Employment Injuries and Occupational Diseases: Benefits (Temporary Incapacity) a), 2009

Transcription

1 Austria Belgium In principle free choice. Persons insured in sickness insurance receive the benefits primarily from sickness insurance; the accident insurance fund, however, can assume the treatment at any time. Free choice, unless for employment accident, if the enterprise has a recognised, comprehensive medical department. For the first 4 weeks: sickness insurance fund covers the expenses, otherwise by accident insurance fund. No co-payment of the insured person with the exception of a minor contribution in case of hospital care, medical or dental treatment, and for pharmaceutical products. Employment accident: If free choice allowed, refund subject to an official scale. If organised department: Free care. Occupational disease: According to official rate and specific nomenclature. 3 days for sickness benefit. Employment accident: Occupational disease: Minimum of 15 days of incapacity. Until recovery or permanent condition (2 years later at the latest a permanent pensions is to be determined). Until recovery or permanent condition. For the first 26 weeks entitlement to sickness benefit: 50% of gross wage or salary, 60% from 43rd day of illness. Ceiling: EUR 4,020 per month (general maximum contribution basis). For persons with earnings below the marginal earnings threshold for compulsory insurance who are voluntary insured, the sickness benefit is EUR Continued payment of wages for workers and employees between 6 and 12 weeks, following the length of service. At the end of this period they are entitled to the payment of half their salaries for a period of 4 weeks. No sickness benefit during 100% continued payment of wages, half of sickness benefit for the period in which 50% of the salaries are paid. Total incapacity: Per calendar day 90% of basic earnings divided by 365 days. Partial incapacity: Benefit equal to the difference between earnings before the accident or the beginning of incapacity due to occupational disease, and the earnings in partial employment. Basic earnings used for calculation: Effective yearly earnings in the year preceding the accident or the incapacity due to an occupational disease. Maximum: EUR 36, Minimum for minors and apprentices: EUR 5,948.76; taking into account of wages of adult workers, when minors become of age. Page 1 of 11

2 Bulgaria Cyprus Patients must register with a general practitioner (GP) who has a contract with the National Health Insurance Fund. Re-registration is possible twice a year (during the periods 1-30 June and 1-31 December). Patients are allowed to select any health care hospital in the country if they have a referral from their GP. Free choice of Government doctors and State hospitals. Benefits in-kind system. Any person covered under contributions funded scheme pays the physician, dentist or health-care facility (providing medical care) for each visit 1%, and for each day of hospital treatment: 2% of the national minimum (monthly) wage, but not more than ten days annually. The minimum wage is currently BGN 220 (EUR 112) per month. Free medical treatment provided by Government hospitals and institutions (the expenses are covered by the Social Insurance Fund). Under certain conditions the treatment may be provided by private institutions as well. Paid from the second day of illness until the recovery of capacity for work or the establishing of invalidity. 3 days. 12 months maximum from the date of accident. 90% of the average daily gross remuneration or the average daily contributory income on which insurance contributions have been paid for the period of six calendar months preceding the occurrence of the incapacity for work. Basic Benefit: 60% of the weekly amount of full Basic Insurable Earnings over the benefit year, increased by 1/3 for the first dependant and by 1/6 for other dependants (maximum of three dependants). A spouse (male or female) is a dependant if he/she is neither working nor receiving any benefit from the Social Insurance Fund. In the case where the spouse is not a dependant of the beneficiary, the increase for the dependant children is equal to the 1/6th of the basic benefit for each child (maximum number of dependant children: two). In no case the amount of the benefit is based on an amount of earnings which is less than the Basic Insurable Earnings. Supplementary Benefit: 50% of the upper part of weekly average insurable earnings over the benefit year. Maximum weekly amount of supplementary benefit cannot exceed Basic Insurable Earnings. Page 2 of 11

