Occupational disease

An occupational disease is recognized if it was caused by the harmful effects at the workplace. This must be checked by the accident insurance institutions. The following must be established for recognition:

• the insured person has one of the diseases listed in the BKV,
• the insured persons were exposed to the relevant harmful effects at their workplace,
• there is a causal link between the activity at the workplace, the exposure and the development of the disease.

Note: If a disease is not included in the list of occupational diseases, it may be recognized "as" an occupational disease. However, this is only possible in exceptional cases if new general findings of medical science are available on the causal relationship. A connection only in individual cases is not sufficient.

In principle, doctors and employers are obliged to report suspected occupational diseases to the accident insurance institution. The official template for a suspected occupational disease report can be requested from the accident insurance institutions. Other persons, in particular the insured persons themselves or their relatives, also have the right to report such a suspicion. The health insurance funds also have the option of sending a report of suspected illness to the accident insurance institutions.

In order to determine whether there is a connection between the occupational activity and the damaging effect, the insured person's work history is usually determined first (work history). This involves examining the stresses and impacts to which the insured person was exposed during their working life. For this purpose, questionnaires are sent to the insured persons and to the companies where they were employed; however, personal interviews and examinations at the workplace may also take place or previous documents, e.g. on pollutants or air measurements at the workplace, may be consulted. Other persons able to provide information (e.g. company medical service, works council, safety officers, work colleagues) can also be included.

Note: The documents relating to the work history form the basis for all further investigations, in particular for the medical assessment of the causal relationship. Insured persons should therefore complete the questionnaires as accurately and in as much detail as possible, as they are often best placed to provide information about the conditions at their workplace.

If a hazard at the workplace could be identified, it must be clarified whether, from a medical point of view, the harmful effect caused the illness. For this purpose, the medical history is regularly determined and an expert opinion is obtained. The accident insurance institutions do not have their own medical experts, but commission external specialists in surgery, orthopaedics, neurology, etc. to provide expert opinions. The accident insurance institution must provide the insured person with at least three experts to choose from

Note: Insured persons can also propose experts themselves. However, they must be suitably qualified. The accident insurance institution can reject persons who do not have the necessary qualifications (e.g. the family doctor) as experts.

In principle, the insured person can receive a copy of the expert opinion from the accident insurance institution. Before the final decision is made, the responsible occupational physicians must be involved as representatives of the state occupational health and safety authorities.

Ultimately, the accident insurance institution decides whether the illness is recognized or rejected as an occupational disease. The insured person is informed of the recognition or rejection of the occupational disease by written notification. The pension committee of the accident insurance institution decides on the recognition or rejection of pensions. This committee consists of one member each from the group of employers and employees.

An appeal against the decision can be lodged with the accident insurance institution within one month. The insured person must be informed of this in the decision. If the accident insurance institution's appeals committee rejects the appeal, the insured person can take legal action before the social court.