Certificate of disability
The certificate of disability (AU-certificate; sick leave), in Switzerland medical certificate called, is the confirmation of a physician or dentist over a determined limitation of the named person that the person on the provision of the performance hindrance. According to German labor law , the certificate of the hindrance to work ( incapacity for work ) must be available to the employer no later than the working day following the third calendar day of incapacity for work, but the employer can also request it earlier ( Section 5 EFZG ). For the insurer, the certificate of incapacity for work is the claim that triggers the benefit.
Colloquially, the certificate of incapacity for work is sometimes referred to as a health insurance certificate.
Labor Law (Germany)
The medical certificate of incapacity for work is recognized by the jurisprudence as having a high evidential value in the context of judicial assessment of evidence. From this a presumption is derived that the employee was actually unable to work as a result of illness. Only if the employer succeeds in shaking this evidential value in the legal dispute does the employee have to offer further evidence, for example by questioning his treating doctor.
If the employer doubts the correctness of the medical certificate of incapacity for work, he can request an expert review by the medical service of the health insurance company in accordance with Section 275 (1a) sentence 3 SGB V.
Changes due to the Appointment Service and Supply Act
The Appointments Service and Supply Act (TSVG) passed on March 14, 2019, introduces a uniform and binding electronic procedure for the transmission of incapacity data by the doctors to the health insurance funds in accordance with Section 295 new paragraph 1 sentence 1 SGB V on January 1, 2021 replaces the previous paper-based certificates of incapacity to be presented to the health insurance company. In this context, it is made clear by law that the obligation to transmit this data to the health insurance is incumbent on the doctors and institutions who determine the incapacity for work. Citizens are to be relieved of at least 43 million euros due to the planned electronic transmission of AU certificates.
form
A four-part, self-copying form (DIN A5 high) is issued for members of the statutory health insurance .
For members of private health insurances, a certificate in simple - free text - is also possible.
Information content
The conventional form is sample 1 from the form agreement concluded between the National Association of Statutory Health Insurance Physicians and the National Association of Health Insurance Funds. This consists of 4 pages:
- Page (yellow) - for the health insurance company (the original)
- Page (yellow - hence the colloquial term: "yellow note") - carbon copy for the employer (he only receives the upper half - DIN A6 landscape - without the disease description)
- Page (yellow) - copy for the insured
- Page (white) - carbon copy for the issuing doctor or dentist (for the medical record ).
Information contained on all four pages:
- Health insurance or insurance provider
- Name, address, date of birth and insured person number of the sick person
- Cost unit identification
- Doctor number and name of the attending doctor
- Dates of the issue of the certificate, the determination as well as the start and the expected end of the incapacity for work
- Initial or follow-up certificate
- is work the cause (yes / no)
- Consultant assigned (yes / no)
On the first, third and fourth page are also noted:
- up to six illnesses or symptom complexes that can justify incapacity for work ( encoded according to ICD-10 ), but not in the case of certificates from the dentist
- Status of the insured
- Permanent establishment number
- Accident as a cause (yes / no)
- Supply problems (yes / no)
- Rehabilitation services required (yes / no)
- gradual reintegration (yes / no)
- other special measures
- Sick pay case (yes / no), if necessary final certificate (yes / no)
On the second page (for the employer) the description of the illness or its symptoms is missing for reasons of health data protection and medical confidentiality .
The health insurance company needs the medical data in order to check the duration of the entitlement to continued payment and, if necessary, to determine the entitlement to sick pay .
Blank form
If the doctor has the appropriate authorization, he can print the AU certificate himself on a blank form with a laser printer (blank form printing process) using certified practice software in accordance with §§ 34 Paragraph 1 Clause 3, 42 BMV-Ä . To do this, he must use a specially developed security paper to prevent falsification of AU certificates, or at least make it more difficult. This security paper is pale pink in color and has a watermark. In order to facilitate machine processing by the health insurances, some of the data listed above are printed on the first page using PDF417 code. Only data that is human-readable on the certificate is coded.
Distribution of the pages to different addressees
The first three pages are usually given to the sick person, who takes care of the further distribution (page 1 to the health insurance company, page 2 to the employer). The fourth page remains with the issuing doctor.
