Sick pay: you don’t have to answer many questions from your health insurer

Those who are at risk of slipping into sick pay or are already receiving sick pay are often contacted by the health insurance company and asked for a lot of information. Under the guise of the duty to cooperate, health insurers repeatedly put pressure on people who receive sickness benefits and get them to disclose sensitive patient data. Read what health insurance companies are allowed to do and what they are not (but if at all the medical service) and help us to rap on the knuckles of the insurance companies.

Questionnaire of a survey is filled out

  1. People with statutory health insurance who are likely to receive sick pay or who are already receiving it are regularly contacted by the health insurance company and asked for information.
  2. Consultations with the consumer advice center show that quite a few insured persons feel under pressure as a result of this. One must have the impression that this is not only accepted by the health insurances, but is even desired.
  3. The "Act on the Further Development of Health Care" significantly restricts the collection of data by health insurance companies when receiving sick pay. There is now only a limited amount of information that health insurance companies are allowed to collect from sick pay recipients. Telephone calls are only allowed with prior consent.
  4. Once a month, the consumer center offers a free online consultation on the subject of sick pay. Interested parties can simply register.

"Hamburg Consumer Protection Level."You have problems with sick pay, then tell us about it. We are currently collecting complaints about the most important consumer problems. ⇒ Participate in survey now.

If you are unable to work in Germany because of an illness, you are entitled to sick pay for up to 78 weeks. The first six weeks, however, one usually receives the so-called continued payment of wages in case of illness from one’s employer; only after that is the so-called sick pay paid to those with statutory health insurance. This is lower than the wage or. Continuation of pay – it is 70 percent of gross wages, with a maximum of 90 percent of net wages.

What may the health insurance company ask me about?

It is undisputed that health insurance companies must and may ask for certain information in order to be able to pay out sickness benefits. This includes, for example, the account number and the amount of the salary. They must also be able to prevent abuse and ensure the success of treatment. If you have doubts about your inability to work or about the success of your treatment, you can have them checked by the medical service. Your health insurance fund may only use information that it has already lawfully collected regarding the question of whether to call in the Medical Service for an assessment of incapacity for work. Only in two exceptional cases may it contact you and these are:

  • They may ask whether a resumption of your work is foreseeable and, if so, at what point in time this is likely to take place.
  • It may ask whether there are any specific upcoming diagnostic and therapeutic measures that stand in the way of a return to work.

Both inquiries are obviously intended to prevent an unnecessary commissioning of the medical service. By the way, the fact that the insurance companies are allowed to ask for this does not mean that you have to have a reliable, binding and generally valid answer to this at all times. Answer honestly, but this also means that you are allowed to formulate the subjectivity of your self-assessment, its changeability and its nevertheless often narrow limits. In other words: If you really don’t know the answers to the questions, or think it could be different tomorrow, such information is also available.

In addition, the health insurance funds may, within a narrow framework, ask the service providers (e.g. your doctor or. your doctor) who issued your certificate of incapacity for work (AU), collect information in order to

  • To specify the diagnoses in the AU certificate,
  • to find out what other diagnostic and therapeutic measures are planned,
  • to gain knowledge of the nature and extent of the last activity carried out or
  • to find out to what extent ALG I recipients are available at the employment agency.

What the health insurance company is not allowed to ask for (anymore)?

The "Act on the Further Development of Health Care" prohibits your health insurance company from collecting any further data or information beyond what is described above: you are therefore not obliged to provide any information that is not covered by the exceptions described above. Previously common questions (albeit in legal gray areas), for example, about a self-assessment of your condition, about the arrangement of your workplace or a pension application are no longer allowed. This also applies to questions about problems at work, family problems or vacation plans, which have of course always been clearly illegal.

Whether burnout, accident or complicated operation – if you are unable to work for a longer period of time, you are usually entitled to sick pay from your statutory health insurance fund. But receiving the benefit is often accompanied by questions. We regularly answer the most important ones in a free online consultation to. Interested? Then simply register for one of the planned events.

By which means may the health insurance company contact me? May the health insurance company call me?

Your health insurance company may only request the information from you in writing – digitally or by letter. Only if you have agreed to a telephone survey in writing or electronically, a telephone call is also possible. This must be recorded by the health insurance company – and you have a right to information on the record, which your insurance company must also point out to you. Even before the amendment, you were not obliged to provide information over the phone – but the fund was allowed to try. We recommend that you do not give permission for a telephone contact exception; too often, those affected report to us in our consultations about being taken by surprise or even aggressive calls.

What may the medical service ask?

If the health insurance company has doubts about the inability to work or the expected success of the treatment, it can have this checked by the Medical Service (MD). But the health insurance funds can only formulate doubts on the basis of the information available to them (see above) and thus select the cases they wish to submit to the Medical Service for review. The determination of an inability to work (or even that it no longer exists) is a medical task that cannot be performed by the health insurance company – that’s what the MD is for. The medical service may inquire health data – however only so far it is necessary in the concrete individual case (§ 275 SGB V).

Mrs. M. Had received a cover letter from her health insurance company, HEK, in September 2017, to which a two-page questionnaire was attached with questions about, among other things, the medical history and the situation at work. This letter states that the questionnaire was prepared in cooperation with the medical service. Ms. M. Was asked to return the completed and signed questionnaire to the health insurance company within ten days. When this did not happen, a further letter was sent requesting that it be sent, even setting a deadline of a further ten days. The patient had the impression that if she did not respond, her sick pay would be cancelled immediately. The HEK had not pointed out with a syllable that the filling out of the questionnaire is voluntary and the consent to the data use is revocable any time.

When may also the health insurance company ask more questions?

If you have agreed to individual counseling and assistance according to §44 paragraph 4 SGB V (often called "sick pay case management"), our instructions do not apply. Then the health insurer may also ask you other questions and call you in case of doubt. Individual counseling and assistance according to §44 paragraph 4 SGB V includes services and supportive offers for the restoration of the ability to work. This includes advice on alternative treatment methods or support in finding suitable service providers. The health insurance company must inform the insured in advance in writing about the content, objectives, nature and scope of the consultation, its voluntary nature, the processing of personal data involved and the possibility of revoking consent – and insured persons must have agreed to this in writing. It concerns a right of the insured ones, from whose refusal no disadvantages may develop.

Unfortunately, some health insurers use the provision to obtain data on the insured person, for example to shorten the duration of benefits when sick pay is received or to oblige the insured person to apply for rehabilitation or a pension, without pointing out the right of refusal. In individual cases, they even blur the boundaries between the separate collection powers of the health insurance funds and the MD.

Important: If you no longer want "sick pay case management", you can revoke your consent at any time.

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