3 Czech Republic Denmark, with the exception of preventive care which may be provided by the enterprise's own health centres or contractual doctors. Every Danish citizen can choose once a year between two groups: Group 1 entitles to free medical treatment by GP who has joined collective agreement with the Public Health Service. Group 2 entitles to free choice of medical practitioner - also among GPs who have not joined collective agreement. The Public Health Service in this group only pays - in the principle a part of the doctor's fee. Free choice of public hospital. Patients can also choose a private hospital in Denmark or abroad with agreement with the regional health authorities if the waiting time after referral to treatment in a regional public hospital is more than 1 month. Costs of treatment, the so-called "adequate expenditure" (set down by law), are borne by the employer (who is compulsorily insured). The public health service at a regional level pays the public health service s contribution directly to the doctor. Public hospitals, approved private establishments and private hospitals with agreement with the regional health authorities: No charge. Non-approved private establishments: patients pay all costs. Costs of prosthesis, artificial limbs, orthopaedic equipment and wheel chairs can be covered by the injury insurance. Group 1: No charges (Treatment by the chosen GP or a specialist to whom he refers the patient). Group 2: The part of expenses which exceeds the amount fixed by the public scheme for Group 1. The employer has unlimited liability for damage as long as he is not fully or partially removed from the liability. The employer s liability depends on existing damages (on loss of earnings). Compensation of loss of earning after inability to work is paid until 65 years of age or until the day of award of the old-age pension. 52 weeks in 18 months. Benefits can be paid for a longer period when an ill person work capacity seems recoverable. If necessary, benefits can be paid for a longer period up to 26 weeks, in order to test the ill person work capacity. The difference between the average gross wages earned in the previous quarter before the employment injury or appearance of the occupational disease, and the full amount of sickness benefit. Employees: Sickness cash benefit calculated upon the basis of the hourly wage of the worker (contributions to Labour Market Fund deducted), with a maximum of DKK 3,625 (EUR 487) per week or DKK 98 (EUR 13) per hour (37 hours per week), and upon the number of hours of work. Period to be covered by the employer: 2 weeks. Self-employed: Sickness cash benefit calculated on the basis of the earnings from the occupational activity of the self-employed person, with the same maximum as mentioned above. The self-employed persons who have taken out a voluntary insurance (see above), are entitled to at least 2/3 of the maximum amount. Page 3 of 11

4 Estonia Finland Free choice of general practitioner. Access to specialists by referral of the patient's general practitioner. Access to psychiatrist, gynaecologist, dermatovenereologist, oculist, traumatologist or surgeon in case of emergency surgery is possible without a referral from the general practitioner. Hospitalisation: Referral by general practitioner or specialist. Private and public sector care are both compensated by insurer in full. Free choice, but avoiding unnecessary costs. The insurance company is, however, entitled to choose the hospital of treatment except in cases of emergency care and a single consultation with a doctor. Benefits in-kind system. Up to EEK 50 (EUR 3.20) per home visit or for a visit for out-patient specialised medical care (set by the Board of the Hospital). Hospitalisation: For the services provided in standard conditions of accommodation. Not for more than 10 calendar days for one case of disease and not for more than EEK 25 (EUR 1.60) for a day. Paid in full by responsible institution. France Free choice. Direct payment by the primary social security fund. No co-payment of the victim within insurance ceiling. No hospitalisation fee. Germany In principle: No free choice; the patient must as soon as possible visit the "transition doctor" appointed by the employers' insurance association. Any subsequent medical treatment is carried out by approved specialists approved by the accident insurance institution. Payment is made by the accident insurance institution from the beginning. In principle no co-payment by the beneficiary. For the agricultural accident insurance the co-payments amounts to at least EUR 10 per day for farm and household support. One day. None provided that the disability last for at least three consecutive days not counting the day on which the accident occurred. (In case shorter, no allowances are paid). In principle no waiting period. Exception: qualifying period of 26 weeks for benefits of an insurance pension to agricultural entrepreneur as well as their spouses / partners. Up to 182 calendar days per case of illness. In case of tuberculosis up to 240 calendar days per case of illness. In case of work injury, occupational disease or other health impairment connected to work caused by the fault of the employer: 100% of the reference wage. 1 year. The amount of the daily allowance equals to sick pay for the first 4 week. After four weeks it is the 360th part of the annual earnings of the insured person. Until recovery or permanent condition. Payment of injury benefits during accident-related incapacity for work, as a rule for a maximum of 78 weeks. Amount: 60% of basic earnings for 28 days, max. EUR thereafter 80%, max. EUR No reduction for hospitalisation. Basic daily earnings used for calculation: 1/30th of the previous salary if it was paid monthly. 1/28th of the two previous wages if these were paid weekly or every 2 weeks up to 0.834% of the annual ceiling. The injury benefits are calculated in principle as in statutory sickness insurance, it amounts to 80% of the average gross earnings of the month before the incapacity occurred. The amount must not exceed the net salary. Page 4 of 11

