Statutory accident insurance in Germany

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The statutory accident insurance ( GUV ) is an insurance branch of the structured social insurance . Its purpose is to prevent accidents at work , occupational diseases and work-related health hazards and to restore the health and professional capacity of the insured "by all appropriate means" after these insured events have occurred. The legal basis is the Seventh Book of the Social Code (SGB VII). Accident insurance was first introduced under Bismarck's social legislation through the Accident Insurance Act of 1884.

tasks

In addition to granting benefits after the occurrence of the insured event, the tasks of the accident insurance institutions also include advising and supervising member companies in the areas of occupational safety, accident prevention and employee health protection (prevention); in this case, the organizations are sometimes working together with the authorities of the state trade supervisory authority.

The assessment of the contributions according to the accident risk of the branches of industry also serves the prevention. For this purpose, the commercial professional associations set a hazard tariff . The agricultural trade associations can also do this; in general they form risk groups.

Insured

Compulsorily insured members

According to § 2 SGB ​​VII, the following groups of people are compulsorily insured in the statutory accident insurance:

  • Employees; this also includes work in a workshop for the disabled and work performed by a prisoner within the meaning of the Prison Act ; Statutory examinations as part of an employment relationship are also included
  • Apprentices, advanced and advanced trainers
  • Farmers, their spouses, family workers and volunteers in agriculture
  • House traders and intermediate masters as well as their spouses
  • Children who attend kindergarten or are looked after by a childminder
  • Pupils in general and vocational schools, including all school measures such as B. Class trips and students at universities
  • Self-employed or voluntary persons in the health care and welfare sector, as long as they are not exempt from insurance, i.e. midwives or legal carers
  • Volunteers in government or church organizations as well as in activities that serve disaster control or civil protection
  • People who are called upon within the framework of a civic duty, such as election workers
  • Witnesses when summoned by a German court
  • Emergency aid in the context of an acute accident as well as persons exercising self-defense and the right to arrest anyone in the context of a criminal offense
  • Donors of blood or organs including preparatory examinations
  • Recipients of unemployment benefit I or II who are summoned by the office as part of the reporting obligation and participants in a measure for activation and professional integration ; also persons who are summoned by the office to participate in working life as part of the services
  • In-patient or semi-in-patient patients and participants in medical rehabilitation as well as participants in a measure to prevent occupational diseases
  • Caregivers

Exemption from insurance

According to § 4 SGB ​​VII, the following are exempt from compulsory membership :

  • Officer
  • People who can already claim financial compensation through the Federal Pension Act, especially conscripts and those doing community service
  • Members of spiritual cooperatives and deaconesses
  • Hunting guests and fishing guests
  • non-commercial inland fishermen, beekeepers and fattening farms
  • Doctors, dentists, veterinarians, psychotherapists, child and adolescent psychotherapists, naturopaths and pharmacists

Voluntary insurance

According to § 6 SGB ​​VII, you can voluntarily take out insurance:

  • Self-employed persons and their assisting spouses
  • honorary members of non-profit organizations, employers' associations, trade unions and political parties

Accident insurance framework

The insurance covers the scope of these activities; in any other context, the person concerned is not legally insured against accidents. According to § 12 SGB ​​VII, the insurance also extends to the Nasciturus insofar as it is damaged by an insured event against the mother.

The Act to Improve the Protection of Civically Committed Persons and Other Persons under Accident Insurance Law extended the protection under accident insurance law for civically committed persons from January 1, 2005.

In the case of accidents in the private environment, especially during housework and family work, the statutory accident insurance does not apply ( see: Article “Housework and family work”, section “Insufficient insurance cover” ).

Insurance cases

Work accident

An accident at work does not automatically mean every accident that occurs at work or on the way to or from the place of the insured activity. Only an accident that is related to the insured activity and that is not part of the general life risk is covered by the statutory accident insurance.

One possible reason for the loss of entitlements in the event of accidents on the way to work is the deviation from the route between home and work and the longer interruption of the route. The legal opinion prevailing in some companies that employees would lose their insurance cover if they exceeded the daily working hours of ten hours is incorrect.

The accident insurance is liable to pay regardless of fault. Restrictions only apply in the case of intent (e.g. willful self-harm by an insured person or the willful disregard of regulations by the employer) or in the case of gross negligence.

