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Statutory occupational accident insurance

Statutory occupational accident insurance services

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Statutory occupational accident insurance is an arm of the social insurance system. As a mandatory insurance scheme, it provides compensation for accidents and illnesses suffered by insured employees in the course of their paid (insured) work activities. The legal basis is provided by Book VII of the Social Code (SGB VII).

The aim of statutory occupational accident insurance

Statutory accident insurance is designed to use all available resources to:

  1. Prevent occupational accidents (occupational accidents and work-related illnesses) and health hazards in the workplace.
  2. Restore an (insured) employee's health and performance following an occupational accident or work-related illness.
  3. Compensate the insured employee or their surviving dependants monetarily.
Who is insured?

Statutory occupational accident insurance covers employees and apprentices (trainees). It also covers the following groups of individuals:

  • People who work in the public interest, e.g. aid workers, emergency rescue teams, blood donors, court witnesses, magistrates.
  • Children cared for in childcare centres or by suitable childminders, school children and students in schools, colleges and universities, and people in vocational education and further training.
  • People who are self-employed and work on a family farm or who work as paid employees in agriculture.
  • People who provide long-term care.
  • Unemployed persons who visit the employment agency either at the agency's instruction or the request of another agency.
  • Certain voluntary workers (e.g. disaster relief workers).
  • People undergoing rehabilitation treatment (e.g. during a stay in hospital).

Business owners may become insured voluntarily if (as in some sectors) they are not already required to pay mandatory insurance contributions by law or company articles of association.

Insurance coverage is provided irrespective of age, religion, nationality and income.

Statutory occupational accident insurance coverage

The occurrence of an (insured) occupational accident or illness is the prerequisite for the provision of services and compensation under the statutory occupational accident insurance scheme. These include accidents in the workplace and work-related illnesses. Accidents in the workplace take in not only those which actually occur while working, but also those that happen on the way to and from work. Work-related illnesses are those which the insured employee contracts because of the work they perform and are either listed in the Work-Related Illnesses Ordinance (Berufskrankheitenverordnung) or which available medical knowledge shows are caused by the work performed.

In addition, there must be a causal relationship between the work performed by the insured person and the accident, and also between the accident and the injury or illness. This means that insurance cover is only provided when the illness or injury can be apportioned to a work-related (insured) activity.

Statutory occupational accident insurance services

Services include homeopathic treatments, medical rehabilitation, occupational integration assistance (e.g. retraining), monetary benefits (e.g. income replacement and pension payments) and - if an insured person dies - surviving dependants' benefits (widows/widowers and orphans pensions).

Statutory occupational accident insurance providers

Statutory occupational accident insurance is provided by private-sector employers' liability insurance and agricultural accident insurance funds (Berufsgenossenschaften), and by public-sector accident insurance associations (e.g. accident insurance funds, Land (state) accident insurance funds, municipal accident insurance funds).

Funding

In the commercial sector, funding comes from contributions paid by employers, meaning that insurance coverage for employees is free. The amount of the employer's contributions depends on the sum total of employees' annual pay and the employer's respective hazard level. In the agricultural sector, separate contribution rates apply which are largely based on the land area farmed and the yield achieved. Public-sector occupational accident insurance providers generally fund their outgoings from their budgets (tax revenue).

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Note: Insurance coverage is always dependent on the actual circumstances of a given case; the decision-making authority in all cases is the competent accident insurance provider.

Status: 07/20/2011

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