In everyday language, many people use the terms work incapacity and occupational disability synonymously. But there is an important difference.
The most important things at a glance
Multiple fractures after a fall, burnout followed by rehabilitation – if you are absent from work for a long period of time, you can sometimes have financial problems. Insurance can help. But not everyone knows who will pay for you if you cannot work.
Many consumers talk about “incapacity for work insurance” when they actually mean “occupational disability insurance”. But that is not the same thing. We will show you what the difference is and what that means when taking out insurance.
You are unfit for work as soon as you are temporarily unable to do your job. “Temporarily” is the key word here. There is therefore a prospect of improvement; inability to work is not a permanent condition – in contrast to occupational disability.
Examples of incapacity to work include a flu infection, a broken leg or a high-risk pregnancy. You will then receive a sick note from your doctor. This certifies your incapacity to work.
However, you are only considered occupationally disabled if you are likely to be unable to continue working in your last job for a long time. If you have occupational disability insurance (BU), it will pay you a pension if you have lost at least half of your ability to work (BU degree of 50 percent). You can read more about BU here.
Occupational disability insurance is one of the most useful types of insurance, as it prevents financial ruin. Anyone born after 1961 would otherwise only receive the statutory disability pension, which is on average less than 1,000 euros per month.
If you are legally insured and on sick leave, your employer will continue to pay your full salary for six weeks. If your inability to work lasts longer, the health insurance company will then take over and pay sick pay. However, this is a maximum of 70 percent of your last gross salary subject to contributions and a maximum of 90 percent of your net salary. In 2024, the maximum amount per calendar day will be 120.75 euros. You can read more about sick pay here.
According to Section 48 Sentence 1 of the Social Code Book V, the entitlement to sick pay for those with statutory insurance is limited to 78 weeks within three years. In practice, however, the period is reduced to 72 weeks because the six weeks of continued salary payment are deducted by the employer. Read here how to apply for sick pay.
Periods in which your entitlement is suspended because you receive other benefits also reduce your entitlement to sick pay. This includes maternity protection, for example.
- Important to know: How to get health insurance during parental leave
Privately insured people are not entitled to statutory sick pay in the event of a long-term illness. You should therefore consider private daily sick pay insurance. Read here which supplementary insurances are useful for whom.
You cannot take out incapacity for work insurance (AU) as a stand-alone insurance policy, but only as a supplement to occupational disability insurance. This works via a so-called AU clause.
Thanks to this, depending on the insurer, you will receive money from the disability insurance if you have been on sick leave for at least three months and a specialist certifies that the illness will continue for at least another two months. This means that permanent occupational disability does not have to exist.
Not all plans require you to simply refer to a doctor’s note. Some insurers require you to provide the same, more comprehensive documents that you have to submit for a regular disability pension.
If your occupational disability insurance has an AU clause, you will receive a payment retroactively. This closes the income gap between the end of the six-week salary payment by the employer and the return to work.
The benefit is usually limited to 18 to 36 months. Providers usually charge a surcharge on the premium for this.
“It is generally advantageous to have occupational disability insurance with an AU clause. This is because it enables a temporary monthly pension after six months of uninterrupted incapacity to work with a sick note – even without proof of the degree of disability,” says Kai Fürderer from the t-online quality control company. The company evaluates, among other things, the quality of financial advice – for example on insurance.
However, it should be remembered that the clause increases the cost of occupational disability insurance. Depending on the insurer, you can expect an increase of 5 to 10 percent. “In the end, everyone has to decide for themselves whether the additional costs for this service offer a personal advantage compared to alternative solutions such as daily sickness benefit insurance,” says Fürderer. It is also important to compare the services of different providers.
If it turns out that you have not recovered and are unable to work instead of being able to work, your BU may pay you a pension retroactively. If this overlaps with payments from your daily sickness benefit insurance, some providers will demand the daily sickness benefit back.
