What the statutory accident insurance coverage does | EUROtoday

The statutory accident insurance coverage is usually forgotten – in some circumstances it even affords extra complete advantages than the medical insurance firm. Why she is so essential and what’s essential.

Legal accident insurance coverage, like unemployment insurance coverage, is likely one of the necessary social safety in Germany. In distinction to care or pension insurance coverage, the employer takes over the contributions solely.

“I suspect that many do not know exactly that they are inevitably insured through the employer,” says Matthias Beenken, professor of insurance coverage business on the Dortmund University of Applied Sciences. All workers are routinely insured.

The statutory medical insurance first arises for all remedy prices, regardless of how they arose, says Elke Weidenbach from the Consumer Center North Rhine -Westphalia. The statutory accident insurance coverage solely grabs whether it is an accident, an accident at work or an occupational illness.

800,000 accidents of labor 2023

According to the Social Association VDK, there have been 800,000 accidents of labor in 2023 alone, 168,000 reported path accidents and 150,000 ads on suspicion of an occupational illness.

“Basically, it is the job of the employer to ensure that health risks are avoided in the course of the professional activity or in the environment of the professional work,” says Jochen Pimpertz, economist on the Institute of German Economy (IW).

If you look into the statistics of the statutory accident insurance coverage, you discover that the statutory accident insurance coverage is a “success story” as a result of skilled illnesses as much as deaths and the retirement dangers have decreased drastically and constantly over the a long time.

To the “round doctor” as an alternative of to the household physician

Books from the University of Dortmund, nevertheless, point out an essential element with the statutory accident insurance coverage: “In fact, it only covers accidents that really happened during work or on a direct path to work or from work. And the direct path can be interrupted by just getting my bread rolls on the way to work – this is privately again.”

In the occasion of an work or path accident, it isn’t the household physician, however a so -called thoroughfare – a specialist in work accidents and occupational illnesses. In addition, the employer must be knowledgeable as quickly as attainable. Detailed data reminiscent of time, witnesses or the precise expiry of the incident can later be essential for insurance coverage advantages.

At first look, this feels like numerous effort, particularly if it’s only a small scratch after a bicycle accident. In such circumstances, some might favor to go on to the household physician with out reporting the incident.

More usually physio and extra money within the occasion of an extended sickness

But the entire thing has a severe and essential background. Not all accidents are instantly recognizable or noticeable. Should a severe damage conceal behind an apparently innocent scratch that leads to lengthy -term well being restrictions and even incapacity, this can lead to each well being and monetary penalties.

The statutory accident insurance coverage takes over the advantages of such an damage. Anyone who fails for a number of weeks due to an accident at work or on the best way will obtain the so -called accidents after six weeks. With 80 p.c of the gross wage, that is additionally above the illness advantage of the medical insurance firm, which is barely 70 p.c.

In addition, there are additionally some benefits in comparison with statutory medical insurance, explains Michael Popp from the VdK Social Association: For instance, extra physiotherapy appointments should you break your hand. The skilled affiliation has an curiosity in working once more, stated Popp. Then “you get almost an infinite number of physiological treatments in a medically necessary framework”.

Claim to Injured pension

Anyone who can now not work as a consequence of an accident can be entitled to a so -called injured pension from accident insurance coverage, which could be as much as two thirds of the annual wage. There are additionally partial pensions for restricted means to work. Such injured pensions may even be paid past retirement age, however in some circumstances they’re counted in direction of the retirement pension. Nevertheless, if you don’t report an accident at work, chances are you’ll not have monetary help that will be entitled to.

Since the injured pension is paid for so long as there’s a discount in incomes capability, any change within the state of well being have to be reported. If you are feeling higher, the pension could be shortened or adjusted. Conversely, nevertheless, the next additionally applies: “The pension can not only be withdrawn, it can also increase if the clinical picture deteriorates,” says Popp. A typical instance is the knee osteoarthritis in roofers, which regularly worsen over time.

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Episode 1: Social Insurance – Basics and Borders (April 9)
Episode 2: statutory vs. personal medical insurance (April 9)
Episode 3: Liability, KfZ & Pets – What is necessary, what is smart? (April 16)
Episode 4: The occupational incapacity insurance coverage and its alternate options (April 23)
Episode 5: Protect the household appropriately (April 30)
Episode 6: Living & Weather Risks – Protection in your own residence (May seventh)
Episode 7: Secure well being prices – from dental extra dental to sick go away (May 14th)
Episode 8: Strict effectively -secured and journey (May 21) (May 21)
Bonus sequence: behind the scenes – how insurance coverage ticks (open)

Occupational illness With skilled soccer gamers

In the case of occupational illnesses, there are additionally advantages from the accident {and professional} funds. These are listed within the listing of occupational illnesses, which, in accordance with Popp, continues to be strongly geared in direction of the 70s and 80s. It could be very troublesome that an occupational illness is acknowledged in any respect and is due to this fact uncommon.

Popp provides an instance: This 12 months, gonarthrosis, the damage on the knee joint, was recorded amongst skilled soccer gamers. He selects the instance of “because you can already see how hard work is defined. Then you have to have played as a professional football player for at least 13 years and at least ten years in one of the three top football leagues in men or one of the two top football leagues in women.”

In this case, that is all about bodily complaints, however the matter of psychological diseases is now changing into more and more essential. The psyche is now the most typical reason for a incapacity. In 2000 the proportion was virtually 1 / 4, in 2020 41.5 p.c.

Mental diseases are usually not but in focus

Just two years in the past, the Federal Social Court acknowledged a psychological sickness for a paramedic with publish -traumatic stress dysfunction for the primary time. This was celebrated as a small success, though the stress dysfunction continues to be not typically acknowledged as an occupational illness. Instead, every particular person case have to be checked.

Michael Popp from the VDK sees this as an issue. But a minimum of there’s some motion. There is at present a preliminary examination as as to if publish -traumatic stress issues will even be acknowledged as an occupational illness sooner or later. “Think of paramedics or train leaders who are often faced with suicide,” says Popp.