In brief
After an occupational disease is diagnosed, the Social Security Institution (SGK) first establishes, by decision of the Institution Health Board, that the disease is an occupational disease and then how much of the worker's earning capacity in their occupation has been lost. The rate is calculated according to the schedules in the regulation, the occupation and age; with more than one impairment the Balthazard formula is used. If the loss is at least 10%, the worker is granted a permanent incapacity income; if the disease arose from the employer's breach of legislation, SGK can recover what it has paid from the employer.
Loss of occupational earning capacity: the process from diagnosis to income
After an occupational disease is diagnosed, the worker and the employer have the same question in mind: what happens next? SGK first establishes that the disease really is an occupational disease, then determines how much of the worker's earning capacity in their occupation has been lost. This rate is the basis of the income to be granted to the worker and, in some cases, of the recourse claim to be directed at the employer. The value called the "disability rate" in practice is named in the legislation the rate of loss of occupational earning capacity.
Under Law No. 5510, the process proceeds through these steps:
- Diagnosis and health board report. Healthcare providers authorised by SGK issue a duly prepared health board report and the supporting medical documents (Art. 14).
- Notification. An employer who learns of an occupational disease notifies SGK within three working days of learning of it (Art. 14; Art. 14/2 of Law No. 6331 on Occupational Health and Safety).
- Determination by the Institution Health Board. The report and documents are examined, where necessary together with inspection reports showing the working conditions at the workplace; the Institution Health Board establishes that the disease is an occupational disease.
- Determining the rate. The Institution Health Board determines the rate of loss of occupational earning capacity according to the schedules in the regulation.
- Granting income. If the loss is at least 10%, a permanent incapacity income is granted (Art. 19).
- Objection. If those concerned object to the Institution's decision, the matter is decided by the Social Insurance High Health Board (Art. 95).
- Reassessment. If an insured person granted income undergoes further treatment, the loss rate is reassessed on the basis of the new reports (Art. 19).
If the disease appears after the worker has left the job, the period between leaving and the disease appearing must not exceed the liability period set for that disease in the list of occupational diseases. Even if the period has been exceeded, if the disease has been established by clinical and laboratory findings and the causative agent identified through a workplace investigation, it may be accepted as an occupational disease with the approval of the Social Insurance High Health Board (Art. 14). For some diseases a minimum exposure period is also required; for example, for pneumoconiosis a total of at least three years' work in dusty jobs is required. For the structure of the list, see our article on the list of occupational diseases, and for diagnosis and notification steps, our article on what an occupational disease is.
Disability rate, loss of earning capacity and loss of working capacity
These concepts are often confused; each has a different threshold and consequence.
| Concept | What does it measure? | Threshold and consequence | Basis |
|---|---|---|---|
| Loss of occupational earning capacity | The loss of earning capacity in the worker's occupation after a work accident or occupational disease | Permanent incapacity income if at least 10% | 5510 Art. 19 |
| Invalidity | Loss of at least 60% of occupational earning capacity as a result of a work accident or occupational disease | Being deemed an invalid; the conditions in Art. 26 are also required for a pension | 5510 Art. 25 |
| Loss of working capacity | Loss of working capacity in general illness or disability | Being deemed an invalid if at least 60% | 5510 Art. 25 |
| Temporary incapacity | Inability to work during sick leave | Daily temporary incapacity allowance | 5510 Art. 18 |
How is the rate calculated? The schedules and the Balthazard formula
The rate of loss of occupational earning capacity is calculated according to schedules A, B, C, D and E in Annex 3 of the Regulation on Procedures for Determining the Rate of Loss of Working Capacity and Occupational Earning Capacity (Official Gazette 11.10.2008) (Art. 22–23):
- Schedule A: Lists the diseases and impairments caused by work accidents and occupational diseases in 14 lists by body region; the impairment's sequence number and weighting are found here.
- Schedule B: The list of branches of activity and occupations; the insured person's occupational group number is found here.
- Schedule C: Gives the permanent incapacity symbol at the intersection of the impairment and the occupational group.
- Schedule D: Shows the loss rate according to the weighting and symbol.
- Schedule E: Adjusts this rate according to age on the date of the first report in which permanent incapacity arose.
The result of this structure is that the same impairment can correspond to a different rate depending on how far the occupation is affected by that impairment and on the worker's age.
