Frequent reasons for refusal by the health insurance company

The care process can be long and arduous. You do not always receive the assistive products you want. Under certain circumstances, the service providers reject the application.

However, an administrative appeal often leads to success. To do this, it is important to understand the argumentation of the service provider. Find out here what the most common reasons are for the rejection of an assistive product and which judgements in legal proceedings have been in favour of the claimant.

Reasons for refusal

The GBA has not yet issued a recommendation on the novel assistive products.

The assistive products are neither a treatment method per se nor are they used in combination with a new treatment method. It serves solely to compensate for disabilities; therefore, the assistive products do not require a GBA recommendation.

No evidence-based studies are yet available on the assistive products.

The assistive products have a CE mark and are therefore considered fundamentally suitable and safe.

The insured person is already provided with a high-quality assistive product and is not entitled to further technical development.

As long as the compensation of the disability has not been achieved completely in the sense of equalization with a non-disabled person, the affected person is entitled to better, higher-quality services that correspond to the current state of medical technology!

The assistive products do not completely compensate for the existing disability (paraplegia).

A complete equalization with the almost unlimited possibilities of non-disabled people is not required; it is sufficient if the lost body function is only partially compensated.

The insured person is already provided with a high-quality wheelchair; this enables him/her to travel even further distances than with an exoskeleton.

A wheelchair only provides indirect compensation for the disability, whereas an exoskeleton directly compensates for the disability. A seated locomotion is no substitute for the basic needs of standing and walking.

Due to the severity of the disability, the duration of use is limited to a few hours per day.

The upright, self-determined walking includes a comprehensible large gain in movement, which can potentially have an effect in all areas of daily life.

The assistive products are uneconomical.

The economic efficiency of an assistive product for the direct compensation of disabilities is to be assumed in principle. It is only to be checked if there are several products that are functionally equally suitable.

Other judgements