If we are affected by an illness that prevents us from working, one of the most burning questions is about financial security. Sick pay plays an essential role here. It provides a protective shield while we can focus on our recovery without having to worry about our economic situation. But how long are we entitled to this support and what do we need to bear in mind in order to actually claim the benefits? In this blog post, we look at the duration of entitlement to sickness benefit, clarify the necessary requirements for receiving it, discuss the amount of payments and shed light on the circumstances under which an extension is possible. We also look at the special features of accidents at work and protection against dismissal while receiving sick pay.
How long will I receive sick pay?
The duration of sick pay is a question that concerns many employees as soon as they are unable to work for a longer period of time for health reasons. In principle, sickness benefit is paid by the statutory health insurance and begins as soon as the continued payment of wages by the employer ends after six weeks. However, how long these payments last depends on various factors and cannot always be answered in advance.
As a rule, entitlement to sickness benefit is limited to a maximum period of 78 weeks within a three-year period for the same illness. Within this time window, however, sickness benefit is not paid continuously, but only for the days on which the insured person is unable to work. If you become unable to work again within three years due to the same illness, the sickness benefit will only start again once the 78 weeks previously received for this illness have been used up.
In addition, the duration of sickness benefit may vary if rehabilitation measures are approved by the health insurance company during the period of sick leave. In such a situation, the entitlement to sickness benefit pauses during the measure and is extended by the corresponding period. Equally relevant is the assessment by the Medical Service of the Health Insurance Fund (MDK), which regularly checks whether the conditions for entitlement to sickness benefit still apply.
It is also important to understand that the amount of sickness benefit is around 70 to 90 percent of gross earnings, depending on whether or not the child allowance is included in the calculation. This limitation contributes to the fact that the duration of sick pay has a direct impact on the financial support an employee can receive during a prolonged period of illness and is therefore of great social and economic importance.
Period of entitlement to sickness benefit
The duration of entitlement to sickness benefit plays a key role in the German social insurance system, as it helps to ensure that employees are covered in the event of incapacity to work due to illness. In principle, sickness benefit is paid after an uninterrupted period of incapacity to work of more than six weeks, whereby this benefit is paid by the statutory health insurance and aims to partially compensate for the financial loss.
According to the applicable statutory provisions, a person is entitled to sickness benefit for the period of incapacity for work, but for a maximum of 78 weeks within a three-year period for the same illness. However, it should be noted that this time frame includes consecutive cases of illness, provided they are the same diagnosis and there are no more than six months between the periods of incapacity for work.
There are certain special cases in which the duration of entitlement to sickness benefit may differ, for example in the case of accidents at work or occupational illnesses; in these cases, benefits may be granted beyond the standard period of 78 weeks. For the exact calculation of the duration of entitlement and to understand the individual requirements, you should contact the relevant health insurance fund.
An important prerequisite for the receipt of sickness benefit is that employment subject to compulsory insurance has continued without interruption prior to the receipt of sickness benefit and that the corresponding social security contributions have been paid at the same time. These complex regulations ensure that insured persons are supported in the event of illness, while at the same time preventing abuse of the system.
Requirements for receiving sickness benefit
In order to receive sickness benefit from statutory health insurance, certain conditions must first be met. One of the basic criteria is that the insured person is unable to work due to illness or medically necessary rehabilitation and is therefore unable to earn an income from work. It is important that the incapacity for work is certified by a doctor and regularly checked so that the receipt of sickness benefit is not jeopardized.
Furthermore, membership of the statutory health insurance scheme must have existed before the start of the incapacity for work, whereby the duration of the previous contribution payment also plays a role. As a rule, it is necessary for the insured person to have been compulsorily insured for at least twelve months within the last five years before the onset of incapacity for work or to have been entitled to insurance cover in the event of unemployment in order to be entitled to sickness benefit.
Another point is that the sick person must observe the so-called waiting period before sickness benefit is paid out. This means that in most cases the employer must continue to pay wages for the first six weeks of the illness before the sickness benefit is paid by the health insurance fund. Only when this period of continued payment of wages has expired does the health insurance fund step in and start paying sick pay.
It should also be borne in mind that self-employed and voluntarily insured persons must observe special regulations and requirements in order to receive sickness benefit. For them, it is necessary to include a so-called optional benefit for sickness benefit in their insurance policy so that they are financially protected in the event of long-term illness. The exact provisions may vary depending on the health insurance company and should be thoroughly researched in advance.
Amount of sick pay
The level of sickness benefit is an important factor in the German healthcare system, ensuring financial security for people who are unable to work due to illness. In general, sickness benefit is based on the average income that the insured person earned before becoming unable to work; this provides an anchor point to support economic stability during the recovery phase.
To understand the exact calculation of sickness benefit: it usually amounts to around 70 percent of gross pay, but not more than 90 percent of net pay. This regulation helps to ensure that recipients of sickness benefit experience a degree of financial continuity, which is essential for an unencumbered and focused recovery.
However, it should be noted that the amount of sickness benefit is limited by statutory maximum limits, so that maximum amounts cannot be exceeded, which can be particularly relevant for higher earners. Furthermore, certain social security contributions can be deducted from sick pay, which can reduce the amount of sick pay actually paid out.
