Accident at work: which insurance pays?

Under § 8 SGB VII, an accident at work is an accident that an insured person suffers as a result of their work. This means a sudden external event of limited duration that leads to damage to health. It is not only the accident at the workplace itself that counts. The direct route from home to work and back is also covered as a commuting accident.

This must be distinguished from an occupational disease. It does not arise from a single event but from long-term effects of work. Both cases fall under the responsibility of the statutory accident insurance and not of health insurance.

For employees, responsibility is clearly regulated. Every employee has statutory accident insurance through their employer, and the employer alone pays the contribution for it. This applies regardless of whether someone has statutory or private health insurance.

If an accident at work occurs, the employers' liability insurance association takes over as the provider of the statutory accident insurance. It pays for the entire medical treatment with no out-of-pocket costs, plus rehabilitation measures and the return to work. Your health insurance's obligation to pay benefits is suspended during this time. Only if the accident insurance does not cover a service can you claim it from your private health insurance.

If you lose income during medical treatment, the employers' liability insurance association pays injury benefit. It amounts to 80% of your most recent earnings and is limited to your net pay. It therefore replaces the Krankengeld (i)KrankengeldStatutory sick pay from the statutory health insurance fund. It starts when the employer stops paying wages, usually from the seventh week of illness. that health insurance would otherwise pay.

If a permanent impairment remains after the accident, an injury pension may be an option. It is paid if your earning capacity is reduced by at least 20% for longer than 26 weeks. This pension can be paid for life and depends on the degree of the reduction in earning capacity.

Privately insured employees are not worse off. They too have statutory accident insurance through their employer. The employers' liability insurance association pays for the treatment, and private health insurance stays in the background and only steps in second.

One advantage shows in the basic cover. Private health insurance makes no distinction between work and leisure. An accident is covered by the plan, wherever it happens. If an event is not recognized as an accident at work and the employers' liability insurance association is not responsible, private health insurance pays for the medically necessary treatment to the agreed extent.

Self-employed people and freelancers are as a rule not automatically protected by the statutory accident insurance. Some professional groups are compulsorily insured by law, for example certain craftspeople, farmers or midwives. Everyone else can take out voluntary insurance with the responsible employers' liability insurance association or take out a private accident insurance.

If you have none of this cover, you depend on your private health insurance after an accident during work. It pays for the medical treatment within the scope of the plan. However, it does not cover the loss of earnings. For this, self-employed people need an agreed Krankentagegeld (i)KrankentagegeldPrivate sick pay: a daily allowance from private insurance while you are unable to work. It replaces lost income from an agreed day of illness.More about Krankentagegeld → or a private accident insurance with daily allowance and disability benefits. For certain professional groups, the Versorgungswerk can also play a role in their cover.

The difference at a glance:

Yes. The direct way between home and workplace and back is covered as a commuting accident by the statutory accident insurance.

No. As an employee, you have accident insurance through your employer, regardless of your health insurance. The employers' liability insurance association provides the same benefits for everyone.