German Statutory Accident Insurance

The statutory accident insurance (GUV ) belongs to the structured social security, it is a " class of insurance ". Their purpose is to prevent occupational accidents, occupational diseases and work -related health risks and restore the health and performance of the insured by any suitable means after the occurrence of accidents at work or occupational diseases. It is based on the Seventh Book of the Social Code (SGB VII ), another important legal basis for an occupational disease is also the occupational disease regulation ( BKV ). Accident insurance as part of the Bismarckian social legislation ( " Accident Insurance Act " ) was first introduced in 1884.

  • 4.1 support
  • 4.2 Organization Reform 2008

Tasks

The duties of the carrier of the UV part next to the granting of benefits after the occurrence of the insured event, the advice and supervision of the member companies in the field of occupational safety, accident prevention and health protection of workers (prevention); Here are carriers of the UV partially cooperating worked with the authorities of the State Labour Inspectorate. The calculation of contributions after the accident risk of commercial activities ( risk classes) is used for prevention.

Insured

In the statutory accident insurance ( UV) is insured, who

  • Is compulsorily insured, so employees,
  • Child attending a nursery or kindergarten,
  • Students,
  • Student,
  • Trainee,
  • Farmer,
  • Caregiver,
  • Helpers in accidents,
  • Helpers in civil defense or civil protection and
  • Blood donor or organ donor is, or who
  • Entrepreneurs (except eg hairdressers )
  • Self-employed or a freelancer or
  • Assisting spouse is.

Due to the high risk of occupational diseases entrepreneurs are a hairdresser operation compulsorily insured ( § 50 BGW Statute ). In addition, there are also various special groups of insured persons such as certain volunteers. Compulsory insurance here does not mean that the insured are obliged to pay a contribution (which the employer must or provide the relevant competent institution in insured volunteers ), but rather that the accident insurance carrier is obligated to pay the claim.

The insured persons are generally insured not universal, but rather the benefits of the statutory accident insurance are subject to additional requirements:

An accident at work is not automatically any accident that occurs at work or on the way to and from the place of the insured activity. There are a number of individual cases and peculiarities.

Also, a disease that occurs in connection with the work is not automatically an occupational disease. The legislature - and not the accident insurance institutions - are one after damage ( eg chemical substances) out sorted list of certain diseases that come as an occupational disease in question. At some (eg asbestos exposure ) while a minimum is linked to harmful exposure to other one forced to abandon the previously practiced professional activity (eg skin diseases). This list is compiled by a committee of experts to write also makes recommendations to the federal government, which disorders should be included in the list. Certain medical conditions can then be compensated as an occupational disease. They are therefore not explicitly on the list, but meet certain other criteria. Individual decisions on the recognition of occupational diseases, which is not mentioned in the list are possible.

Services

Benefits of the statutory accident insurance to the insured are essentially medical and professional promotional services for rehabilitation, and wage replacement or compensation in money ( injury benefit, injury pension, survivor's pension). The medical treatment shall be granted in kind; the attending physician issues an invoice directly to the relevant professional association. It is the UV GOÄ 2001, as amended from 1 July 2007, which provides for a fixed value for each service item. Minimally, the resulting fee is different if, instead of General Medical treatment a special medical treatment is performed.

In whereabouts of a loss of earning capacity ( and over) in pensionable Direction height ( from 20 % ) over the 26 weeks after the insured event beyond by a pension and other benefits to the insured. An insured person has, however, already an accident with a reduction in earning capacity in the amount of 10%. - No matter what the statutory accident insurance - and there is added a new claim, there is a so-called supporting facts. Example: Two different claims, each with an earning capacity of 10 per cent: Both pensions after MdE 10 per cent paid. The claims are based. If one gone through recovery, also ends the other. An exception is the case of insurance cases from 1 January 2008 on agricultural entrepreneurs, their spouses and family members. Here is an earning capacity of at least 30 % requirement for a pension.

The assessment is done by the accident insurance institutions. He makes use of collected experience and may well deviate from the assessment of a medical expert. The earning capacity is not a " schedule of compensation " as in the private insurance industry. In a private accident insurance, a contract for certain services in certain body damage is completed (eg, loss of a digit = X% of the sum insured - regardless of age, profession and the size of the actual loss of function ). In determining the earning capacity, however, in particular the loss of function is considered. So it can happen that two different insured with the same injury have different levels of impairment of earning capacity.

In the pension benefits previously not served by income deduction. Only the bearer of the statutory pension insurance taken into account for its performance a pension from the statutory accident insurance as income.

The survivors' benefits are calculated not by an individual level as the earning capacity, but are paid as a fixed percentage. However, low income is entitled to those payments as a percentage ( fixed by law for various types of income ) accounted if it exceeds a certain exempt amount.

The basis for calculating performance of annual earnings ( JAV). This is 2/3 of the total labor income of the twelve calendar months preceding the month in which the insured event has occurred. While there are special provisions, such as the fact that their benefits after a statutorily specified sum insured set for entrepreneurs.

It is disputed whether the accident insurance also granted damages or a civil damages claim blocks. Under the current statutory scheme, such a replacement is not provided. The lying herein unequal treatment of injured workers to other victims, who receive for pain and suffering, has been deemed by the Federal Constitutional Court in 1995 to be constitutional ( Az 1BvR 753/94 ). More recently, critical voices are increasing (see only Fuhlrott, New Journal of Social Law [ NZS ] 2007, pp. 237 ff ), who want to see herein an unconstitutional unequal treatment. Younger reform plans being discussed, therefore, provide for such a claim for compensation for moral damages.