If there is more than one impairment, the rates are not added together; the Balthazard formula in Art. 24 of the regulation is applied. The rates are ranked from largest to smallest, the highest rate is subtracted from 100, the remainder is multiplied by the next rate and divided by 100, and the result is added to the highest rate.
Example: A worker has two impairments at rates of 20% and 10%.
- 100 − 20 = 80
- 80 × 10 / 100 = 8
- 20 + 8 = 28%
If there is a third impairment of 5%, the calculation continues with the combined rate: (100 − 28) × 5 / 100 = 3.6; the total becomes 31.6%.
Permanent incapacity income: an example calculation
Under Art. 19 of Law 5510, in permanent total incapacity the insured person is granted an income of 70% of their monthly earnings calculated under Art. 17. In partial incapacity, the income is paid at the loss rate applied to the full income. If the insured person needs the constant care of another person, an income rate of 100% is applied.
| Loss rate | Calculation | Income as a share of monthly earnings |
|---|---|---|
| 10% | 70% × 10% | 7% |
| 28% | 70% × 28% | 19.6% |
| 60% | 70% × 60% | 42% |
| 100% | 70% × 100% | 70% |
| 100% and in need of care | Income rate 100% | 100% |
The income starts from the beginning of the month following the date on which the temporary incapacity allowance ended or, if permanent incapacity arose without temporary incapacity having been established, the date of the related health board report. If the insured person has a new work accident or contracts a new occupational disease, all disabilities are assessed together.
The employer's possible liability
An occupational disease can have three separate consequences for the employer:
- SGK's recourse claim. If the occupational disease arose from the employer's intent or from a breach of OHS legislation, SGK makes the employer pay the payments it has made and will make and the initial capital value of the income granted. The amount is limited to what the insured person could claim from the employer, and the principle of unavoidability is taken into account (Art. 21). Details are in our article on the SGK recourse action.
- Late notification. If notification is not made within three working days, the expenses SGK has incurred and the temporary incapacity allowances it has paid are recovered from the employer (Art. 14). An administrative fine is also applied under Law No. 6331; you can see the current amount in our OHS administrative fines tool.
- Occupational disease compensation. The worker can also bring a separate action for material and non-material damages.
In these actions, the employer's strongest defence is records kept before the disease appeared: the risk assessment, workplace exposure measurement results, health surveillance records, training certificates and PPE issue and replacement records. Missing records may count against the employer in the assessment of fault.
What does the workplace physician do in this process?
The workplace physician does not determine the rate; but plays a role at both the beginning and the end of the process:
- Early detection. In periodic examinations, picks up early signs such as hearing loss, declining lung function or skin findings, and refers the worker to a healthcare institution that can diagnose occupational disease. Details are in our article on the workplace physician's role when occupational disease is suspected.
- Exposure information. Ensures that the job description, exposure duration and measurement results needed in the SGK investigation are ready on file.
- Preserving records. The personal health file is kept for at least 15 years after the worker leaves; these records can be decisive in an occupational disease file opened years later.
- Work adaptation. Recommends placing the worker in work suited to their remaining capacity; plans screening of other workers with the same exposure.
For who health data may be shared with, see our article on employee health data and the KVKK (Turkish Personal Data Protection Law). As part of its workplace physician services for businesses in Bursa and the surrounding provinces, Bursa Sistemer OSGB maintains health surveillance records and carries out referral and notification steps when occupational disease is suspected, in line with this process.
Frequently Asked Questions
At what percentage of loss of occupational earning capacity is income granted?
An insured person whose occupational earning capacity is established by the Institution Health Board to have fallen by at least 10% is granted a permanent incapacity income. The income is the full incapacity income multiplied by the loss rate.
Can an objection be made to the rate set by SGK?
Yes. If those concerned object to the Institution's decision on the loss of occupational earning capacity, the matter is decided by the Social Insurance High Health Board.
Does a disease that appears after leaving the job count as an occupational disease?
It can, if the time since leaving does not exceed the liability period set for that disease in the list. Even if the period has been exceeded, it may be accepted as an occupational disease with the approval of the Social Insurance High Health Board if the findings and the workplace investigation confirm the causative agent.
Does SGK always seek recourse from the employer in occupational disease?
No. For recourse, the disease must have arisen from the employer's intent or a breach of OHS legislation. The amount is limited by the employer's fault and by what the insured person could claim from the employer; the principle of unavoidability is also taken into account.
A physician assigned for the time your hazard class requires: pre-employment and periodic examinations, fitness-for-work reports and health surveillance.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.