Frequent reasons for refusal by health insurance companies

The fitting process can be long and arduous. It is not always possible to get the aid you want. Under certain circumstances, the service providers reject the application.

But a contradiction often leads to success. Therefore it is important to understand the argumentation of the top performers. Find out here what are the frequent reasons for the rejection of an aid and which judgement in a lawsuit was in favour of the applicant.

The JCC has not yet issued a recommendation on the new tool.

The aid is not a treatment method in itself, nor is it used in combination with a new treatment method. It is used solely to compensate for disability; therefore the device does not require a GBA recommendation.


REHADAT law: Judgment B3 KR 10/07 R

No evidence-based studies are yet available on this tool.

The device has a CE mark and must therefore be regarded as fundamentally suitable and safe.

REHADAT law: Judgement B3 KR 20/04 R

The insured person has already been provided with a high-quality aid and is not entitled to any further technical development.

As long as the compensation for disability is not fully achieved in the sense of equalisation with a non-disabled person, the person affected is entitled to better, higher quality services in line with the current state of medical technology!

REHADAT law: Judgment B3 KR 20/08 R

The aid does not completely compensate for the existing disability (paraplegia).

It is not necessary to completely equalize with the almost unlimited possibilities of non-disabled people; it is sufficient if the lost body function is even partially compensated.

REHADAT-Right: Judgment B3 KR 13/13 R

The insured person is already fitted with a high-quality wheelchair; with it, he or she can even cover longer distances than with an exoskeleton.

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

REHADAT-Right: Judgment B3 KR 5/09 R

The period of use is limited to a few hours a day due to the severity of the disability.

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

REHADAT-Right: Judgment S19 KR 350/15

The aid is uneconomical.

The economic efficiency of an assistive device for the direct compensation of disabilities is to be assumed in principle. It should only be checked if there are several products with the same function.

REHADAT law: Judgment B3 KR 68/01 R
REHADAT law: Judgment B3 KR 4/08 R