Cash benefits

In the event of an insurance claim within the meaning of SGB VII, the following benefits can be considered:

  • Injury benefit
  • Injury pension
  • Severance payment
  • Care allowance
  • Transitional allowance
  • Survivor's pension
  • Reimbursement of transportation expenses
  • Death benefit
  • More benefits for volunteers
  • Subsidy

Benefits in kind

In addition, insured have a comprehensive claim on property or services, including inpatient and outpatient medical care, nursing home care, domestic help, participatory services, medicines and medical aids. The claim is sometimes far beyond what the statutory health insurance offers, because all necessary measures from the carrier must be exhausted to make the earning capacity of the injured back. There are no budgeting of resources to be used. The accident insurance institutions hold this against special accident clinics, which are specially equipped for the care of victims of occupational accidents and diseases. Subsequent rehabilitation measures are provided in the BGSW method approved bodies. In contrast to physicians' ambulatory care patient choice of the insured is severely restricted in BG treatments. May Erstbehandeln usually only a licensed physician passage.

Further assistance for vocational rehabilitation, so-called professional help, be granted.

Hazard insurance coverage

One possible reason for the loss of rights of way accidents is the deviation from the path between home and work and the longer interruption of the way. NA is the company in some prevailing legal opinion that employees would lose their insurance coverage when they exceed the daily working time of 10 hours. Accident insurance is independent of the debt liable to pay. Restrictions may apply in case of intent ( for example, intentional self-injury an insured person or the intentional disregard of regulations by the employer) or gross negligence, and this circumstance is usually determined by a court.

The accident insurance coverage can also be compromised by the use of alcohol and other intoxicants:

  • Under moderate alcohol consumption by the accident insurance coverage is void if the influence of alcohol is the only legally significant cause of accidents. This means that, for example, a moderately intoxicated employee who proposes to hammering on the thumb, an accident at work suffers because of this process could occur without the influence of alcohol. Crash on staff at gleichartigem the influence of alcohol, the operating downstairs, as he has alcohol-related lost his balance, shall not constitute a work accident dar. in a road traffic accident in absolute unfitness to drive (from 1.1 ‰ blood alcohol concentration) is generally assumed that the influence of alcohol, the law alone essential cause of the accident was.
  • If a drunken stupor before, so that a worker is no longer purposeful activity in a position he is like a " non-employee " treated and loses his insurance coverage regardless of the specific cause of the accident.

Organization

Carrier

The statutory accident insurance in Germany are listed in § 114 para 1 of the SGB VII.

These are as follows:

  • Commercial trade associations. Nine commercial professional associations (broken down by sectors of activity ), in detail BG wood and metal ( BGHM )
  • BG Energy, Textile, Electrical and Media Products (BG ETEM )
  • BG raw materials and chemical industry (BG RCI),
  • BG food and hospitality industry (BGN )
  • BG trading and distribution of goods ( BGHW )
  • Administrative BG (VBG )
  • BG for Transport Economics (BG traffic)
  • BG for Health and Welfare Services (BGW )
  • The BG Bau (BG BAU).
  • Agricultural trade associations. Nine regionally structured professional agricultural cooperatives, (this is the agricultural and forestry trade associations of the countries and the horticultural trade association )
  • Accident insurance and fire - accident insurance. 32 accident insurance institutions of the public sector for government agencies and businesses by the federal, state and local governments, as well as for universities, schools and kindergartens, relief services, such as firefighters, lifesavers and volunteers, in detail the Accident Fund of the Federation ( UK-Bund )
  • The Railroad Accident Fund ( EUK ),
  • Unfallkasse Post and Telecom (UK PT )
  • The accident insurance of countries
  • The municipal health insurance associations and accident insurance of the communities,
  • The fire - accident insurance (FUK )
  • The common accident insurance for the state and the municipal sector.

The standing under state supervision BGs and the public accident insurance institutions are public bodies and are self-administered. They had banded together to June 2007 in three separate federations, the Federation of Trade Associations ( HVBG ), the Federation of Accident Insurers ( BUK ) and the Federation of professional agricultural cooperatives (BLB ). On 1 June 2007, the HVBG and the BUK have merged to a common umbrella association German Social Accident Insurance ( DGUV).

Organizational reform in 2008

The law on the modernization of the statutory accident insurance - UVMG brought sweeping reforms for the organization and financing of the statutory accident insurance in Germany, which have entered into force since 2009. In particular, the number of BGs was reduced by mergers of carriers. In addition, the load balancing between the professional associations was revised. Other innovations included the assessment of the entrepreneur to the hazard classes in accordance with the hazard pay and the collection of insolvency benefit contributions that since is no longer on the BGs, but about the health insurance companies, together with the total social insurance contribution.

Financing

The statutory accident insurance system is financed by contributions ( levies ) of member companies in a subsequent PAYG (annual contribution).

The amount of the contribution depends on industrial accident insurance and the insured companies (eg transport companies ) of public casualty insurers according to the wage sum as well as the risk class to which the operator has been assessed. The risk class is in any professional associations of the representative assembly in their hazard pay fixed ( § 157 SGB VII). The contributions are provided solely by entrepreneurs ( employers ) (§ 150 paragraph 1 of the SGB VII). The contribution amount is determined thereby, inter alia, also according to the amount of the bonus paid to the employees pay, the so-called payroll ( § 153 SGB VII).

The agricultural accident insurance is financed by contributions, which depend on the size of the cultivated area and the number of animals kept.

Accident insurance of the public sector is financed in the field of kindergarten children, pupils and students from taxation.

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