{"id":5226,"date":"2024-10-04T16:54:24","date_gmt":"2024-10-04T16:54:24","guid":{"rendered":"https:\/\/www.mth-partner.de\/?p=5226"},"modified":"2025-06-12T06:57:07","modified_gmt":"2025-06-12T06:57:07","slug":"sozialrecht-anspruch-auf-krankengeld-bei-unterbrochener-feststellung-der-arbeitsunfaehigkeit-bei-verhinderung-wegen-geschaefts-oder-handlungsunfaehigkeit","status":"publish","type":"post","link":"https:\/\/www.mth-partner.de\/en\/social-law-entitlement-to-sickness-benefit-in-the-event-of-interrupted-assessment-of-incapacity-for-work-due-to-business-or-inability-to-work\/","title":{"rendered":"Social law: Entitlement to sickness benefit in the event of interrupted determination of incapacity for work due to incapacity for business or action"},"content":{"rendered":"

Aachen Social Court, 14\/03\/2017, Ref.: S 13 KR 312\/16<\/strong><\/p>\n

According to \u00a7 44 Para. 1 SGB V, insured persons are entitled to sickness benefit if the illness makes them unfit for work or if they are treated as an inpatient in a hospital, a preventive care or rehabilitation centre (\u00a7 23 Para. 4, \u00a7\u00a7 24, 40 Para. 2 and \u00a7 41) at the expense of the health insurance fund. Incapacity for work (AU) is the inability, due to illness, to continue the last occupation or a similar occupation or activity (BSG, judgement of 30 May 1967 - 3 RK 15\/65).<\/p>\n

According to \u00a7 46 Para. 1 No. 2 SGB V, however, the entitlement to sickness benefit only exists if the incapacity for work is medically certified. Furthermore, the entitlement only continues until the day on which the immediately subsequent further incapacity to work due to the same illness is medically certified.<\/p>\n

<\/span>Background to the legal dispute: Entitlement to sick pay<\/span><\/h3>\n

In the present case, the plaintiff and the defendant, a health insurance company, were in dispute about the entitlement to sickness benefit for the period from 1 March to 31 July 2016. The plaintiff, who had been unemployed since July 2014 and was receiving unemployment benefit until February 2016, was unable to work from 8 January 2016 due to moderate depression. After her unemployment benefit expired, she received sickness benefit from 29 February 2016. However, due to gaps in the certificate of incapacity for work, the health insurance fund refused to continue payment from 1 March 2016.<\/p>\n

<\/span>Decision of the health insurance company: Refusal of sickness benefit<\/span><\/h3>\n

In a decision dated 9 March 2016, the health insurance fund refused to continue paying sick pay from 1 March 2016. It justified this by stating that the entitlement to sickness benefit only existed if the incapacity for work was certified by a doctor without any gaps. As there were gaps of a few days between the individual certificates from the treating doctor, the health insurance fund considered the claim to have lapsed. The claimant then filed a lawsuit and argued that she had not been able to see her doctor in time due to her depressive illness.<\/p>\n

<\/span>Judgement: Social court rules in favour of the plaintiff<\/span><\/h3>\n

The Aachen Social Court ruled in favour of the claimant and declared the health insurance company's rejection notices to be unlawful. The claimant was entitled to sick pay for the period from 1 March to 31 July 2016. The court found that the claimant had been unable to work due to her illness and that the gap in the certificates was therefore justified. The treating doctor also confirmed that the incapacity to work had existed continuously since 8 January 2016.<\/p>\n

<\/span>Legal basis and exceptions: Incapacity to act as a decisive factor<\/span><\/h3>\n

According to \u00a7 192 Para. 1 No. 2 SGB V, incapacity for work must be medically established. The court stated that in exceptional cases, a retroactive determination of incapacity to work is permissible if the person concerned was unable to seek medical help in good time due to their illness. In this case, the court recognised that the plaintiff was actually incapable of acting. The claimant had taken the necessary steps to secure her entitlement to sickness benefit immediately after the end of her incapacity to work.<\/p>\n

The judgement makes it clear that in special cases, such as serious mental illnesses, exceptions to the strict application of sick pay regulations are possible.<\/p>\n

Source: Social Court Aachen<\/p>\n

Lawyers in Cologne advise and represent you in social law.<\/a><\/p>\n

Important Note: The content of this article has been prepared to the best of our knowledge and belief. However, due to the complexity and constant evolution of the subject matter, we must exclude liability and warranty.<\/strong> Important Notice: The content of this article has been created to the best of our knowledge and understanding. However, due to the complexity and constant changes in the subject matter, we must exclude any liability and warranty.<\/p>\n

If you need legal advice, feel free to call us at 0221 \u2013 80187670 or email us at info@mth-partner.de.<\/p>","protected":false},"excerpt":{"rendered":"

The Aachen Social Court ruled that the claimant was entitled to sick pay for the period from 1 March to 31 July 2016 despite an incomplete certificate of her incapacity to work due to her illness.<\/p>","protected":false},"author":4,"featured_media":11739,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[],"class_list":["post-5226","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-erbrecht-anwalt"],"yoast_head":"\nSozialrecht: Anspruch auf Krankengeld bei unterbrochener Feststellung der Arbeitsunf\u00e4higkeit bei Verhinderung wegen Gesch\u00e4fts- oder Handlungsunf\u00e4higkeit - Rechtsanwaltskanzlei\u00a0Tieben<\/title>\n<meta name=\"description\" content=\"Kl\u00e4gerin hatte trotz l\u00fcckenhafter Bescheinigung ihrer Arbeitsunf\u00e4higkeit aufgrund ihrer krankheitsbedingten Handlungsunf\u00e4higkeit Anspruch auf Krankengeld\" \/>\n<meta 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