Insurance cover for work-related accidents – regulations and benefits

If an accident occurs at work, this is a work-related accident – also known as a workplace accident or occupational accident. Work-related accidents are covered by statutory accident insurance. This means that accident insurance pays for treatment costs and awards other benefits as required, such as injury benefit or supports for re-integration into working life. Support is also provided if a person is left with lasting health impairment – e.g., in the form of pension payments.
 
However, insurance cover may also apply to other activities. Accidents covered as “work-related accidents” can also occur in other areas of daily life. Work-related accidents also include the following:

• an accident while working as a volunteer
• an accident while acting as a carer for a loved one in their own home
• an accident while attending school
• an accident while attending daycare/childcare
• an accident while providing first aid following a traffic accident
• an accident on the way to work, school, or daycare (commuting accident)

Under certain circumstances, additional activities that are related to the insured activity may also be covered. These include, for example, business trips and work parties. School pupils are normally also covered during class trips and school functions.

Not all health-related incidents that suddenly occur in the workplace are automatically considered to be work-related accidents. For example, if an office employee suffers a heart attack at work or a child has a sudden nosebleed at school, neither of these is a work-related accident. It is a matter of coincidence that these health issues arise while the person is at work/school. In addition, there is no direct external cause for the issues. Accidents, by their very definition, are temporary external events causing injury to the body and resulting in health impairments.

The accident insurance fund providing the accident insurance differs depending on the employer. Employees are normally covered by this insurance. However, company owners and self-employed people do not automatically have accident insurance. These groups of people can usually sign up voluntarily for accident insurance so that they are entitled to benefits in the event of a work-related accident. To do so, they must apply in writing to the relevant accident insurance provider.

A commuting accident is a specific type of work-related accident. It is an accident that occurs on the route between a person’s own home and their place of work or place of learning. Accidents suffered by children and adolescents on the way to daycare or school are also included in the category of commuting accidents. A person with accident insurance is covered on their route, regardless of which mode of transport they use. In other words, it doesn’t matter whether they travel on foot, by bike, with their car, or use public transport. 

Accident insurance normally covers the direct route between your home and place of work. The direct route is the shortest or fastest route. However, certain indirect routes are also covered. These include, for example, indirect routes taken as a result of traffic diversions, as part of car-pooling arrangements, or to facilitate child-minding arrangements.

In addition, your own home doesn’t always have to be the start or end point for the journey to/from work. For example, if you visit relatives after you finish work, your route from work may end at their home on that specific day. However, certain conditions apply from an insurance perspective – for example, you must spend or have planned to spend at least 2 hours at this “third place”. When you travel back home after your visit, this is no longer considered part of your route from work.

If, however, you take a detour on the way home from work and spend less than 2 hours in this “third place”, any accidents that may occur on this detour are not considered to be work-related accidents. In other words, they are not covered by statutory accident insurance.

If you have been injured at work or on the way there, the first step is usually to visit an accident insurance doctor. The accident insurance doctor (D-doctor) can then take care of the injury. D-doctors have completed specialized training in accident medicine and are trained to treat people injured in accidents. 

If you attend another medical practice (e.g., your family doctor), you will normally be referred to a D-doctor. In some cases, however, you will only need to visit your family doctor. This is the case, for example, with minor injuries that:

• don’t require a sick note for time off work outside of the day on which the accident occurred,
• can be treated within a week,
• don’t require a prescription for therapeutic services or medical aids, and,
• are not in fact recurring injuries from a previous accident. 

For serious injuries, there’s no need to begin looking for a D-doctor. In such cases, it’s best to attend a hospital immediately or call emergency services. Hospitals usually also employ D-doctors. 

In the event of injuries to the eyes, teeth, or the ear, nose, and throat region, you should immediately attend a specialist in the relevant area. 

The relevant insurance provider can also provide information about work accident doctors located near you. In addition, you can search for a suitable D-doctor practice on the German Social Accident Insurance website.

The following questions should be answered in the accident documentation: 

• What is the name of the injured person?
• What caused the accident? How exactly did the accident unfold? What injuries were sustained?
• When and where exactly did the accident occur?
• Are there any witnesses? What are the names of these witnesses?
• Was first aid provided? What specific first-aid measures were taken? Who provided the first aid and when? 

Who needs to report a work-related accident?