The 16th Senate of the State Social Court of North Rhine-Westphalia decided on August 26, 2004 (Az .: L 16 KR 324/03) that the doctor has to inform the health insurance company about the inability to work. This reporting obligation of the doctor could not be transferred to employees (not even by handing over the first page of the form). From 2021, this will be regulated by the aforementioned Appointment Service and Supply Act. Until then, however, the Federal Social Court regards the notification of incapacity to work with the health insurance company as an obligation of the insured person.
The employee can also submit the report retrospectively within one week of the incapacity for work. It is not tied to any form and does not require the submission of the certificate (using the first page), so that the insured person can also report the incapacity for work verbally or by telephone.
Civil service law
A civil servant must in any case notify the superior of his incapacity to work, usually immediately. Some federal states regulate the obligation to submit a certificate of incapacity for work by law, statutory ordinance or administrative regulation analogous to the law applicable to employees. In individual cases, however, the submission requirement for civil servants is also regulated differently (for example for teachers in Baden-Württemberg). In addition, a civil servant must submit a certificate of incapacity for work at least “on request” (which may, however, also result from administrative practice).
The legal consequences of an unexcused absence from work are a loss of earnings and disciplinary action.
Web links
- Guideline of the Federal Joint Committee on the assessment of incapacity for work and the measures for gradual reintegration according to Section 92, Paragraph 1, Clause 2, Number 7 of Book V of the Social Code (Incapacity Directive) , October 20, 2016 (PDF file; 81 kB)
- Text of the Continued Payment Act (Germany)
- Info in German Ärzteblatt on the notification and proof obligations
- Information on possible legal consequences for the doctor who issues a false AU certificate (legal situation in Germany)
- Association of Statutory Health Insurance Physicians in Bavaria : Certificate of Incapacity for Work (PDF file), Information Management, March 19, 2018
Individual evidence
- ↑ bill TSVG , BMG. Retrieved March 14, 2019.
- ↑ Agreement on forms for statutory medical care - form agreement; Appendix 2 to the Federal Collective Bargaining Agreement - Doctors (BMV-Ä)
- ↑ Annex 2a BMV-Ä - Agreement on the use of the blank form printing process for the production and printing of forms for medical care
- ↑ IT in medical practices - Technical Manual Blankoformularbedruckung, KBV_ITA_VGEX_Technisches_Handbuch_BFB , Department digitization and IT, National Association of Statutory Health Insurance Physicians , Version 4.31, May 3, 2018. Retrieved on September 26, 2018
- ↑ Full text of the judgment in the decision database of the Justiz NRW
- ↑ Federal Social Court, judgment of November 8, 2005 - B 1 KR 30/04 R, paragraph 17; Judgment of 12 March 2013, B 1 KR 7/12 R, paragraph 16
- ^ Brandenburg: LBG § 61 ; Mecklenburg-Western Pomerania: LBG MV § 55 ; Rhineland-Palatinate: LBG § 81 ; Saxony: SächsBG § 71
- ↑ Bavaria: UrlV § 21 ( Memento of the original from February 1, 2016 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. ; Thuringia: ThürUrlV § 22
- ^ Lower Saxony: VV on § 81 NBG ; North Rhine-Westphalia: VV to § 62 LBG NRW
-
↑ Administrative regulation part-time, vacation, incapacity to work and inability to work, responsibilities in the Kultusverwaltung dated June 10, 2014. Part C, II., No. 2: “The headmistress is required to provide a medical certificate stating the incapacity to work or the incapacity for work and its expected duration or to be submitted to the school principal
2.1 by civil servants if the incapacity for work lasts longer than a week,
2.2 by collective bargaining employees if the incapacity for work lasts longer than three calendar days ... " - ↑ Section 96 (1) sentence 2 BBG and corresponding state law
- ↑ cf. Michael A. Else: Submission of a certificate of incapacity for work on the 1st day for civil servants? ( Memento of the original from February 27, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (November 15, 2012)
- ↑ § 9 BBesG and corresponding state law