5 Greece Hungary Ireland In urban regions, the insured choose the family doctor according to a list. In rural areas, there is no free choice; the insured goes to the local insurance institute doctor. The insured has the right to hospitalisation in a public hospital or in a registered clinic designated by the insurance institute or in a hospital of the social insurance institute. In emergencies, hospitalisation in a noncontracted hospital/clinic is allowed. In these cases, the insured is entitled to reimbursement of an amount equal to the set State fee. (but referral system exists). Persons with full eligibility must choose from a list of local general practitioners who are contracted by the HSE b) to provide services under the GMS c) Scheme. Persons with limited eligibility attending a GP in a private capacity choose their own GP. Persons with limited eligibility holding a GP visit card select a GP from a list of those who are contracted by the HSE to provide services under the GMS Scheme. Hospital: Referral via general practitioner/ specialist. Full payment by the competent institution. No co-payment by the beneficiary. All costs (including medicines, medical aids and dental care) are paid by the Health Insurance Fund. Costs of medical care which are not met under the General Medical Health scheme may be paid where such care is considered reasonable and necessary. Work Accident Sickness Benefit: Duration of benefits depending on the length of the period of contributions: 182, 360 or 720 days. Work Accident Sickness Benefit: Payable (irrespective of the preceding period of insurance and any previous payments of sick pay) for one year with the possibility of an extension for a further year. 3 days. Maximum of 156 days (Sundays excluded). In the case of sickness: For the first 15 days: The total ceiling for sickness benefit plus supplement for dependants (max. 4) is EUR per day (daily wage assumed for 3rd insurance category). After 15 days: The total ceiling for benefits plus supplements for dependants (max. 4) is EUR per day (daily wage assumed for 8th insurance category). 100% of the average income forming the basis of Sickness Benefit. EUR per week. Additional allowances payable for dependants. Page 5 of 11

6 Italy Free choice of general practitioner among those approved for the region. The choice is confirmed unless the insured decides otherwise. Free choice of a public or private hospital under contract. Where corresponding structures exist, the National Insurance Institute for Employment Injuries insures first aid, otherwise recourse to the National Health Service. Insured persons pay up to EUR 36 for each test carried out or each visit to a specialist, to a physiotherapist or a water cure; by prescription there can be a maximum of 8 services rendered in the same specialised field and a maximum of 6 for sports medicine or rehabilitation benefits. Hospitalisation: Direct assistance free (sharing a room). Latvia. Costs, which are not covered by the basic health care programme and costs of rehabilitation not covered by the basic social care programme are met by the work injury insurance. Lithuania. Full payment by the competent institution. 3 days from the day after the accident. In practice, the employer indemnifies this period (100% the day of the accident, 60% for the following 3 days). As of the fourth day, the National Insurance Institute for Employment Injuries compensates the worker with up to 60% of his/her daily earnings for 90 days or 75% from the 91st day. Until recovery or permanent condition. 1 day. 52 weeks from first day of incapacity if incapacity has been continuous, or 78 weeks over a 3 year period if incapacity has been repetitive with interruptions. No waiting period Until recovery or permanent condition. 60% of the average daily earnings received during the 15 working days prior to cessation of work for 90 days; thereafter 75%. 80% of the average gross wages upon which contributions have been calculated during six months. This six-month period applies from two months before the month in which the incapacity occurred. 100% of average monthly Compensatory Wage. The monthly compensatory wage comprises the average wage based on insured person s insured income earned in the calendar quarter before the last calendar quarter proceeding the calendar quarter in which the temporary incapacity occurred. The compensatory wage cannot exceed 5 times the national average insured income (although contributions are paid on the full gross wage). Lump sum compensation for lost capacity of work is paid in the amount of: Page 6 of 11