Accident insurance coverage can also be jeopardized by the consumption of alcohol and other intoxicants:

  • In the case of moderate alcohol consumption, accident insurance cover does not apply if the influence of alcohol is the only legally significant cause of the accident. This means that z. B. a moderately drunk employee who hits his thumb while hammering, suffers an accident at work, as this process could happen without the influence of alcohol. If the employee falls down the steps with the same alcohol influence because he has lost his balance due to alcohol, this does not constitute an occupational accident. In the event of a traffic accident, in the case of absolute driving incapacity (from 1.1 ‰ blood alcohol concentration ) it is generally assumed that the alcohol influence is the only legally significant one Cause of the accident.
  • If an employee is in a state of intoxication, so that he is no longer able to perform a purpose-oriented activity, he is treated like a “non-company” and loses his insurance cover regardless of the specific cause of the accident.

Occupational disease

Even an illness that occurs in connection with work is not automatically an occupational disease. The legislature - and not the accident insurance institutions - publishes a list of certain illnesses sorted according to damage (e.g. chemical substances) that may be considered occupational diseases. Some are linked to a minimum level of harmful effects, such as the effects of asbestos on the insured person, while others are forced to give up their previous professional activity, such as skin diseases. This list is drawn up by an expert advisory board, which also makes recommendations to the federal government as to which diseases should be included in the list. Certain illnesses can then be compensated “like an occupational disease”. So they are not yet explicitly on the list, but meet certain other criteria. Individual decisions about the recognition of work-related illnesses that are not included in the list are possible, but rare.

Services

Statutory accident insurance benefits to insured persons are essentially medical and occupational rehabilitation benefits, as well as wage replacement or compensation benefits in cash ( injury benefit , injury pension , survivor's pension ). Medical treatment is provided in kind; the treating doctor issues an invoice directly to the responsible professional association. The UV-GOÄ 2001 in the version of July 1, 2007 applies, which provides a fixed value for each service item. The resulting fee differs slightly if a special treatment is carried out instead of the general treatment.

If a reduction in earning capacity (MdE) remains in the amount entitled to a pension (from 20%) beyond the 26th week after the insured event, also through a pension and other cash benefits to the insured person. However, if an insured person has already had an accident at work with an MdE i. H. v. 10%. - Regardless of the provider of statutory accident insurance - and there is a new insured event, there is a so-called supporting fact. Example: Two different insured events, each with an MdE of 10%. H .: Both pensions according to the MdE 10 v. H. paid. The claims are based. If one disappears through improvement, the other ends too. An exception applies to insurance cases from January 1, 2008 for agricultural entrepreneurs, their spouses and family members. An MdE of at least 30% is a prerequisite for a pension entitlement.

The assessment is carried out by the accident insurance company. He makes use of collected empirical values ​​and can also deviate from the assessment of a medical expert. The MdE is not a “member tax” like in the private insurance industry. With private accident insurance, a contract is concluded for certain benefits in the event of certain physical injuries (e.g. loss of a finger = X% of the sum insured - regardless of age, occupation and the size of the actual loss of function). When determining the MdE, however, the loss of functionality is particularly taken into account. It can happen that two different insured persons with the same injury have differently high reductions in earning capacity.

So far, no income has been offset against the pension benefit. Only the statutory pension insurance provider takes into account a pension from the statutory accident insurance as income for its benefits.

The survivors' benefits are not calculated according to an individual amount like the MdE, but are paid according to fixed percentages. However, income is credited to these benefits with a certain percentage (stipulated by law for different types of income) if it exceeds a certain allowance.

The basis for the performance calculation is the annual earnings (JAV). This is 2/3 of the total earned income for the twelve calendar months prior to the month in which the insured event occurred. There are special regulations for entrepreneurs, such as the fact that their benefits are based on a statutory sum insured.

It is disputed whether the accident insurance also damages granted or blocks a civil damages claim. According to the applicable legal regulation, such a replacement is not provided. The unequal treatment of injured employees compared to other injured parties who receive compensation for pain and suffering , which lies in this, was deemed constitutional by the Federal Constitutional Court in 1995 ( Az. 1 BvR 753/94). Recently, there has been an increasing number of critical voices (cf. nur Fuhlrott, Neue Zeitschrift für Sozialrecht [NZS] 2007, p. 237 ff.) Who want to see this as unconstitutional unequal treatment. More recent reform plans that are being discussed therefore provide for such a claim for compensation for non-material damage.

Cash benefits

As a result of an insured event within the meaning of SGB VII, the following statutory cash benefits can be considered:

Benefits in kind

In addition, insured persons have an extensive right to goods and services, in particular outpatient and inpatient medical treatment , psychotherapy , home nursing , household help , participation benefits , remedies and aids. The claim sometimes goes far beyond what the statutory health insurance offers, because all necessary measures must be exhausted by the carrier in order to restore the injured person's ability to work. There is no budgeting of the funds to be used. The accident insurance institutions have special accident clinics for this purpose , which are specially equipped to care for victims of occupational accidents and diseases. Subsequent rehabilitation measures are carried out in facilities approved for the BGSW procedure. In contrast to outpatient care provided by statutory health insurance providers, the insured person's free choice of doctor is severely restricted in the case of professional association medical treatment. As a rule, only a licensed transit doctor is allowed to give initial treatment .

