Determination of an occupational disease

  • Performance specification

    Occupational diseases are diseases which the Federal Government designates as occupational diseases by ordinance with the consent of the Bundesrat and which insured persons suffer as a result of an activity giving rise to insurance cover. The Federal Government is authorised to designate as occupational diseases in the ordinance those diseases which, according to the findings of medical science, are caused by special influences to which special groups of persons are exposed to a considerably higher degree than the rest of the population in the course of their insured activity. Not every illness can be recognised as an occupational disease. Diseases currently designated as occupational diseases can be found in the Annex to the Occupational Diseases Ordinance (BKV).

    If you suffer from an occupational disease, you are entitled to benefits from the statutory accident insurance. These benefits include, for example:

    • Treatment costs
    • Costs for necessary redesigns of the workplace
    • Pension
      However, a pension is only paid if the injury assumes a certain degree of reduction in earning capacity (MdE).
    • Retraining measures

    Note: For illnesses that are not occupational diseases, the necessary medical benefits are provided by the health insurance and any pension benefits are provided by the statutory pension insurance.

    If you suspect that your illness is occupational and you would like to receive benefits from the statutory accident insurance, it must first be clarified whether your illness can be recognised as an occupational disease. This is done in the occupational disease determination procedure, which is carried out by the responsible statutory accident insurance.

  • Process flow

    Doctors and limited employers are obliged to report the suspicion of an occupational disease to the statutory accident insurance institution or the body responsible for medical occupational health and safety in the federal state. All others (e.g. affected persons, relatives of the affected person or work colleagues) also have the right to report the suspicion of an occupational disease. However, it is advisable to ask the attending doctor to make the report.

    The Berufsgenossenschaft shall also inform the body responsible for medical occupational health and safety of the suspicion.

    The question of whether there is a connection between the activity and the harmful effect is clarified by taking the work history of the person concerned (work history). The aim is to find out what stresses you have been exposed to during your working life. This can be done by sending questionnaires to the companies where you were employed, but also by personal interviews or by looking at documents. As a rule, all relevant persons (e.g. company doctor, works council, safety officers, work colleagues) should be involved. You yourself can also submit a statement, which should be as detailed as possible and can include the workloads of colleagues at the same workplace.

    Attention: The documents on the work history survey form the basis for the subsequent medical report. Therefore, make sure that no false information is provided and that all information is complete.

    If the work history concludes that there is no connection between the activity and the harmful effect, the procedure is terminated and recognition as an occupational disease is refused.

    If the opposite is the case, a medical expert opinion must clarify whether the harmful effect actually caused the illness. The accident insurance institution must provide you with several medical experts to choose from. You can also propose an expert yourself - but the accident insurance institution does not have to abide by your proposal.

    Tip: You may bring both a trusted person and - if necessary - an interpreter to the expert's appointment.

    The expert opinion will be forwarded to the competent accident insurance institution. You will receive a copy of it on request. Check whether all the information is complete and correct. If you discover any deficiencies, you can inform the accident insurance institution of these in writing.

    In addition, the accident insurance institution may also have received an expert opinion from the body responsible for medical occupational health and safety, as industrial physicians may comment as medical experts on individual occupational diseases in accordance with §§ 4 and 5 BKV on the question of the connection between occupational activity and the occurrence of an occupational disease.

    The responsible person in the Berufsgenossenschaft prepares a draft decision based on all the documents, which is submitted to the pension committee for a decision. The committee either recognises the disease as an occupational disease or rejects the application.

    Tip: Detailed information on occupational diseases and the determination procedure can be found in the information sheet "Occupational diseases - what you should know about them" of the German Trade Union Confederation.

    Information is also provided by the German Social Accident Insurance (DGUV) at the following link: https://www.dguv.de/inhalt/versicherung/bk/index.jsp

    Note: For some diseases on the list (e.g. skin, asthma and spinal diseases or tendovaginitis), recognition as an occupational disease requires that the harmful activity has been abandoned.

     

  • Requirements

    A prerequisite for the procedure for determining an occupational disease is the notification of the (suspected) occupational disease to the competent statutory accident insurance institution. Doctors or dentists are obliged to notify the statutory accident insurance institution or the body responsible for occupational health and safety without delay if they have a reasonable suspicion that an insured person has an occupational disease.

    In the procedure for determining an occupational disease, 2 questions, among others, must be answered:

    1. Is there a connection between the activity and the harmful effect?
    2. Is there a connection between the harmful exposure and the disease that occurs?

  • Legal basis


Who do I need to contact?

The institutions responsible for deciding on recognition as an occupational disease are those that also have to provide compensation benefits - these are the statutory accident insurance institutions:

  • the industrial and agricultural employers' liability insurance associations
  • the public sector accident insurance institutions