Incapacity for work due to depression: How to secure your claims and maintain financial stability
26 May 2025
3
Minutes
Katrin Straub
Managing Director at nextsure
Depressions are one of the main causes of occupational disability, yet many affected individuals are not aware of their rights. Discover how to successfully apply for an occupational disability insurance and what to consider when dealing with mental illnesses. Secure your financial future.
The topic in brief and concise terms
Mental illnesses, particularly depression, are the most common reason for occupational disability in Germany, accounting for over 34 percent.
To be recognised as unable to work due to depression, there must be evidence of at least a 50 percent reduction in the ability to work, expected to last at least six months, usually through specialist medical assessments.
Truthfully answering the health questions when taking out a disability insurance policy is crucial, as undisclosed pre-existing conditions can lead to a denial of benefits.
Understanding the growing significance of mental health conditions as a cause of occupational disability
Mental disorders are now the leading cause of occupational disability in Germany. Recent figures show that about one in three people who become unable to work suffers from depression or similar mental issues. This proportion has risen from around twenty percent to over thirty-four percent in the past fifteen years. Particularly among people under fifty, the proportion is even over thirty-five percent. This trend highlights the necessity of taking the risk of occupational disability insurance seriously, regardless of the type of professional activity. It is a misconception to believe that only physically demanding jobs are affected; office workers and academics are also at significant risk. The average duration of a work disability due to depression is 43 days per case.
These figures illustrate that early safeguarding of one's labour capacity is vitally important. The next section highlights the specific requirements for benefits.
Check the requirements for recognising an occupational disability due to depression
For an occupational disability insurance to cover depression, certain criteria must be met. In general, an occupational disability is recognized if the insured person is likely to be unable to perform their last occupation due to the mental illness for at least six consecutive months at fifty percent capacity or more. Providing evidence of this limitation is often the most critical aspect. This is done through detailed medical certificates and assessments, ideally from a specialist in psychiatry. It is not sufficient to merely present a diagnosis of 'depression'; the specific impacts on the professional activity must be clearly documented. Insurers meticulously assess whether the symptoms actually cause such a severe performance limitation. A claim for occupational disability must be carefully prepared.
The following points are often crucial for providing evidence:
Detailed description of the daily professional routine and specific tasks.
Concrete depiction of which of these tasks can no longer be performed due to depression.
Expert medical reports confirming the link between the condition and the performance limitation.
Documentation of previous treatment attempts and their results.
The exact definition of occupational disability can vary depending on the contract, so looking at one's own insurance conditions is essential. Next, we will consider the procedure for the application process.
Submitting a benefits claim for occupational disability due to depression correctly
Applying for benefits from an occupational disability insurance due to depression requires diligence and complete documentation. First, you must notify your insurance of the claim. You will then receive extensive questionnaires. Complete them truthfully and as detailed as possible. Describe your daily routine before the illness and how the depression affects your ability to perform your job. Include all relevant medical reports, diagnoses, and findings, especially from specialists in psychiatry or psychotherapists. A degree of disability of at least fifty percent must be clearly evident. Insurers often request their own appraisal; you are generally obliged to cooperate with this. It is advisable to make copies of all submitted documents for yourself and to document correspondence precisely.
Our expert tip: Seek support early, for example from specialized advisors or a lawyer specializing in insurance law, to avoid mistakes in the application process. The complexity of the procedure, especially with mental illnesses, is often underestimated. In the next step, we will address potential pitfalls and clauses.
Know important contract clauses and potential pitfalls with pre-existing mental health conditions
When taking out a disability insurance policy, health questions play a central role. Withholding or incompletely disclosed pre-existing conditions, such as a previous depressive episode or psychotherapy, can lead to a refusal of benefits. Insurers closely examine health details in the event of a claim (pre-contractual duty of disclosure). There are various contract clauses that may be relevant for mental health conditions:
Exclusion clauses: Certain mental health conditions or their consequences may be excluded from coverage.
Premium surcharges: A higher premium may be required for known pre-existing conditions.
Limitation of recognitions: Some insurers attempt to recognise benefits only for a limited period of time.
Abstract referral: Check if your contract contains a clause on abstract referral, which would allow the insurer to refer you to another profession you could theoretically still perform.
It is important to know the terms of your contract in detail. Honest and complete answers to health questions are essential, even if this may lead to a premium surcharge or exclusion clause. Disability insurance after psychotherapy is not automatically excluded. Now to the legal aspects and recent judgements.
