Judgment sick pay also with indefinite sick leave

Health insurance companies have to pay sickness benefits even if they have been indefinitely sick
If a worker has been on sick leave for more than six weeks, the health insurance company pays the so-called sickness benefit as compensation, which amounts to between 70 and 90 percent of the previous, regular, contributory (gross) remuneration. The employer then no longer has to pay for the duration of the sick leave. But the health insurance has to pay even for a permanent sick leave?

LSG recognizes incapacity for work "until further notice"
A health insurance company must also pay sickness benefits beyond a re-appointment date if the attending physician has certified the incapacity for work "until further notice". This was decided by the Landessozialgericht (LSG) of Rhineland-Palatinate in its judgment of 16 April 2015 (file reference: L 5 KR 254/14), which is reported by the Arbeitsgemeinschaft Sozialrecht of the Deutscher Anwaltverein (DAV). An end to the sick leave does not have to come from the certificate of incapacity for work.

Verdict: sickness benefit even with permanent sick leave. (Image: M. Schuppich - fotolia)

In the specific case a woman suffered from shoulder and spinal complaints. The last certificate of incapacity for work did not contain an end date, but the words "until further notice". In addition, the attending physician gave a re-presentation date. However, the medical service of the health insurance funds (MDK) came to the conclusion that the incapacity for work was only used up to an earlier date. The health insurance company then stopped paying sickness benefits. The woman was again able to work and had to make herself available to the labor market, it said in the explanatory statement. Although the woman then submitted two more sick leave "until further notice", the health insurance company refused to pay sickness benefit. Then the woman complained and got right.

The LSG recognized the finding of incapacity for work "until further notice". The specified rescheduling date does not mean that the sick leave is only valid until then, the court said. The health insurance company was obliged to pay sickness benefit for two more months. (Ag)