As the exact amount of sickness benefit depends on various individual factors, such as previous salary and social security contributions paid, it is advisable to contact the relevant health insurance fund in the event of illness and clarify the specific modalities. This ensures that all entitled persons receive the full and correct amount of sickness benefit to which they are entitled.
Extension of sickness benefit entitlement
The question is often raised as to the circumstances under which an extension of the entitlement to sickness benefit is possible, as the recovery process is often more protracted than originally assumed. It is important to understand that sickness benefit serves as financial security in the event of incapacity to work due to illness in order to compensate for the loss of earnings and is therefore an essential support benefit.
The regulations for extending the entitlement to sickness benefit can be complex and are linked to strict conditions, including proof of continued incapacity for work by means of a medical certificate. In addition, the entitlement to sickness benefit is generally limited in time, but exceptions are permitted under certain conditions that allow the period of benefit receipt to be extended.
What many of those affected do not know: At the end of the regular period of entitlement to sickness benefit, which in Germany is set at a maximum of 78 weeks within three years for the same illness, it is possible under certain circumstances that the insured person will no longer be able to work. However, there are options for extending the entitlement to sickness benefit, for example if another, new illness is diagnosed that justifies an independent inability to work.
However, it should always be noted that when examining a possible Extension of the entitlement to sickness benefit individual case constellations play a role and it is therefore advisable to contact the responsible health insurance fund at an early stage in order to clarify the personal conditions for an extension and thus ensure a seamless transition in the receipt of benefits.
Sickness benefit in the event of accidents at work
Employees who suffer an accident at work in Germany are entitled to sickness benefit under certain conditions. This financial support is crucial in order to be financially secure during periods of incapacity for work. However, it is important to understand that entitlement to sickness benefit requires a detailed examination of the situation in question and official recognition of the accident as an occupational accident by the employers’ liability insurance association.
In the event of an accident at work, the statutory accident insurance initially pays benefits for the injured person. After the employee has received sick pay for the first six weeks, sick pay comes into effect if the incapacity to work continues. In this context, sickness benefit is referred to as injury benefit and is intended to compensate for the financial loss so that the person affected can concentrate fully on their recovery.
The amount of sickness benefit in the event of an accident at work is generally around 80 percent of the regular earnings of the person concerned, but may not exceed the net pay. It is essential that employees submit all the necessary documents on time and work closely with their doctor and the relevant employers’ liability insurance association to ensure entitlement to sickness benefit and avoid delays in payment.
It should be noted that there are specific regulations regarding the duration and conditions for receiving sickness benefit in the event of an accident at work. It is therefore essential that employees obtain detailed information and legal advice in order to fully understand and assert their claim. One of the foundations of the social security system in Germany is to ensure that employees who are injured in accidents at work receive the protection and support they need to return to work.
Protection against dismissal while receiving sick pay
Protection against dismissal while receiving sick pay is a key element of the German Social Code, which aims to provide employees with financial support during periods of incapacity for work and protect them from losing their job. It is very important to understand the framework conditions and legal regulations that are relevant in such situations in order to be able to accurately assess your own position and the associated rights and obligations.
In Germany, employees who are ill through no fault of their own and receive sick pay as a result of this illness have special protection against dismissal by their employer. This protection begins with the determination of incapacity for work by a doctor and can extend over a longer period of time, whereby the exact provisions can depend on various factors, such as length of service or duration of the illness.
However, it is important to note that protection against dismissal is not absolute. Under certain circumstances, the employer can give notice of termination even while the employee is receiving sick pay. For example, a dismissal for operational reasons or a dismissal for conduct-related reasons may be lawful if these reasons are not related to the illness or the receipt of sick pay.
In order to protect your own rights, it is therefore essential to find out about the provisions of the Employment Protection Act in good time and, if necessary, to seek legal advice in the event of illness and the resulting claim to sick pay. This is the only way to avoid unfair treatment and effectively secure your own position.
What is the general duration for which I can receive sickness benefit?
The general duration of sickness benefit is a maximum of 78 weeks within three years for the same illness.
What requirements must be met in order to receive sickness benefit?
In order to receive sickness benefit, you must have statutory health insurance, present a doctor’s visit with a corresponding certificate of incapacity for work and may no longer receive continued payment of wages from your employer.
How is the amount of my sickness benefit determined?
The amount of sickness benefit is calculated on the basis of your regular gross income and is usually around 70% of your gross salary, but not more than 90% of your net salary.
Under what circumstances can the duration of my sickness benefit entitlement be extended?
It is not possible to extend the entitlement to sickness benefit beyond the regular 78 weeks, unless the illness is new. In this case, a new entitlement period begins.
How does an accident at work affect my entitlement to sickness benefit?
In the event of an accident at work or an occupational illness, the employers’ liability insurance association usually pays the injury benefit, which is similar to sickness benefit, from the day after the accident.
Is there protection against dismissal while receiving sick pay?
Yes, there is extended protection against dismissal while you are receiving sick pay. Dismissal by the employer is more difficult in certain circumstances, especially during the first six weeks of incapacity for work.
Can my entitlement to sickness benefit be suspended if I receive certain benefits?
Yes, your entitlement to sickness benefit is suspended if, for example, you receive maternity benefit, injury benefit or a compensation payment from the Federal Employment Agency.