7 Lithuania (cont.) less than 20% loss of capacity: 10% of 24 times the monthly compensatory wage. The amount is 3 times higher in case of permanent incapacity. 20% to 30% loss of capacity: 20% of 24 times the monthly compensatory wage. The amount is 3 times higher in case of permanent incapacity. Luxembourg Free choice. Directly by the insurance association. Sickness benefit until recovery but for a maximum period of 52 weeks. For permanent condition, granting of an annuity. Gross salary which the employee would have earned if he had continued to work. Malta Free hospitalisation and treatment are available in Government Hospitals or Government Health Clinics. Benefit-in-kind system. First 3 days of injury or disease is not paid by the Social Security department but are covered by the employer. The insured victim is entitled to have one year injury leave on full pay from his employer and has to refund the amount received from the Social Security department to his employer. The employed person is entitled to full-pay as long as the duration of incapacity does not exceed 1 year from the date of injury. The social security benefit is paid directly to the insured person but he has to refund this amount to his employer. In the case of self-occupied persons the amount is paid to the claimant and kept by the claimant. Injury Benefit is payable according to the number of days normally worked by the injured person. The rates are as follows: Married person: EUR per day. Single person: EUR per day. Page 7 of 11

8 Netherlands Free choice of doctor and among hospitals or institutions approved by the Minister of Health. Poland Portugal Free choice of registration with a general practitioner contracted by regional National Health Fund. Change possible twice a year. Free choice of contracted hospital. Hospitalisation upon referral by a contracted doctor Employment injuries: Insurance provides for all forms of care. Occupational diseases: Care provided by National Health Service. Payment by the private health insurance company. Health Insurance Act: Mandatory deductible. General Exceptional Medical Expenses Act: For most types of care under the Act, insured persons over 18 are required to make personal contributions towards the costs. Direct payment by the National Health Fund. Paid in full by responsible institution. 104 weeks. 70% of the daily wage. The maximum daily wage considered: EUR months; 9 months in case of tuberculosis. Whilst victim is undergoing medical treatment or occupational rehabilitation. Amount: 100% of reference wage per month from sickness insurance. Reference wage: calculated on the basis of contributory earnings during the 12 months insurance preceding the cessation of work. Employment Injuries: Total incapacity: 70% of reference wage. Partial incapacity: 70% of the reduction of general capacity of earnings. Reference: daily wage or 1/30 of the monthly wage at the day of accident. Occupational diseases: Total incapacity: 70% of daily wage during the first 12 months of incapacity. After this period: 75%. Partial incapacity: 70% of the reduction of general capacity of earnings. The amount is reduced to 45% when there is hospitalisation, except if there are dependent persons. Reference: daily wage resulting from the division of the annual wage by the number of days with registered contributions. Page 8 of 11

9 Romania Slovak Republic The administering institution of the employment injury and occupational diseases insurance scheme chooses the medical rehabilitation providers., with the exception of preventive care which may be provided by the enterprise's own health centres. by the employment injury and occupational diseases insurance scheme. No co-payment. Borne by the compulsorily insured employer. Slovenia. The compulsory health insurance covers all costs of medical treatment for employment injuries and occupational diseases as well as any rehabilitation thereafter. Temporary Working Incapacity Indemnity due to employment injuries or occupational diseases: No waiting period. 180 days in one-year period, counted from the first day of medical leave (may be extended up to maximum 270 days). Injury Surcharge Benefit: Maximum 52 weeks. Paid from first day of incapacity until recovery or entitlement to Invalidity Pension) or other invalidity benefits. Recipients are referred to the Invalidity Commission by their personal doctor, or health board, if a return to full working capacity is not expected and in any case after one year's uninterrupted claim. 80% of reference earnings (100% in case of medical/surgical emergencies). Reference earnings: average of the monthly gross incomes earned by the beneficiary during six months preceding the contingency (or during the period that is shorter than six months) Injury Surcharge Benefit as a surcharge to the Sickness Benefit: 55% of the daily assessment base for the first 3 days; 25% of the daily assessment base for the following days of incapacity. Daily assessment base: Average daily earnings in the calendar year before the injury occurred. Sickness Benefit: Compensation of wages for temporary absence from work due to an occupational disease or employment injury is 100% of the base. The base is the average monthly gross wage the insured person received in the calendar year preceding the year in which the temporary absence occurred. Sickness benefit must be no lower than the Statutory Reference Amount of EUR and no higher than the wage the insured would receive if she/he worked. Page 9 of 11

