Sick pay trap
An accident, a major operation or burnout: there are many reasons why employees can be absent from work for a longer period of time. To ensure that you receive the full amount of sick pay to which you are entitled, you should make sure that you provide full proof of your incapacity for work. Health insurance does not pay, then there is no such thing.
6-week rule As a general rule, people with statutory health insurance who are unable to work for longer than six weeks receive sick pay from their health insurance fund. This is generally 70 percent of the gross salary, but no more than 90 percent of the previous net income.
Sick note While you are receiving sickness benefit, you will always need a sick note from your doctor. This is usually issued for a few weeks, after which you must return to the doctor's surgery and have your incapacity for work re-established.
The tricky thing is that if you cannot prove your incapacity to work for even one day, you are not entitled to sick pay. The health insurance company will then not pay. And a gap can quickly arise: Suppose you need a new sick note on a Monday and call the doctor's office. You are told that the doctor is not free until Tuesday and can then write you off sick retroactively. Be careful, don't accept this. Because: Such a sick note will not help you, as backdating is not possible here and it always depends on the day of the diagnosis.
Refusal of therapy
Regardless of whether it's a cure, a modern hearing aid or other medical aids: if the health insurance company doesn't want to pay, you don't have to accept it.
Three-week deadline Health insurance companies must decide on an application for benefits no later than three weeks after receipt of the application or, in cases where an expert opinion is obtained, in particular from the Medical Service of the Health Insurance Fund, within five weeks of receipt. If the health insurance fund does not respond within this period, the application is automatically deemed to have been approved.
Appeal If the insurer rejects the application, patients should lodge an appeal within four weeks. Help is available from the Consumer Advice Center or the Independent Patient Advisory Service, for example.
Justification In your objection, list in detail why you need the requested benefits. A statement from your doctor is also helpful.
Registered mail Be sure to send the letter to your health insurance company by registered mail.
Unsuccessful appeal If the health insurance fund still does not want to pay, it will automatically pass the case on to the appeals committee. The patient must receive its decision within three months at the latest.
Appeal to the social court If the decision of the appeals committee is negative, insured persons can file an appeal with the social court. This involves little risk, as they do not have to pay any court costs - even if the claim is rejected.
Mother-child cure
The number of mothers suffering from severe exhaustion has risen by almost 40 percent in recent years. If you pay attention to the following points, you have a good chance of being approved for a mother-child cure.
Doctor's certificate To get the certificate required for the application, tell your doctor as precisely as possible why you need the cure. Physical complaints such as back problems should also be mentioned. You should also mention any aggravating factors, such as being a single parent or caring for a relative.
Application You can download the documents online at www.kur.org/mutter-kind-kur. Complete everything carefully - incomplete applications are the most common reason for rejection. A self-disclosure form is also useful. www.muettergenesung-frankfurt.de/download.php
Appeal If your application is rejected, be sure to lodge an appeal. Every second appeal is successful. The Müttergenesungswerk will help you with this. www.muettergenesungswerk.de