ZDF magazine Frontal 21: health insurance companies refuse sick pay

Wednesday, 03.04.13 , written by Anja Schlicht More and more often legally insured persons complain about problems with their health insurance company when paying the sickness benefit. The coffers should put pressure on their insured or completely deny the sick pay, as reported by the ZDF 

 ZDF-Magazin Frontal 21: Krankenkassen verweigern Krankengeld

Not only the social association VdK has determined that the subject of sickness benefit has increased during consultations. Current numbers of Independent Patient Counseling (UPB) prove: Insured complain most often about trouble with their health insurance in the payment of sickness. This is reported by the ZDF magazine Frontal 21. However, conflicts with the cash register are no longer an isolated case. The VdK president Ulrike Mascher summarizes that the health insurance companies are “more and more based on business principles and not in the well-being of the insured”. As a reason Mascher calls the competition of the cash registers. It’s now much more about avoiding costs than restoring health.

Sick pay causes high costs for health insurance companies

The sick pay is an increasing cost factor in the health insurance. In the last year alone, the corresponding expenditures for the health insurances were, according to estimates of the GKV-Spitzenverband, at nine billion euros. Therefore, there should be at the statutory health insurance departments, which specialize in disabled registered members. The employees have the goal of “controlling” the insured, that is, to force the change of cash, as an insider reports to Frontal 21.


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Frontal 21: AOK Bayern and TK canceled sick pay

The health insurance companies use several possibilities to discontinue the payment of the sickness benefit. One concerned insured told the Frontal 21 reporters that their sickness benefit was canceled because she had failed to provide proof of incapacity for work. A small delay for the new certificate of incapacity for work of two days was sufficient for AOK Bayern to stop paying the sickness benefit. In fact, there is a legal regulation that requires complete proof. However, this is “blind to the problems in everyday life,” as Ulrike Mascher of the VdK notes. It therefore calls on the legislator to allow for retroactive invalidity certificates. But the Federal Ministry of Health currently sees no need for action. Since the AOK Bavaria sees in the right, the person concerned had no choice but to change the box office.

Expertise according to the file of the MDK

In another case, the Techniker Krankenkasse (TK) ended the payment of sickness pay, as an opinion of the Medical Service of the health insurance (MDK) has determined according to documents, that the GKV member can work fully again. Six months were planned for the reintegration into the profession after a burn-out disease. After only six weeks, the person in question received a call from the TK, which informed her that she would no longer receive any sick pay. Only after a violent contradiction took the Techniker health insurance the decision back again.

VdK advises in case of refusal sick pay: seek advice

In order to save money, health insurance funds should also have re-applications for rehabilitation to pension applications reinterpreted. Instead of a sickness benefit from the health insurance, those affected then receive a disability pension from the statutory pension insurance, which usually turns out to be much lower than the health insurance company’s benefit. In the Frontal 21 interview, Mascher advises people who have problems with their health insurance to seek urgent advice. In addition to the VdK and the UPB there are other organizations that help those affected by the difficult and complex situation.

Entitlement to sickness benefit after six weeks sick leave

Anyone who has been on sick leave for longer than six weeks usually receives sickness benefit from his health insurance. This replaces the wage continuation in case of illness by the employer. The sickness benefit is intended to compensate for the loss of income due to sick leave. The amount of the wage replacement depends on the regular income before the incapacity for work begins. Sick leave is usually 70 percent of the last gross monthly salary, but the highest 90 percent of the net income.

However, if employees are permanently unable to work due to an accident or illness, financial security is critical. The statutory disability insurance pays only under certain conditions. Professionals should therefore provide with a disability or occupational disability insurance and protect themselves from the financial consequences of disability.


Here you will find tips and further information on the statutory health insurance. >

Anja Schlicht

editorial staff

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