7 Critical Steps Regarding Work Disability

7 Critical Steps Regarding Work Disability. Working life harbors various risks. Work accidents or illnesses can temporarily cause loss of working capacity. The Social Security Institution (SGK) protects employees in this situation. Incapacity to work is the situation where the insured person is unable to work. This situation is secured by laws. The Social Insurance and General Health Insurance Law No. 5510 constitutes the fundamental basis. In this article, the concept of incapacity to work is examined. The reporting process and the calculation of the allowance are discussed in detail.

1. Definition and Legal Basis of Incapacity to Work

Incapacity to work is the inability of the insured person to work due to health reasons. This situation has been registered by the SGK.

• Temporary Incapacity to Work: This is the insured person’s inability to work for a short period. It is proven with a health report. Payment is made by the SGK during the report period.
• Permanent Incapacity to Work: This is the situation where there is a permanent loss in the insured person’s working capacity. An income is provided based on the permanent loss rate.
• Legal Basis: Law No. 5510 regulates incapacity to work payments. The Law determines the conditions and amount of the allowance. Consequently, the victimization of workers is prevented.

2. Types of Incapacity to Work and Allowance Conditions

The temporary incapacity to work allowance is paid under three main branches of insurance. Each branch has its own conditions.

a. Work Accident and Occupational Disease: In this case, no insurance period condition is sought for the incapacity to work allowance. The insured person gains the right to receive the allowance from the first day. However, the accident must occur at the workplace or during commuting.

b. Sickness Status: This situation is when a person is unable to work due to illness. Certain conditions are necessary to receive the allowance. Payment is made from the third day of the report. The insured person’s condition of paying premiums for at least 90 days within the last year is sought.

c. Maternity Status (Birth): An allowance is given to the female insured person during the maternity leave period. The leave period before and after the birth is within this scope. The condition of paying premiums for at least 90 days within the last year is sought. Furthermore, this payment is popularly known as “maternity money.”

3. The Process of Issuing the Incapacity to Work Report

A valid health report is mandatory for receiving the allowance. The report must be issued in accordance with the procedure.

• Report Authority: The incapacity to work report is issued only by authorized physicians or health boards. Private or public hospitals have this authority.
• Electronic Transmission: Reports are transmitted to the SGK electronically. In addition to this, the employer must also be informed. The insured person is expected to present the report to the employer.
• Single Physician Report: A single physician can issue a report for a maximum of 10 days at a time. The total report period cannot exceed 40 days. Health board reports are required for situations exceeding 40 days.

4. Conditions for Temporary Incapacity to Work Allowance (Report Money)

Conditions set by the SGK must be fulfilled to benefit from the allowance.

• Premium Day Condition: The 90-day premium payment condition is sought for sickness and maternity insurance. This condition is not sought in the case of a work accident.
• Notification by the Workplace: The employer is obliged to notify the SGK that the insured person is on rest leave. The notification period is determined as 5 days.
• Payment with Transition Words: Payment is made throughout the period of the insured person’s report. The first two days of the report are not paid in case of sickness. However, payment is made from the first day in the case of a work accident.

5. Incapacity to Work Allowance Calculation Method

The incapacity to work allowance is calculated based on the insured person’s daily earnings. This calculation is done with a simple formula.

• Earnings Basis: The daily earning serving as the basis for the allowance is calculated. For example, the prime-based earnings of the last three months before the report date are summed up. The total earnings are divided by the number of premium days in these three months.
• Allowance Rate: The incapacity to work allowance is a rate of the calculated daily earning. Half (%50) of the daily earning is paid for outpatient treatment. This rate is applied as two-thirds (%66.66) for inpatient treatment in the hospital.
• Maternity Status: In the maternity situation, the allowance rate is calculated based on the outpatient treatment rate. Therefore, this situation provides an advantage to the insured person.
• Payment Method with Transition Words: Payment is made via PTT or banks. Consequently, the insured person’s registration in the SGK system is mandatory to receive the payment.

6. Permanent Incapacity to Work Income and Conditions for Provision

7 Critical Steps Regarding Work Disability. Permanent loss of working capacity may occur as a result of treatment. In this case, a permanent incapacity to work income is provided.

• Permanent Incapacity to Work: There has been a permanent reduction in the insured person’s earning capacity in the profession. The reduction rate must be at least 10%.
• Health Board Report: The permanent loss rate is determined by the health board report authorized by the SGK. This report must be final.
• Income Calculation: The permanent incapacity to work income is calculated based on the loss rate. For example, if the loss rate is 20%, 20% of the determined income is paid.
• Income Provision Period: The income is paid until the insured person’s death.

7. Status of the Employment Contract During Incapacity to Work

The state of incapacity to work also affects the relationship between the employee and the employer. The termination processes of the employment contract are affected by this situation.

• Employer’s Right to Terminate: The employer has the right to terminate the employment contract. However, this right is limited by certain periods.
• Just Cause Termination Limit (Seniority Period): If the incapacity to work period exceeds the employee’s notice period by six weeks, the employer gains the right to terminate. This period varies according to the employee’s seniority. In addition to this, the employer must not abuse the right to terminate.
• Obligation to Pay Wages: The employer is relieved of the obligation to pay wages during the report period. An allowance is paid by the SGK instead of wages. However, the employment contract is not terminated.

Guarantee of Social Security

7 Critical Steps Regarding Work Disability. The incapacity to work allowance is the guarantee of employees against health risks. Firstly, the premium day conditions must be met to receive the allowance. The premium condition is not sought in the case of a work accident. The allowance is calculated at a rate of 50% or 66.66% of the daily earning. Consequently, the correct tracking of report and notification processes is critically important for the insured persons not to suffer a loss of rights.