What is the name of this model 6
1. The most important things in a nutshell
The gradual reintegration (so-called Hamburg model) is intended to gradually bring disabled employees to full workload after a long period of serious illness and thus facilitate the transition to full employment. During the gradual reintegration, the employee is still on sick leave. If you are unable to work for more than 6 weeks, the possibility of gradual reintegration is regularly checked by a doctor. Gradual reintegration is only possible if the insured and the employer agree and this does not result in any adverse health consequences.
Everyone involved, employee, employer, doctor or insurance company can suggest gradual reintegration. Certain forms are required for this.
The following requirements must be met for all insurance providers:
- The attending physician determines that the previous activity can at least partially be resumed.
- There is an incapacity for work (AU) before and during the measure.
- The employee is deployed in the previous workplace and is sufficiently resilient, i.e. he can work at least 2 hours a day.
- The employee agrees to the integration voluntarily and in writing. He can cancel the reintegration at any time.
Severely disabled and employees who are equivalent to them, unlike employees who are not severely disabled, are entitled to the consent of the employer for gradual reintegration if a reintegration plan is available with all work that is permitted from a medical point of view and a prognosis as to whether and when full or partial ability to work can be expected. With the help of this information, the employer can check whether the employment is reasonable for him. He can refuse a gradual reintegration of a severely disabled employee due to unreasonableness but only in individual cases.
Even if the reintegration takes place in the course of a BEM (company integration management), the employer must not reject reasonable suggestions, but must discuss them with all parties involved.
3. Initiation of a gradual reintegration
Gradual reintegration is used after long, serious illnesses.
3.1. Reintegration after rehab
It can begin following medical rehabilitation or in parallel with outpatient rehabilitation measures. If a patient is discharged from a rehab facility and is unable to work, the rehab facility must send a checklist for gradual reintegration to the health insurance company and the pension insurance agency, in which they state the (non-) need and the (non-) initiation of reintegration documented. The patient can object to the transfer of data to the health insurance company. He also receives a copy of the checklist for his doctor.
Within 14 days after the end of the rehabilitation measure, the health insurance company can also suggest gradual reintegration if there has been a change in the items on the checklist.
3.2. Examination of reintegration after being unable to work for more than 6 weeks
If the duration of incapacity for work is more than 6 weeks, each subsequent certificate from the AU (see incapacity for work) will be checked to determine whether gradual reintegration is possible. The aim is to give insured persons with long-term illnesses the opportunity to return to work at an early stage.
The medical assessment for gradual reintegration can also be rejected by the insured person. His consent is always voluntary.
3.3. Operational integration management (BEM)
Employers must offer employees who have been sick for more than 6 weeks a company integration management (BEM) (Section 167, Paragraph 2 of Book IX of the Social Code). For the 6 weeks, all times are added up that the employee has in the last 12 months
- was reported incapable of work (incapacity for work),
- has reported sick without an AU certificate or
- was absent due to cures and rehab services.
The gradual reintegration can be part of a BEM.
The duration of the gradual reintegration depends on the individual health condition and can be flexibly shortened or extended at any time. It can last up to 6 months, but is usually granted for a period of 4 to 8 weeks.
5. Reintegration plan
In order for the gradual reintegration to take place, both the insured person and the employer must have a so-called Reintegration plan agree, which regulates the exact conditions of the reintegration. The plan is drawn up jointly by all those involved. The following can be in charge, for example: a doctor, a social counselor, the rehab provider or the independent participation counseling.
The reintegration plan contains the following information:
- Beginning and end of the reintegration plan
- Details of the different levels (type and duration) and the financial modalities
- Right of withdrawal before the agreed end
- Reasons for an early resignation
- The conflicting provisions of the employment contract are suspended for the duration of the reintegration
- Amount of any wages paid
The reintegration plan must be flexible and adjusted if necessary, e.g. in terms of duration, levels and daily working hours. This is checked during the regular medical examinations that must accompany the reintegration.
6. Payers and financial security
In terms of social law, gradual reintegration is not an independent measure of medical rehabilitation. In the case of the cost bearer, the main question is who the reintegrated person with so-called Compensation payments financially secure:
- If the reintegration takes place immediately after a medical rehabilitation measure, i.e. if it is started within 4 weeks after discharge from a rehabilitation clinic, the pension insurance is the cost bearer and pays transition allowance.
- If this is not the case, in most cases the health insurance is responsible and pays sick pay.
- If the sickness benefit has expired, the employment agency pays unemployment benefit in the event of incapacity for work.
- In the event of rehab because of an industrial accident or an occupational disease, the accident insurance institution pays injury benefits.
In addition, further rehabilitation services may become due in the course of reintegration, e.g. supplementary rehabilitation services or professional rehabilitation services. The respective institution responsible for reintegration is then responsible; the integration office is only responsible for job assistance.
If the employer voluntarily pays wages during the measure, this will be taken into account and lead to reductions or omission of the wage replacement benefit. However, there is no obligation to pay for the employer.
The right to compensation payments also exists if the gradual reintegration should fail.
7. Practical tips
8. Who can help?
Health insurance, employment agency, accident insurance or pension insurance, social counseling of the rehabilitation clinic, attending doctor, employer.
9. Related links
incapacity for work
Vocational Rehabilitation> Services
Sources of law: § 74 SGB V - §§ 44, 71 Abs. 5 SGB IX
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