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When it comes to securing your workforce in Germany, there is no way to do one Occupational disability insurance past. But when exactly are you actually unable to work? Often it is not really tangible what an occupational disability can look like. You may also have the image of a wheelchair user in your head who is unable to work. However, disability can occur much faster than you think. In this expert article, you will find out which requirements must be met according to the conditions of the insurer for you to be classified as incapacitated.

Quick overview “occupational disability”

Definition of occupational disability

The insured profession

Illness, bodily harm or more than age-related decline in strength

The 50% hurdle

6 month forecast period

How is occupational disability defined?

As always, we try to explain the topic for you so simply and without insurance-German. But sometimes it doesn’t work without it. Therefore, here is the legally correct definition of occupational disability. This can be found like this (or something like that) in the general insurance conditions of the insurers.

Incapacitated is anyone who is at least 50% restricted in the ability to pursue their occupation as it was last in healthy days, due to illness, physical injury or more than age-related loss of strength, for at least 6 months or a meaningful work result is no longer possible .

Your current job is always insured

In concrete terms, this means for you that your current job (= your last job) is insured. And this is where misunderstandings often arise.

You may have taken out your disability insurance back then as an office worker, but are now a landscape gardener. If you can no longer work as a landscape gardener for at least 50% for at least 6 months due to illness, physical injury or more than an age-appropriate loss of strength, you are unable to work.

In summary, this means that it does not matter which profession you took out your disability insurance for at the time. Your last activity is always insured before the onset of occupational disability.

What exactly do illness, bodily harm or more than age-related decline in strength mean?

Taken together, pretty much everything is covered that can somehow lead to a health problem. German courts do not allow much leeway when interpreting the terms either.

Here are a few examples for you to make it more tangible:

Illnesses that often lead to disability:

  • Cancer, or diseases of civilization in general
  • Burnout

Possible bodily harm:

  • Accidents of all kinds

More than age-appropriate decline in strength

  • This is a kind of additional safety buffer for the customer, should an occupational disability not clearly be due to illness or physical injury.

A combination of the three mentioned is also possible. So you notice that an occupational disability is super individual and there are umpteen possibilities and variations of how it can arise.

Restriction of at least 50%

Now we come to the 50% at which you can at least no longer carry out your job as a further requirement for paying the disability pension. You have to consider this number both qualitatively (result of your work) and quantitatively (time spent on individual activities).

Time spent on individual activities

The time required is relatively easy to show. Here it is simply checked how much time you have to spend on individual activities. How long you work, for example, standing or sitting. This is then compared to the existing health restriction, or this is placed over it as a “template”.

If in the end it turns out that more than 50% of the time you can no longer perform your activities, then the definition would be fulfilled in this regard.

Result of your work

This is where things get a little more complex. The time spent on individual activities is no longer relevant, but the result of your work. So it may be that you could still carry out 85% of the activities, but a single task that only takes 15% of the time is so important that the work result cannot be achieved because you no longer carry out precisely this activity can.

Another example makes it clearer:

Let’s say you work in the field as a sales representative. You are constantly on the move in the car and with customers. In terms of time, driving only accounts for approx. 20% and 80% of the time you advise customers, make offers, make phone calls, etc.

If you can (or are not allowed to) drive a car due to illness or an accident, then only 20% of your time would be affected, but since you can no longer drive to customers and they can no longer advise them, the work result is no longer in itself manufacturable. So you would be more than 50% restricted in your work results. The disability insurance would pay you your disability pension.

Inability to work is expected to last for at least 6 months

Last but not least, you have to prove to the insurer that the present restriction of your professional activity will also exist for at least 6 months.

It’s not that easy at all. Because a doctor will usually not lean that far out of the window and confirm this to you. Often it is not even possible for him to make a prognosis of this kind.

Fictitious forecast period

This problem is solved over a so-called “bogus forecast period”. If you have actually already been unable to work for 6 months, the insurer assumes that you will probably continue to be unable to work in the future.

In practice, the latter is the most common. For you as an insured person, this means that you have to be able to financially bridge the first 6 months of your disability. This is usually possible through, for example, sick pay from the health insurance company or additional private daily sickness allowance insurance.

However, you will still receive your disability pension retrospectively from the 1st day of your disability.

In order for a claim to run smoothly for you, it is essential to select the right insurer with a very good tariff and very good insurance conditions.

If you are still looking for a very good disability insurance and do not want to fight your way through this complex topic on your own, then you can check here whether there is another one free appointment for free online consultation from our disability experts.