Under what circumstances am I entitled to benefits?
State accident insurance pays benefits only to the people it insures. It covers accidents at work, accidents on the way directly to and from work and the consequences of occupational diseases, i.e. diseases contracted thanks to the exercise of one's trade or profession.
In particular, the following people have compulsory cover from the state accident insurance scheme:
- Manual and office workers
- Certain self-employed people
- Children in day-care centres, kindergartens and similar establishments
- Pupils attending non-vocational or vocational schools
- Students undergoing education or further education at tertiary level,
- Beneficiaries of rehabilitation payments (participants in rehabilitation measures)
- Certain volunteers and
- Domestic care personnel
The employer pays the accident insurance contributions for manual and office workers and trainees. Benefits including for children in nurseries, pupils and students are tax-financed.
The self-employed can voluntarily take out insurance against the consequences of accidents at work through professional associations who provide insurance (Berufsgenossenschaft). They must pay the contributions themselves.
Accident insurance covers the costs resulting from accidents at work and occupational diseases.
Accidents at work are accidents which occur during the performance of an insured activity (normally the work specified in the employment contract) and accidents on the way to and from this insured activity (commuting accident). Detours on the way to and from work can be insured under certain conditions; business trips are normally insured.
Occupational diseases are diseases listed in the Occupational Diseases Regulation and contracted by insured parties through the insured activities. The Occupational Diseases Regulation at present lists 80 recognised occupational diseases (combination of list and provision of proof system).
The policy holder receives benefits from the accident insurance only if a causal link exists between the insured activity and the accident/disease, as well as between the accident/disease and the damage to their health. The insured activity against must therefore have led to the accident or disease and the damage to health.
What am I entitled to and where can I apply for the benefits?
Workers and employees have compulsory state accident insurance to cover the consequences of accidents at work. For most liberal professions, this is done through professional associations who provide insurance (Berufsgenossenschaft)
Civil servants (employees at the federal, state and local levels and at other public institutions) are insured by the accident insurance providers for cities, communities, districts, states and the national federation (accident insurance funds, municipal federations for accident insurance and prevention).
As compensation for the damage to your health caused by an event for which you have made a claim, you receive from the accident insurance company:
- Remedial treatment: The medical care covers first aid, medical treatment, medication, treatments and equipment, as well as home nursing care and medical rehabilitation services.
- Reintegration into working life: These are services to retain or obtain a job, find a new profession or trade or a traineeship (work experience), vocational training, initial and further training or retraining.
- Services for integration into community life: The aim of these services is the reintegration into social life. This includes in particular assistance
- in acquiring practical knowledge and skills
- to come to manage one's environment
- with the purchase, maintenance and equipment of accommodation adapted for persons with disabilities
- to lead an independent life in supervised accommodation, and
- to participate in cultural and social life.
If necessary, the insurance also pays for:
- medically prescribed rehabilitation group sports,
- Travel costs to the location of the services,
- social assistance or household help and
- Childcare costs (babysitter, child minder and similar assistance).
Benefits for those in need of care:
If you need care following an insurance claim, the insurance pays for the necessary care services or money for the care (also in addition to the pension).
Throughout the period that you are unable to work, you receive injury benefit: 80% of your gross wages before the start of the period when you are unable to work, but no more than your last net wage. The insurance pays your injury benefit for up to a maximum of 78 weeks after the employer's sick pay ceases. If, on doctor's orders you must stay in a hospital or similar institution for longer than this, you will receive the injury benefit until either you are discharged from the clinic.
While you are involved in one of the activities for "reintegration into the workplace" (retraining, rehabilitation measures, training courses, work experience or a similar programme to restore your ability to work), a transitional allowance is paid. This somewhat lower than the injury benefit.
If your ability to work is curtailed by at least 20% as the result of an accident at work or an occupational disease for more than 26 weeks following the event leading to the claim, you will receive a pension. The amount depends on the extent of the reduction in your fitness for work (Minderung der Erwerbsfähigkeit (MdE)) and on your earnings over the previous twelve calendar months prior to the insurance claim, the full pension (100% MdE) equals 2/3 of the income.
If your spouse or civil partner dies following an accident at work or an occupational disease, you will receive a survivor's pension.
- are at least 47 years old, or
- are unable to work or are disabled, or
- are raising a child entitled to an orphan's pension,
the insurance will pay you an annual pension of 40% of the annual earned income of the deceased.
If you are younger than 47 and not raising any children, you will receive for two years an annual pension of 30% of the annual earned income of the deceased. The pension is continued after the 2 years if:
- your spouse died before 1 January 2002 or
- either of you was born before 2 January 1962 and
- you married before 1 January 2002.
Children under 18 receive an orphan's pension. A semi-orphan is entitled to an annual pension of 20%, and full orphan to 30% of the policy holder's annual earned income. If the child is still studying, the pension will be paid until their 27th birthday.
Income earned by the person entitled to a pension may be deducted from the widow’s or widower’s pension. No income is offset for an orphan’s pension.
In some cases, instead of a pension, the insurance may pay a one-off compensation amount following the death of a family member.
If an accident at work or an occupational disease leads to the death of the insured person, the insurance will pay the funeral expenses (funeral payment). In 2018, this amounted to EUR 5,220 in West Germany ("old" German states), and EUR 4,620 in East Germany ("new" German states).
Benefits for accidents at work and occupational diseases:
The accident insurance provider alone decides whether the conditions exist for an insurance claim, and whether the insured person or surviving dependants are to receive benefits. You do not need to apply for this. The employer must report any accident to the accident insurance provider if the insured person is unable to work for more than three days or if the insured person dies.
After an accident, you visit one of the doctors approved by the accident insurance providers. The doctor, together with your accident insurance provider, decides on further treatment.
The benefits are ex officio determined by the competent accident insurance (professional association, accident insurer).
- You can find the Federal Ministry of Labour and Social Affairs at http://www.bmas.de
Trade unions, among others, offer their members free advice on social rights issues. Charitable associations such as unemployment centres help those in need with the forms and will also accompany you, if required, to the public authorities.
European Commission publications:
If you still have social insurance in one or more countries other than Germany, ask about the effects of this on accident insurance:
German Liaison Office
Statutory Accident Insurance – Abroad
Tel.: +49 30 288763-640
The accident insurance providers publish an overview of state accident insurance and the addresses of the accident insurers at http://www.dguv.de.