Organ donors receive more money
According to Pohl, the legal basis for sick pay has not changed in the past few years. But since August 2012, people who donate an organ during their lifetime have a claim that the recipient's health insurance pays them sick pay for the time after the donation. „Organ donors even receive more money“, so Pohl. In contrast to the usual 70 percent, organ donors received up to 100 percent of their salary in the event of donations.

Cash registers often deny needed help
However, the statutory health insurance companies in Germany increasingly refuse their approximately 70 million members the help they need. Hundreds of thousands of health insured would have received from their insurance in 2012 a negative decision on benefits such as rehabilitation measures, aids or sick pay, the news agency reported „dpa“ citing figures from the Medical Service of Health Insurance (MDK) a few months ago. For example, in 16 percent of all disability-induced disability reviews, experts came to the conclusion that the workers were healthy and could work again. (Ad)

Picture: Andrea Damm