Accident insurance doctor: the required first doctor after an accident at work

After an accident at work, the accident insurance doctor has several roles at the same time. The doctor examines and treats the injury, determines whether and to what extent an accident at work has occurred, and decides whether general medical treatment is enough or a special treatment procedure must be started. The special procedure is used for more serious injuries and includes specialized clinics, rehabilitation measures and, where applicable, an injury pension.

The accident insurance doctor coordinates all further steps: admission to hospital, further treatment by specialists, prescription of rehabilitation and the report to the employers' liability insurance association. Privately insured people do not have to do anything actively, apart from seeing the accident insurance doctor and naming the employers' liability insurance association as the payer. Billing then runs directly between the treating doctor and the employers' liability insurance association.

D-Arzt status is a special approval that specialists must apply for with the statutory accident insurance. Not every specialist is automatically an accident insurance doctor. Throughout the whole treatment after an accident at work, one rule applies: your private health insurance has nothing to do with the case, and all bills go to the employers' liability insurance association. If you still submit a doctor's bill to your private health insurance, expect rejections and corrections.

The statutory accident insurance is only responsible for accidents at work and occupational diseases. An accident at work exists if the event is causally linked to your job, for example an accident on the direct way to work as a commuting accident under § 8 (2) SGB VII, an injury at your workplace or an accident during a business trip.

Private accidents, such as a sports accident, a fall at home or a traffic accident in your free time, are the responsibility of your private health insurance. Here you submit the bill to your own insurer, and the usual contract terms, including the deductible, apply as with any other treatment. Borderline cases can be more complicated, for example an accident on the way to lunch outside the company premises, a fall during an approved company sports event or an injury while working from home. If you are unsure, have the classification clarified before you submit a bill.

After an accident at work, we recommend that you always see the nearest accident insurance doctor first and do not submit the bill to your private health insurance. For accidents at work, the employers' liability insurance association is your payer, so you have no own share from your private contract.