Application procedure in social law

In the structured social security system, various service providers can provide participation benefits in order to promote life in society and avoid disadvantages. Benefits that include benefits in kind or services also include aids or technical work aids.

Where do I submit the application?

Cross-provider regulations that are binding for all service providers, such as the clarification of responsibilities and the participation plan, are summarised in SGB IX, while the individual benefit laws of the providers specify the benefit entitlements and responsibilities. The aim is to provide services quickly and in a well-coordinated manner ‘as if from a single source’, as several organisations can be involved in a single service.

Which service provider is responsible depends on various factors. These can be the severity and cause of the disability, the purpose of the aid or the duration of employment subject to social insurance contributions.

In principle, those entitled to benefits can submit their application to any of the benefit providers. They must clarify among themselves who is responsible and whether there is an entitlement to benefits (see § 14 SGB IX). However, experience has shown that processing is accelerated if the applicants know the right contacts and points of contact in advance.

In general, rehabilitation organisations (Section 6 SGB IX) such as health insurance or pension insurance take priority over the integration office/inclusion office. Integration offices/inclusion offices are not rehabilitation organisations, but their support in working life for people with severe disabilities and people of equal status is closely linked to rehabilitation services.

What do I need to bear in mind when applying?

Important:

  1. You can submit applications for aids or technical work aids informally, but in writing. The only exception is the statutory accident insurance, which takes action ‘ex officio’./li>
  2. Submit the application to the service provider before purchasing an assistive device or before starting a barrier-free conversion.
  3. Wait for approval from the service provider. If your application was submitted to a rehabilitation provider or integration/inclusion office that is not responsible for the benefit, they will clarify the responsibility and coordination of the procedure among themselves if several benefits and/or several service providers are involved.
  4. Please note that each decision made by the service provider is an individual case.

Required documents

Depending on the service provider, different documents are required for the application. Information on the required documents and forms can be obtained from the rehabilitation providers and integration/inclusion offices.

These documents may be required:

  • Medical prescription with a detailed and comprehensible justification
  • Any expert reports or discharge reports from the (rehabilitation) clinic
  • At least one cost estimate
  • Assessment notice on the degree of disability
  • Severely disabled person's pass
  • Employment contract and job description

Cost estimates are available from service providers such as medical supply stores or from aid manufacturers or dealers. You can find the addresses of the aids documented by REHADAT in the product descriptions.

Assistive products are material resources or technical products for which there are no reference values and therefore no medical budgeting. Applicants should point this out if doctors refuse to prescribe medical aids with reference to the limited volume of expenditure and prescription quota of the statutory health insurance funds. However, medical practices are obliged to comply with the principle of cost-effectiveness (Section 12 SGB V).

How does the application process work after the application has been submitted?

This only applies to aids to compensate for disability, not to ensure medical treatment!

Procedural steps according to SGB IX

  1. If the institution to which the application is first submitted is also responsible, it becomes the ‘providing rehabilitation institution’ two weeks after receipt of the application.
  2. If the first institution received is not responsible, it forwards the application within two weeks to the second rehabilitation institution, which becomes the providing rehabilitation institution if it is responsible.
  3. If this second institution is also not responsible, it can forward the application to the institution it considers to be responsible by mutual agreement (turbo clarification). The latter 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 organisation must decide on the benefit within three weeks of receiving the application. This period is extended in the event of a clarification of the situation or if expert opinions have to be obtained or if other organisations are involved.
  5. If other providers are also partially responsible, the providing rehabilitation provider must involve them and carry out a binding participation plan procedure (§ 19 to § 23 SGB IX) in a standardised, early and coherent manner.
  6. In complex cases, the provider of rehabilitation must organise a participation plan conference. The person submitting the application, the rehabilitation providers and possibly the integration/inclusion office are involved if the latter is also a service provider.

Providing rehabilitation organisation

  • The providing rehabilitation organisation must inform the applicant 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 organisation must make advance payments if other responsible service providers do not make payments on time. The service providers clarify the reimbursement of costs among themselves.

Duration of the procedure

  • The entire procedure usually takes between six (without an expert opinion) and eight (with an expert opinion) weeks.
  • 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.

Fictitious authorisation

If no written notification has been received after the two-month deadline (in accordance with SGB IX) and an assistive device has been procured before the rejection notice, the application may be 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 and providers of social compensation law (previously: providers of war victims' welfare).