Here a flu, there a gastrointestinal infection - people are not immune to illness. In order to protect yourself and others, you should then stay away from the job. But what if it is a serious illness and a quick recovery is not to be expected? The employer continues to pay the salary for six weeks, if the inability to work lasts longer, insured persons with the same diagnosis are entitled to sick pay from the statutory health insurance company.
You can get sick pay for up to 72 weeks. That costs money: in 2021, health insurance companies had to pay a total of 16.6 billion euros in sick pay. For this reason, some insurance companies are – to put it mildly – motivated to determine as early as possible how likely it is that the insured person will ever be able to work again. As soon as it is clear that there is a permanent inability to work, the German pension insurance is responsible. Instead of sickness benefit, there is then a reduced earning capacity pension – this is lower than sickness benefit.
How do you defend yourself in such cases? Five tips from Stiftung Warentest to help enforce your own rights with health insurance companies.
Only those who can prove their inability to work with sick notes from a doctor are entitled to sickness benefit. The certificates must be issued consistently; if there are time gaps, the entitlement to sick pay is no longer valid.
Anyone who is unable to work for a longer period of time can expect to receive a call from their health insurance company at some point. If this is the case, you do not have to answer questions about your health. You are not obliged to provide information over the phone. Finanztest recommends: Instead, insist on a written notification from your health insurance company.
On behalf of the insurance companies, the medical service not only checks the status of the illness, i.e. whether, for example, the ability to work is significantly at risk, but can also lift the incapacity for work. If you do not agree, you can take action against the report. According to the financial test, if the incapacity to work is to be lifted, this can be contested with a statement from the treating doctor.
If your ability to work is extremely jeopardized according to a medical report, the health insurance company may ask you to apply for rehabilitation. This is enshrined in the Social Security Code. If you have received a written request, be sure to meet the deadline, otherwise there is a risk of losing your entitlement to sickness benefit.
Privately insured people do not receive sick pay. Finanztest therefore advises agreeing on a daily sickness allowance in the policy. If you are unable to work for a long time, the health insurers can commission an expert report after just a few months. If you are then classified as unable to work, the insurer's obligation to pay ends. If you want to take action against this classification, you have to prove the opposite.
You can find more tips for long-term patients at test.de