Question 1

When is an occupational physician mandatory in Germany?

Accepted Answer

The appointment duty under § 2 Para. 1 ASiG starts with the first employee; the law sets no minimum headcount. Only the model and scope vary. Sites with up to 50 employees may opt for the alternative needs-based care under DGUV Vorschrift 2 Annex 2; from 51 employees the standard care applies with basic and operation-specific contact hours. Hours depend on the industry code (WZ-Code) and range from 0.2 hours (offices) to 1.2 hours per employee per year (construction, nursing). Failure to appoint triggers fines up to 5,000 EUR under § 209 SGB VII and, where harm occurs, personal criminal liability of the managing director under § 222 StGB.

Question 2

What is the difference between mandatory, offer-based and request-based medical surveillance?

Accepted Answer

Mandatory surveillance under § 4 ArbMedVV is compulsory before exposure to hazardous work and at fixed intervals, for example noise above 85 dB(A), carcinogens or biological agents in risk group 3 or 4 under Annex Part 2. Without a surveillance certificate the employee may not perform the task. Offer-based surveillance under § 5 ArbMedVV must be offered by the employer (typical example: screen work under Annex Part 4 Para. 2 or skin load); the employee decides. Request-based surveillance under § 5a ArbMedVV is initiated by the employee and must be facilitated whenever an occupational health risk cannot be excluded.

Question 3

What is a G42 examination and when is it mandatory?

Accepted Answer

G42 is a DGUV principle for medical surveillance covering tasks with infection hazard, mainly in healthcare, laboratories, waste and wastewater services and overseas assignments to tropical regions. The legal base is ArbMedVV Annex Part 2 combined with the Biological Agents Ordinance (BioStoffV). Mandatory G42 applies to biological agents in risk group 3 or 4 and to targeted activities with pathogens such as hepatitis B, tuberculosis or SARS-CoV-2. The exam covers history, vaccination status, where indicated blood tests and counselling. Intervals are typically three years, shorter for heavy exposure. For overseas postings, G42 is often combined with G35.

Question 4

Can the employer access mandatory surveillance results?

Accepted Answer

No. § 6 Para. 1 ArbMedVV only allows the employer to know that and when surveillance occurred (surveillance certificate), but not individual findings or diagnoses. The physician is bound by medical confidentiality under § 203 StGB. The exception is the fitness-for-work examination: it is not governed by ArbMedVV but rests on private-law or licensing grounds (G25 for driving tasks, G26 for respiratory protection, G41 for fall hazard), and its pass-fail result goes to the employer. The two examination types should never be combined in a single appointment.

Question 5

What does an external occupational physician cost?

Accepted Answer

Pricing depends on the care model, the industry code class and hourly load. Hourly rates run from 110 to 220 EUR net for medical work; specific surveillance such as G37 (screen work) or G25 costs 60 to 120 EUR per exam, G42 or G41 between 90 and 180 EUR. For a mid-market office site with 100 employees (industry code 0.2 hours per employee), annual standard care costs run from 3,000 to 6,000 EUR plus exam fees. Production sites with 200 employees on an industry code of 0.6 hours land between 18,000 and 35,000 EUR per year. CIVAC works with transparent flat-fee tiers per location and risk class.

Question 6

Who runs the workplace integration management (BEM)?

Accepted Answer

§ 167 Para. 2 SGB IX requires the employer to offer a BEM procedure to every employee with more than six weeks of sick leave within twelve months. BEM is an exploratory process involving the employee, management, the works council, the disability representative where applicable and, on request, the occupational physician. The physician is not mandatory but standard practice because they assess medical capacity and propose workplace adjustments. The employee's participation is voluntary and refusal must not lead to disadvantage. The BEM file is kept separate from the personnel file and deleted after closure unless follow-up measures are pending.

Question 7

What sanctions apply when no occupational physician is appointed?

Accepted Answer

Breaches of § 2 ASiG (missing or insufficient appointment) trigger fines up to 5,000 EUR under § 209 SGB VII in conjunction with § 21 ASiG, higher in repeated cases. Missing mandatory surveillance under ArbMedVV can be sanctioned up to 25,000 EUR under § 9 ArbMedVV in conjunction with § 25 ArbSchG. Where an accident causes personal injury and organisational failure is shown, management faces personal criminal liability under § 222 StGB (negligent homicide) or § 229 StGB (negligent bodily harm). The Berufsgenossenschaft may further impose contribution surcharges under § 162 SGB VII and pursue subrogation claims.

Occupational Physician

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What does an occupational physician do?

Duties of the occupational physician

When must an occupational physician be appointed?

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Frequently asked questions about the occupational physician

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