Information sheet on gradual reintegration pursuant to the Hamburg Model

Gradual reintegration is often referred to as the Hamburg Model (e.g., Section 74 of book V, and Section 28 of the German Social Security Code IX). This measure is frequently recommended after a longer incapacity to work with rehabilitation or hospital treatment for the time afterwards.

Your attending doctor will create a step-by-step plan to ensure your return to work is free from undue stress. This first involves reducing your working hours or workload and then gradually increasing them again over a set period of time. In short, this is called “protected start of work.”

Gradual reintegration helps you test and train your performance level at work. The long-term goal is to keep affected employees in their jobs.

• employee consent
• approval of and recommended step-by-step plan from the attending physician
• consent of the employer, incl. supervisor and HR Services
• approval from a cost center for employees and trainees

Gradual reintegration is a medical rehabilitation measure. In most cases, the health insurance provider is chargeable. If the measure takes place immediately after a medical rehabilitation measure, i.e., if it is started within 4 weeks after discharge from a rehabilitation facility, the pension insurance will cover the costs. In special cases, the Federal Employment Agency or German Social Accident Insurance may bear the costs. During gradual reintegration the employee is still on sick leave. Based on a doctor’s recommendation civil servants can also apply for gradual reintegration after an extended illness. This is a type of service relief, as civil servants are considered fit for service during gradual reintegration.

• For civil servants, the staff medical service for the civil service (Personalärztlicher Dienst, PÄD) must provide confirmation if necessary.
• Severely disabled employees have legal entitlement to reintegration—and can thus reintegrate without employer consent.

Employees who are incapable of working can:

• assess their capacity for work;
• gain confidence regarding their abilities; and
• prevent possible worries about overwork or a relapse.

The duration of gradual reintegration depends on the individual health condition and development; it usually spans 2–6 weeks, occasionally up to 6 months.

All employees, civil servants, and trainees of Universität Hamburg may apply, provided they meet all requirements.

During gradual reintegration, employees continue to receive so-called remuneration replacement benefits, i.e., sick pay from the health insurance fund, transitional allowance from the pension insurance fund, unemployment benefits from the employment agency, or injury benefits from the accident insurance provider (the German employers’ liability insurance association Berufsgenossenschaft). Employees of the University may be entitled to sickness benefits for a specific period of time. Contact HR Services for binding information. Civil servants continue to receive their full remuneration.

Gradual reintegration is possible only if the employee’s work area is suitable for limited employment. Gradual reintegration comprises 3 phases:

Planning and application Recommendations for gradual reintegration are usually provided by the attending doctor. If the employee wishes to follow the recommendation, a reintegration plan will be drawn up in consultation with the doctors, taking into account the individual ability to cope with stress and the requirements of the job. The plan also details the steps for gradually increasing the workload. It specifies the sequence and duration of the individual steps and the workplace requirements. In addition, the plan describes what activities may be taken up again during what phase and indicates risks that should be avoided. In this context, it may be useful to consult the state occupational health service (AMD)–also known as the company medical officer. When the supervisors have been informed, the application is submitted to HR Services and the financial provider.

Execution: Following approval from the employer and financial providers, the gradual reintegration of employees and trainees can begin. Reintegration should be conducted in close coordination with all parties involved.

Conclusion: Gradual reintegration ends as soon as the employee has fully recovered. For medical reasons, doctors may adjust the step-by-step plan during reintegration to the state of health, extend or shorten the measure, or recommend its discontinuation. If physical conditions are not restored as intended, it will be examined whether further medical or occupational rehabilitation measures or, alternatively, a pension due to reduced earning capacity are necessary. This also applies if the measure has to be terminated prematurely. 

The best time to apply is when a return to work is or seems likely. A lead time of about 2 weeks gives all parties involved sufficient time to process the application. If adaptation assistance, e.g., a special desk, chair, etc., is required, a longer lead time helps ensure their availability at the start of work.

Gradual reintegration aims to help employees transition back smoothly to full professional activity in their previous workplace after a long period of serious illness. This goal is called into question if the measure is interrupted. Also, employees and trainees are still considered unfit for work during reintegration. Thus, they cannot go on vacation during this time. Although civil servants are considered fit for (limited) service during this period, they should not take leave for the above reasons; exceptions are possible, however.

Gradual reintegration may be interrupted for health and operational reasons for a maximum of 7 days— provided the step-by-step plan is adhered to. If gradual reintegration is interrupted for more than 7 days, it shall be deemed discontinued from the first day of the interruption.

Only the fact that a gradual reintegration process was conducted and the gradual reintegration plan shall be included in the personnel file. This information must be stored in a separate medical file in the personnel file. Access shall be governed by legal regulations applying to employee records and personnel files.

NO! The BEM procedure is a cornerstone of the University’s staff health management aiming to protect employee health. Employers must offer the Return-to-Work program BEM with the goal of overcoming the employee’s incapacity for work as far as possible, preventing renewed incapacity for work, and maintaining the job of the employee concerned. The legal basis is Section 167 subsection 2 of book IX of the German Social Security Code (SGB IX) The Hamburg Model of gradual reintegration is just one of several conceivable measures that can be agreed upon in the BEM procedure. Individual cases may call for a combination of both procedures.