Employers are required to report work-related accidents, including commuting accidents, to the relevant accident insurance provider. This requirement applies as soon as the person injured in the accident is unable to work for a period of more than 3 calendar days. An official accident report (“Unfallanzeige”) must be submitted within a period of 3 days of the employer being made aware of the accident occurring. Serious or fatal accidents or accidents involving multiple people must be reported to the relevant accident insurance provider immediately.

Employers can send an accident report by post. There is also an option to submit the report directly online via the service portal of the German accident insurance funds and Employers’ Liability Insurance Associations.  

After an employer has reported an accident, the relevant accident insurance provider investigates whether the accident can be deemed a work-related accident. This may involve questioning the injured person, witnesses to the accident, or the employer, for example. The investigation also examines the extent to which the accident is responsible for the person’s health impairment. The injured person’s medical history is an important consideration in this regard. If necessary, the accident insurance provider may also commission an expert report to assess the medical context. 

Once all the results have been collected, the accident insurance provider decides whether to verify that the accident that occurred was indeed a work-related accident. The decision is usually communicated in writing. 

If the accident was not verified as a work-related accident, the costs of medical treatment are covered by the relevant health insurance provider. The health insurance provider is informed by the accident insurance provider if an accident has failed to be verified as a work-related accident.

The relevant accident insurance provider depends on the sector in which the person who had the accident was working at the time of the accident. The statutory providers are:

• the Employers’ Liability Insurance Associations (“Berufsgenossenschaften”)
• the Social Insurance Fund for Agriculture, Forestry and Horticulture (SVLFG) 
• public accident insurance providers (i.e., statutory/social accident insurance funds)

In case of uncertainty as to which accident insurance provider is responsible, assistance is available from the social accident insurance telephone information line. 

This helpline is available free of charge from 8:00 am to 6:00 pm, Monday to Friday, on 0800 6050404. 

In principle, everyone is entitled to treatment following an accident – this is usually paid for by health insurance providers. In the case of a verified work-related accident, however, the relevant accident insurance provider covers the costs of essential medical treatment as well as the costs of any therapeutic and medical aids required. Home nursing costs may also be covered. In addition, the person may be entitled to further extensive benefits.

These include:

• Medical rehabilitation benefits
• Benefits to enable participation in working life
• Social participation benefits
• Benefits that apply if the person is in need of care
• Cash benefits

If a person is unable to work for an extended period, the accident insurance provider pays injury benefit (“Verletztengeld”) which is similar to sickness benefit (“Krankengeld”) paid by health insurance providers. Injury benefit is intended to provide compensation for loss of income, and it is paid as soon as the employer stops paying continued pay (sick pay) for the person who had the accident. This usually occurs after a period of 6 weeks. Injury benefit amounts to 80 percent of the person’s regular pay, which is higher than the sickness benefit (70 percent of gross wages).

In addition, a person may be entitled to child injury benefit (“Kinderpflege-Verletztengeld”) if they are unable to go to work because they need to provide care to a child who was injured in an accident at a daycare facility or in school.

This entitlement applies if:

• the claimant has a medical cert confirming that they are unable to work because they need to supervise, look after, or provide care to the injured child,
• no other person from the same household is able to take on the role of supervision/care of the injured child, and,
• the injured child is younger than 12 years of age

Accident insurance providers also cover the costs of measures for re-integration into working life. These benefits include counseling and training measures. Accident insurance may also pay for workplace adaptations or for retraining. 

If a person has permanent health impairments following a work-related accident, the accident insurance provider may sometimes pay pension payments. If the injured person dies, their family may be eligible to receive surviving dependents’ benefits (“Hinterbliebenenrente”).

For more information about statutory accident insurance benefits following a work-related accident, visit the website of the Federal Ministry for Labor and Social Affairs (Bundesministerium für Arbeit und Soziales).

Anyone can ask their employer for more detail about how work-related accidents are handled in their workplace, e.g., how accidents are documented.

For more information and contact details, see the website of the German accident insurance funds and Employers’ Liability Insurance Associations. 

The website of the umbrella association “German Social Accident Insurance” (DGUV) provides contact details for the Employers’ Liability Insurance Associations, the statutory accident insurance funds, and the Social Insurance Fund for Agriculture, Forestry and Horticulture (SVLFG).