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application proceedings

In the structured social insurance system in Germany, various cost bearers provide benefits for participation. These include the provision of assistive products or technical work aids.

The specific provisions for these benefits are regulated in the individual social codes of the rehabilitation providers (e.g. health insurance, pension insurance) or in the Severely Disabled Persons Compensation Levy Ordinance, which applies to the Integration Office. Several cost bearers can also be involved in a benefit.

Overarching regulations that are binding for all cost bearers regarding the determination of needs, the participation plan procedure and the clarification of responsibilities are summarized in SGB IX (§ 14 ff.).

The aim is to provide the person making the application with care as quickly and in a coordinated manner as possible, i.e. "as if from a single source".

An application for assistive products or technical work aids is always made in writing. The applications can be obtained from the service providers (rehabilitation providers or integration office).

It is important

  1. submit the application before the procurement or the start of a barrier-free construction measure and
  2. wait for approval.

Different underlays are required depending on the cost bearer.

As a rule, the application includes

  • a doctor's prescription with a detailed and comprehensible justification,
  • possibly an expert opinion or discharge report from the rehabilitation clinic and
  • at least one cost estimate.

If the application is for workplace equipment, further evidence/copies must usually be submitted, such as

  • Assessment notice on the degree of disability
  • Severely disabled person's pass
  • Employment contract and job description

It should be noted that assistive products are not included in the doctors' budget. The person submitting the application should point this out if doctors refuse to prescribe aids due to a limited quota of prescriptions.

The cost estimate can be obtained from a service provider (e.g. medical supply store) or a company that manufactures or distributes occupational assistive products or technical work aids.

The formal application proceedings with the respective deadlines are regulated by SGB IX (§ 14 ff.):

  1. If the rehabilitation provider that receives the application first is also responsible, it becomes the "performing rehabilitation provider" two weeks after receipt of the application.
  2. If this first rehabilitation provider is not responsible, it forwards the application within two weeks to the second rehabilitation provider, which becomes the providing rehabilitation provider if it is responsible.
  3. If this second rehabilitation provider is also not responsible, it can forward the application to the rehabilitation provider it considers responsible by mutual agreement (turbo clarification). This becomes the providing rehabilitation provider, even if it is not responsible, and can no longer forward the application.
  4. As a rule, each providing rehabilitation provider must decide on the benefit within three weeks of receiving the application. This period is extended in the case of a turbo clarification or if expert opinions have to be obtained or if other rehabilitation providers are involved.
  5. If other rehabilitation providers are also partially responsible, the providing rehabilitation provider must involve them and carry out a binding participation plan procedure (Sections 19 - 23 SGB IX-new) - in a uniform, early and coherent manner.
  6. In complex cases, the rehabilitation provider must hold a participation plan conference (with the applicant, rehabilitation providers and possibly the integration office, if this is also a service provider).

Other important points:

  • The providing rehabilitation provider must inform the person making the application of the status of the application and of any forwarding of the application.
  • The providing rehabilitation provider can split the application and forward it in part.
  • The providing rehabilitation provider must make advance payments if other responsible providers do not make payments on time. The service providers clarify the reimbursement of costs among themselves.
  • The entire procedure usually takes six to eight weeks (without or with an expert opinion).
  • If several rehabilitation providers are involved (Section 15 SGB IX), the duration is six weeks from receipt of the application by the providing rehabilitation provider and eight weeks if a participation plan conference is required for complex cases.
  • If no written notification or an unjustified rejection has been received after two months , the application is deemed to have been approved(fictitious approval in accordance with Section 18 SGB IX - reimbursement of self-procured benefits). However, this does not apply to providers of integration assistance, providers of public youth welfare services, providers of social compensation and integration/inclusion offices.