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Abschnitt 3 BGI/GUV-I 506 E, III. Comprehensive insurance - ...
Abschnitt 3 BGI/GUV-I 506 E
In good hands. Your Statutory Accident Insurance Functions, services and organization (BGI/GUV-I 506 E)
Titel: In good hands. Your Statutory Accident Insurance Functions, services and organization (BGI/GUV-I 506 E)
Normgeber: Bund
Amtliche Abkürzung: BGI/GUV-I 506 E
Gliederungs-Nr.: [keine Angabe]
Normtyp: Satzung

Abschnitt 3 BGI/GUV-I 506 E – III. Comprehensive insurance - when we help.
Occupational and school accidents, and occupational diseases

Any time, anywhere, and in whatever way necessary: the statutory accident insurance system provides protection at work, in schools, and during journeys to and from them. Specifically, this means that the accident insurance institutions are responsible for all consequences of occupational accidents, accidents in educational establishments, commuting accidents, and occupational diseases.

Occupational, school and commuting accidents

Occupational accidents are accidents suffered by insured persons in connection with their work, or whilst travelling on company business.

Such accidents also include, for example, those occurring:

  • During the transport or repair of work equipment

  • During company sporting events, unless they are primarily of a competitive nature

  • During company parties and trips organized by companies.

School accidents are accidents suffered by children or students in their educational establishments. They include accidents suffered by children or young people whilst attending schools, nursery schools, after-school care centres or vocational colleges; or whilst under supervision by such educational establishments or in association with them immediately prior to or following lessons. This category of accidents also includes those suffered by students during education and training at institutes of higher education.

Activities outside the educational establishment are also insured, such as:

  • School trips

  • School parties

  • School sports

  • Visits to university and public libraries

Commuting accidents are accidents occurring during journeys directly to and from the workplace, school, nursery school, after-school care centre or institute of higher education. Employees are also insured on detours which are necessary, for example:

  • In order to accommodate children during working hours

  • For the purpose of car-sharing

  • Owing to traffic diversions

  • Where the workplace can be reached more quickly by a longer route (e.g. by motorway)

Journeys undertaken in any connection with work are also insured.

Info

Company sports

Statutory Accident Insurance cover does not automatically extend to all sporting events which a company permits its employees to participate in. The sporting activity must have some inherent connection with the company's activities, i.e. be in its interest. Company sport is included in the insured activity when the following criteria are met:

  1. 1

    The purpose must be recreational, and not competitive

  2. 2

    It must be performed regularly

  3. 3

    It must essentially be limited to company employees

  4. 4

    It must be conducted during, prior to or following working hours

  5. 5

    It must be organized from within the company

Where company sports are insured, cover also extends to journeys to and from the venue, and to changing and showering.

Occupational diseases

Occupational diseases are formally recognized as such when they have been contracted as a result of exposure, during insured activity, to health hazards at a higher level than the exposure for the wider population. Formally recognized occupational diseases are indicated on the list of occupational diseases which is issued by the German government with the approval of the upper chamber. Other diseases may also be recognized as being occupational in origin if new medical/scientific findings show them to meet the requirements for inclusion in the list of formally recognized occupational diseases. The list of formally recognized occupational diseases is available (in German) on the Internet: www.dguv.de webcode: d1303

Disputes over occupational diseases

Occupational diseases are a complex issue, and their formal recognition frequently becomes a matter for the courts. The fates of individuals collide with statutory limit values, individual cases with standardized patterns. Inevitably, difficult distinctions must be drawn. The legislator has nevertheless attempted to find the best solution for all parties concerned. As at the end of 2006, almost 820,000 people in Germany were receiving ongoing pension payments. Pension payments for occupational diseases, occupational accidents and commuting accidents amount to approximately € 5 billion. This is an enormous figure, one which assures many people of their livelihood. At the same time, it must be established in each case that the disease was in fact caused by pursuit of the occupation (principle of causality), since the costs to companies would otherwise rise unchecked and without justification, with a corresponding threat to jobs. This would be in the interests neither of the insured individuals, nor of the companies.

What procedure must be followed when an accident or disease occurs?

The employer is obliged to inform the statutory accident insurance institution whenever an employee is unable to work for a period exceeding three days as a result of an occupational injury. Any accident requiring treatment by a doctor which is suffered by a child or student in an educational establishment must be reported. Fatal accidents must of course also be reported to the accident insurance institutions. Forms are available for reporting accidents. No application need be made for benefits, since the benefits delivered by the statutory accident insurance system are determined by the authorities. Suspected cases of occupational disease must generally be reported both by the employer, and by the doctor treating the condition. This is a statutory requirement. Insured individuals may also contact their accident insurance institution themselves at any time should a (possible) occupational disease not yet have been reported by their employer or the doctor. The doctor first treating the condition is also obliged to produce a report.

Note: Employers should also record minor occupational accidents in the company's accident book. This enables them to provide the necessary evidence more easily should the consequences of the accident prove to be more serious than was originally assumed. The administrative procedure and expert opinion are free of charge for the insured individual. Should the latter involve a lawyer, however, they must pay the associated costs themselves. The insured individual may appeal against the decision of the accident insurance institution within one month of notification.

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Accident insurance does not apply in the following cases:

Injury caused deliberately, accidents caused by the influence of alcohol, or accidents attributable essentially to private activities.