Furthermore, help with professional reintegration, so-called professional assistance, can be provided.

organization

carrier

The statutory accident insurance carriers in Germany ( accident insurance carriers , abbreviated UVT ) are listed in Section 114 (1) SGB VII.

These are in detail:

The professional associations, which are under state supervision, and the public accident insurance institutions are corporations under public law and are self-administered. Self-administration is organized on an equal footing: half of the committees are made up by the employer, the other half by the insured party. These bodies decide on the budget, the contributions and the statutes. Parity also applies to pension and appeal committees. By June 2007 they had come together in three separate umbrella associations, the Main Association of Commercial Employers ' Liability Insurance Associations (HVBG), the Federal Association of Accident Insurance Funds (BUK) and the Federal Association of Agricultural Employers' Liability Insurance Associations (BLB). On June 1, 2007, the HVBG and the BUK merged to form the joint umbrella association of the German Social Accident Insurance (DGUV).

Organizational reform in 2008

The law for the modernization of statutory accident insurance - UVMG brought far-reaching reforms for the organization and financing of statutory accident insurance in Germany, which came into force in 2009. In particular, the number of commercial employers' liability insurance associations was reduced through mergers between the organizations. In addition, the burden sharing between the employers' liability insurance associations was reorganized. Further innovations concerned the assessment of entrepreneurs in the risk classes according to the risk tariff as well as the collection of the insolvency payment , which since then is no longer carried out via the professional associations, but via the health insurance companies, together with the total social security contribution .

financing

The statutory accident insurance is financed by contributions ( allocations ) from the member companies in a subsequent allocation procedure (annual contribution).

In the area of ​​commercial accident insurance and for the insured companies (e.g. transport companies) the public accident insurers, the amount of the premium depends on the total wages and the risk class to which the entrepreneur has been assessed. The hazard class is set in each commercial trade association by the representatives' assembly in its hazard tariff ( Section 157 SGB ​​VII). The contributions are made solely by the entrepreneurs (employers) ( Section 150 (1) SGB VII). The amount of the contribution depends u. a. also according to the amount of the wages paid to the employees, the so-called total wages ( § 153 SGB ​​VII).

The agricultural accident insurance is financed from contributions based on the size of the cultivated area and the number of animals kept.

Public accident insurance for kindergarten children, schoolchildren and students is financed as a federal subsidy from tax revenues, as these are non- insurance benefits .

literature

  • Dörner, Ehlers, Pohlmann, Steinmeyer, Schwienhorst (eds.): 12th Münster Social Law Conference. Reforms in the statutory accident insurance . December 8, 2006 in Münster. Insurance industry, Karlsruhe, 2007.
  • Hermann Plagemann, Kerstin Radtke-Schwenzer: Current developments in statutory accident insurance law (following the corresponding article in NJW 2010, 201), NJW 22/2012, 1552.
  • Horst Riesenberg-Mordeja: Statutory accident insurance: structures - benefits - self-administration. Publisher: ver.di Federal Administration, 2nd edition. August 2014, ISBN 978-3-938865-39-2 .
  • Stefan Bresky, Brigitte Vogel-Janotta, Joachim Breuer (eds.): Working safely. 125 years of statutory accident insurance in Germany 1885–2010 . Berlin 2010 ( dguv.de [PDF; 3.6 MB ; accessed on April 26, 2019]).

Web links

Wiktionary: Accident insurance  - explanations of meanings, word origins, synonyms, translations
Wikisource: Accident Insurance  - Sources and Full Texts

Individual evidence

  1. ↑ Draft of a law to improve the protection of citizens and other people under accident insurance law. In: Drucksache 15/3439. German Bundestag, June 29, 2004, accessed June 2, 2015 .
  2. ↑ Written answer from the Saarland government to the major question from the CDU parliamentary group: Volunteering in Saarland. (No longer available online.) CDU parliamentary group in the Saarland state parliament, October 9, 2007, archived from the original on April 7, 2015 ; Retrieved June 2, 2015 . 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. @1@ 2Template: Webachiv / IABot / www.cdu-fraktion-saar.de
  3. ↑ Horst giant mountain Mordega: Statutory accident insurance - structures services self-government , Publisher: ver.di -Bundesverwaltung, 2nd edition. August 2014, p. 52, ISBN 978-3-938865-39-2
  4. ^ UVMG (G. v. 30.10.2008 BGBl. I p. 2130, 2010 I p. 252) - legal text, synopsis, reasons . - See also the overview of the legislative process in the DIP of the German Bundestag.