10 Spain Sweden United Kingdom Free choice of doctor but not of hospital. Free choice of doctors in the public health and private practitioners affiliated to a county council. Free choice of regional public hospitals and approved private establishments. Free choice by patient (or parent/guardian), subject to acceptance by the practice. If a patient cannot find a practice willing to accept them, the Primary Care Organisation has the power to assign a patient to a practice's list. Hospital: On referral by the general practitioner. No fees to be paid by beneficiary. Cost of treatment borne by social security scheme. Official scale for all items of treatment by health professionals and establishments not forming part of, or operating under agreement with the National Health System. The patient pays a part of the cost himself. The doctor, if a private practitioner, is paid the rest from the county councils. The insured person pays between SEK 100 (EUR 9.22) and SEK 200 (EUR 18) per visit to a doctor. For specialist care: between SEK 200 (EUR 18) and SEK 300 (EUR 28). Emergency cases: between SEK 100 (EUR 9.22) and SEK 300 (EUR 28). Hospitalisation: The patient will be charged maximum SEK 80 (EUR 7.38) per 24 hours. Necessary costs for medical treatment abroad, dental care and special aids for handicapped persons are covered. No charges to the patient for National Health Services 12 months. Possibility of extension for 6 months when foreseeable that the beneficiary will become capable for work. 1 day. There is no formal limitation but the sickness cash benefit may be converted into Activity compensation (for persons aged 19 to 29 years) or Sickness compensation (for persons aged 30 to 64 years) if the illness continues for an extended period of time. Industrial Injuries Disablement Benefit: Payable from 91st day after the date of the industrial accident or onset of the disease, except mesothelioma, which is payable from the date of onset (all subject to 3 months limitation on backdating). Industrial Injuries Disablement Benefit: Payable for the duration of the assessment of the disablement. Sickness Benefits: Maximum of 28 weeks for Statutory Sick Pay and 52 weeks for Short-term Incapacity Benefit. 75% of the calculation basis from the date after the sick leave starts. The factor 0.97 is multiplied by 80% of the income qualifying for sickness cash benefit. The rate of payment depends on the degree of disablement ("t"): "t" = 1%-13%: Nothing payable, except for pneumoconiosis and byssiniosis: "t"=1%-10%: GBP13.68 (EUR14) a week, "t" = 11%-19%: GBP (EUR 28) a week. For all other diseases: "t" = 14% required for a pension ("t" = 14%-19%: treated as 20%). Except occupational deafness where t = 20%. Page 10 of 11

11 United Kingdom (cont.) Occupational deafness is payable from the date of onset or the date of claim, if later. Statutory Sick Pay or Short-term Incapacity Benefit: 3 days. Diffuse Mesothelioma and Primary Carcinoma of the lung with exposure to asbestos, are paid at the 100% rate. Benefit Amount: Paid weekly in 10% increments according to the level of disablement (rounded to the nearest 10%): Age 18+, or under 18 with dependants: From 20%: GBP (EUR 28) to 100%: GBP (EUR 142) Under age 18: From 20%:GBP (EUR 17) to 100%: GBP (EUR 87). Norway Switzerland All residents are individually linked to a regular primary doctor of their own choice, where possible. Change of regular primary doctor can be made up to twice a year. Opt out possibility exists. Free choice of hospital (does not apply in cases of emergency). Free choice. The insured person is entitled to treatment, board and accommodation in the general ward of a hospital with which an agreement on collaboration and tariffs has been concluded. No co-payment in case of medical treatment of occupational injuries. Payment by the insurer. No contribution by person involved. 1 year. Basic system: 100% of the income at the time of the accident. Occupational Injury Insurance: Top-up where needed to give full compensation. 3 days. According to labour law the employer must pay 80% of the salary the first 3 days. (a) Situation as of 1 January (b) HSE: Health Service Executive. (c) GMS: General Medical Services. Duration of the incapacity but only up to the payment of a pension or the death of the insured person. Source: European Commission, Directorate-General for Employment, Social Affairs and Equal Opportunities, MISSOC 2009 ( accessed 09/11/ % of the insured salary, in the event of total incapacity. Proportional reduction in the case of partial incapacity. Insured salary = latest salary the insured person received before the accident, including family allowances. Maximum daily insured salary: CHF 346 (EUR 233). Page 11 of 11