Status: 16.01.2024, 12:00 p.m.
By: Marco Blanco Ucles
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The Federal Social Court has ruled that sickness benefit must also be paid out if the sick note is received by the health insurance company late.
In Germany, employees are not left alone in the event of illness – even if they have been hit worse. As a rule, the employer continues to pay the salary for six weeks. After that, the health insurance company takes action and transfers sick pay to the person concerned. And this even if the sick leave, which is increasingly triggered by mental illness, is received too late by the health insurance company. This has now been decided by the Federal Social Court in Kassel, first reported by the tagesschau on the case.
The trigger for the ruling, which had previously been made by the Social Court of Cologne and the State Social Court of North Rhine-Westphalia, was a case from 2021. At that time, the plaintiff was certified as unfit for work from 31 March to 21 July. The problem: The follow-up certificate – valid from 12 May – was submitted too late to the health insurance company. Therefore, the health insurance company did not want to pay the sick pay.
Sickness benefit is paid despite late sick leave – this was decided by the Federal Social Court. (Symbolic image) © Rolf Poss/IMAGO
Submission of the certificate of incapacity for work is the responsibility of the doctors
However, the court has now ruled that the health insurance company is indeed obliged to pay the sick pay. Since the beginning of 2021, contract doctors have been obliged to submit sick notes – including follow-up certificates – to the health insurance companies. If a doctor's office fails to submit the certificate to the health insurance company in time, the insured person does not have to suffer and still receives his full sick pay.
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The original judgment of the court states: "The defendant's admissible appeal on points of law is unfounded (§ 170 para. 1 sentence 1 SGG). The lower courts correctly ruled that the claimant's entitlement to sickness benefit was not suspended and that he can claim sickness benefit from 12.5 to 21.7.2021." The fact that the technical requirements for the electronic dispatch of certificates of incapacity for work were not available in doctors' surgeries for the period in question is also irrelevant to the insured person's entitlement to sickness benefit.
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Private doctors and rehabilitation facilities not affected by the ruling
However, there are also exceptions to the ruling: it does not apply to doctors and institutions that do not participate in contract medical care. These are, for example, private doctors and rehabilitation facilities. Also interesting: When reintegrating after a long illness, employees should pay attention to a few things.