Scand J Work Environ Health 1996;22(4):306-311 pdf
https://doi.org/10.5271/sjweh.145 | Issue date: Aug 1996
Regulations on occupational diseases and the current situation in Germany
Statutory accident insurance institutions in industry and trade (Berufsgenossensdaft) recognize and compensate only those occupational diseases which have been attributed to particular tasks by the legislative body. Social safeguards against other diseases are principally covered by the health insurance system, and those against the restriction or loss of work ability due to other reasons are a part of the legal pension scheme.
The Ministry of Labour and Social Affairs (Bundesministerium für Arbeit und Sozialordnung, BMA) keeps statistics on both the claims made to all insurance carriers and the compensations that then are paid. In addition to statutory accident insurance institutions in industry and trade, insurance carriers exist in the public and agricultural sectors. Occupational diseases of the latter primarily refer to infectious diseases (no 3101 and 3102), diseases due to organic dusts (no 4202), obstructive airway diseases (no 4301), and skin diseases (no 5101) (3).
Available data on the other insurance carriers, namely, those in the public sector and the statutory agricultural insurance institution, are shown in figure 1 A (4).
The increase in the number of reports in recent years can be traced directly to three phenomena (figure 1 A and B). Until 1985, statutory accident insurance institutions in industry and the trades did not register claims that had been earlier identified as not fulfilling statutory requirements for occupational diseases. However, since 1986, each claim has been registered as "report of suspected occupational diseases." This measure has resulted in a rapid increase of suspected cases in the statistics since 1986. In 1988, the list of occupational diseases was broadened to include additional occupational diseases (no 1314, 4109, 4110 and 4203). Finally, since 1991, data from the German Democratic Republic (GDR) have been included in the statistics. The GDR applied a similar system for occupational diseases. Compensations according to former GDR law were granted temporarily. Since 1992, 551 of the National Insurance Code has also been valid for the new federal states (Bundesländer). Although the former GDR law on occupational diseases is no longer valid, full-scale benefits are granted for diseases not included in the list if their onset dated before 1 January 1992.
In addition, there have been some more indirect influences on the increase in the number of reported cases of occupational disease. For example, public relations work in the media has sensitized the population to health risks in workplaces. Besides, the introduction of occupational medicine to university studies has elevated the attention of the medical profession. The increase in systematic occupational medical examinations to more than four million in 1994 is also a causal factor.
The great increase in the number of cases in 1993 was mainly a result of the inclusion of discogenic diseases of the cervical and lumbar vertebral column due to the long-term lifting and carrying of heavy loads, activities in extreme postures or exposure to whole-body vibration requiring the cessation of activities (no 2108--2110). These new occupational diseases have to be recognized retrospectively on demand if the event occurred after 31 March 1988. Reports on, for instance, discogenic disease of the cervical and lumbar vertebral column due to the lifting or carrying of heavy loads or due to long-term activities in extreme positions (no 2108) decreased in 1994 by more than 5000 cases because the surplus of the previous year was reduced. The cases reported according to former GDR regulations dropped by about 50%. This development is due to the fact that diseases consistent with GDR law only had to be reported if they occurred before 1 January 1992.
With a maximum of 31%, compensation claims for diseases due to mechanic impact (25 722 cases) dominated, followed by skin diseases with 18 786 cases (22%) and impaired hearing due to noise with 12 616 cases (15%).
Claims for airway diseases due to inorganic dusts amounted to 9141 cases (11%), and there were 6912 cases (8%) of obstructive airway disease.
This group also includes persons who were not granted a lifetime or a postmortem pension. In addition to acute poisoning leading to death (eg, due to carbon monoxide) occupational diseases of patients who undergo rehabilitative treatment between the event and death and were thus not entitled to a pension according to 580 of the National Insurance Code (eg, silicotuberculosis) are included.
In 1994 the mortality rate rose by 10%. Two-thirds of these cases were induced by inorganic dusts. Mortalities due to ionizing radiation mainly resulting in lung cancer due to activities in uranium mining in the former GDR also increased distinctly.
The spectrum of benefits provided by statutory accident insurance institutions in industry and the trades is comprised of medical rehabilitation, occupational rehabilitation, cash payments to injured persons, and temporary payments and benefits according to 3 of the Occupational Disease Ordinance.
The total payment for compensation in 1994 amounted to DEM 13.4 billion. More than DEM 8.9 billion had to be spent on pensions and benefits to diseased persons, while the costs of cures added up to DEM 4 billion, corresponding to 66% or 30%, respectively. DEM 523 million was paid for occupational reintegration.