Examine courses of action for occupational disability due to depression without private insurance
Those who become unable to work due to depression and have not taken out private occupational disability insurance face significant financial challenges. The statutory disability pension often offers only inadequate protection. The full disability pension, usually less than a third of the last gross salary, is only granted to those who can work less than three hours a day in any occupation. For everyone born after 1st January 1961, the hurdles are particularly high. It is therefore important to consider alternative support options:
Application for a disability pension with the German Pension Insurance.
Check entitlement to sickness benefit, if available and the conditions permit this for mental health issues. Sickness benefit and disability insurance are different benefits.
Social benefits like citizen's income as a last option to secure one's livelihood.
Consultation offers from social associations or the employment agency for occupational rehabilitation.
However, the best strategy is prevention through early private coverage. The situation without disability protection is precarious. Finally, we summarise the most important course of action.
Plan your next steps for financial security in the event of occupational disability due to depression
Dealing with occupational disability due to depression is complex and emotionally taxing. Careful preparation and knowledge of your rights are crucial. Start with an honest self-assessment of your health situation and your professional limitations. Consult with your attending doctors and document everything carefully. If you have occupational disability insurance, examine your contract conditions in detail. In the event of an application or rejection, professional support is often indispensable. Remember, mental illnesses are recognised as a cause of occupational disability, and you may be entitled to benefits if the conditions are met. The statistical probability of becoming occupationally disabled during one's working life is about one in four.
Request an individual risk analysis now: Have your insurance situation checked free of charge and receive specific optimisation suggestions.
More useful links
Wikipedia offers a comprehensive overview of occupational disability insurance in Germany.
Die Versicherer, the German Insurance Association, provides information on the most common causes of occupational disability.
Die Deutsche Rentenversicherung Bund publishes press releases on mental illnesses as a cause for reduced earning capacity.
Die Deutsche Rentenversicherung offers extensive information on disability pensions and their requirements.
Das Bundesgesundheitsministerium provides information on depression and prevention.
gesund.bund.de offers information on mental health in the workplace.
Statista provides current statistics on the proportion of mental illnesses as a cause of occupational disability.
Das Statistische Bundesamt (Destatis) provides data and information on workplace stress.
Die Verbraucherzentrale informs about occupational disability insurance and options for income protection.
Die Deutsche Depressionshilfe offers comprehensive information and support for those affected and their relatives.
FAQ
Was passiert, wenn ich bei Abschluss der BU-Versicherung eine Psychotherapie verschwiegen habe?
Das Verschweigen einer Psychotherapie oder einer diagnostizierten Depression bei den Gesundheitsfragen kann als Verletzung der vorvertraglichen Anzeigepflicht gewertet werden. Im Leistungsfall kann der Versicherer dann vom Vertrag zurücktreten oder die Leistung verweigern.
Reicht ein Attest vom Hausarzt für die Berufsunfähigkeit bei Depression aus?
Ein hausärztliches Attest allein reicht oft nicht aus. Versicherer fordern in der Regel detaillierte Befunde und Gutachten von Fachärzten für Psychiatrie und Psychotherapie, um die Diagnose und den Grad der Berufsunfähigkeit nachzuvollziehen.
Kann ich eine Berufsunfähigkeitsversicherung abschließen, wenn ich aktuell in Psychotherapie bin?
Der Abschluss einer BU während einer laufenden Psychotherapie ist schwierig und führt oft zu Ablehnungen, Risikozuschlägen oder Ausschlussklauseln für psychische Erkrankungen. Eine anonyme Risikovoranfrage kann hier sinnvoll sein.
Wie wird der Grad der Berufsunfähigkeit bei Depressionen festgestellt?
Der Grad der Berufsunfähigkeit (meist mindestens fünfzig Prozent) wird anhand ärztlicher Gutachten und der konkreten Auswirkungen der Depression auf die zuletzt ausgeübte berufliche Tätigkeit bemessen. Es wird geprüft, welche Tätigkeiten nicht mehr oder nur noch eingeschränkt ausgeführt werden können.
Was kann ich tun, wenn mein BU-Antrag wegen Depression abgelehnt wurde?
Prüfen Sie die Ablehnungsgründe genau. Legen Sie gegebenenfalls Widerspruch ein und reichen Sie weitere aussagekräftige Unterlagen nach. Die Unterstützung durch einen auf Versicherungsrecht spezialisierten Anwalt ist oft ratsam.
Gibt es Alternativen zur Berufsunfähigkeitsversicherung bei psychischen Vorerkrankungen?
Ja, Alternativen können Erwerbsunfähigkeitsversicherungen oder Grundfähigkeitsversicherungen sein. Diese bieten jedoch oft einen geringeren Leistungsumfang als eine BU-Versicherung. Die gesetzliche Erwerbsminderungsrente ist meist nicht ausreichend.
