Injury benefit from statutory accident insurance; payment
If you are unable to work because of an accident at work or an occupational disease, you will receive injury benefit.
In the event of an insured event under the statutory accident insurance scheme, i.e. an accident at work or an occupational disease, you will receive injury benefit if you are unable to work. Injury benefit compensates for your loss of income and ensures your livelihood and that of your dependents. It is calculated individually on the basis of your regular income.
You do not have to file an application. Your employers' liability insurance association or accident insurance fund will examine possible claims ex officio.
The amount of the injury benefit varies depending on your situation:
- As a rule, the injury benefit amounts to 80 percent of your regular pay and income from work. However, it may not be higher than your regular net pay.
- If you continue to earn money while receiving injury benefit, your income will be counted towards the injury benefit. This means that your injury benefit will be reduced in this case.
- If you are not employed but had earned income before your disability began, there is a different procedure: In this case, the 360th part of the earned income in the calendar year before the onset of the incapacity for work serves as the basis for calculating the injury benefit.
- Your contributions to pension and unemployment insurance are deducted from the injury benefit. As long as you receive injury benefit, your employers' liability insurance association or accident insurance fund will pay the other social insurance contributions. If you are a member of a professional pension scheme, your employers' liability insurance association or accident insurance fund will pay your share of the social security contributions on application. This is the case, for example, with doctors and notaries.
If you are entitled to a contribution from your employer towards private health and long-term care insurance contributions, this will be covered.
Injury benefit is paid if you are unable to work due to an insured event. Occupational accidents and commuting accidents as well as occupational diseases are deemed to be insured events.
You do not have to apply for the injury benefit. Benefits from statutory accident insurance are generally determined ex officio. Your employers' liability insurance association or accident insurance fund will itself determine who is entitled to benefits and the necessary documents for the amount of benefits.
If you are entitled to benefits, you will receive a corresponding decision.
Injury benefit is payable from the day on which the incapacity for work is medically established.
Due to the priority of continued payment of wages or salaries, payment of the injury benefit does not usually begin until the 7th week of incapacity for work.
Payments end with the last day of incapacity for work, or with the start of payment of transitional benefits.
If you are unable to return to your previous job and benefits for participation in working life are not eligible, the injury benefit will end at the end of the 78th week at the latest, but not before the end of inpatient treatment.
The employers' liability insurance association or accident insurance fund begins to investigate and process the case as soon as it is foreseeable that injury benefit will have to be paid. This means that, as a rule, there are no gaps between earned income, continued remuneration and injury benefit.
Detailed information on how to lodge an appeal can be found in the decision issued by the accident insurance institution.
Links to more information
Responsible for editing: Bundesministerium für Arbeit und Soziales
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