Content

Application procedure

In the structured social insurance system in Germany, various cost units provide benefits for participation. This also includes the provision of aids or tread.

The specific provisions for these benefits are regulated in the individual Social Codes of the rehabilitation providers (for example, health insurance, pension insurance) or in the Severely Disabled Persons Compensation Levy Ordinance, which applies to the Integration Office. Several cost units can also be involved in a service.

The SGB IX (§ 14 ff.) summarises overriding regulations on needs assessment, the participation plan procedure and clarification of responsibility which are binding on all funding bodies.

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

An motion and oppisition for an aid or a technical work aid is always made in writing. The motion and oppisitions are available from the service providers (rehabilitation provider or integration office).

It is important

  1. to submit the motion and oppisition before the procurement or the start of a barrier-free construction measure and
  2. wait forthe approval.

Depending on the funding agency, different documents are required.

As a rule, the motion and oppisition includes

  • a medical prescription BGG a detailed and comprehensible justification,
  • possible expert opinion or discharge report of the rehabilitation clinic and
  • at least one cost estimate.

If the motion and oppisition is for training equipment, further proof/copies must usually be submitted, such as for example:

  • Determination of the degree of disability
  • Disability certificate
  • Employment contract and job description

It should be noted that aids are not included in the medical budget. The applicant 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 sells occupational aids or tread.

Sample motion and oppisition forms

The formal motion and oppisition procedure BGG the respective deadlines is regulated by SGB IX (§ 14 ff.):

  1. If the rehabilitation agency to which the motion and oppisition is first sent is also responsible, it becomes the "providing rehabilitation agency" two weeks after receipt of the motion and oppisition.
  2. If this first rehabilitation provider is not responsible, it forwards the motion and oppisition BGGin two weeks to the second rehabilitation provider, which becomes the providing rehabilitation provider if it is responsible.
  3. If this second rehabilitation institution is also not competent, it can forward the motion and oppisition to the rehabilitation institution which is competent in its opinion by mutual agreement (turbo clarification). The latter becomes the rehabilitation provider even if it is not responsible and can no longer forward the motion and oppisition.
  4. As a rule, each rehabilitation provider must decide on the benefit BGGin three weeks of receipt of the motion and oppisition. 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 partly responsible, the providing rehabilitation provider must involve them and carry out a binding participation plan procedure (§§ 19 - 23 SGB IX-neu) - uniformly, garden work and coherently.
  6. The providing rehabilitation provider must conduct a participation plan conference in complex cases (BGG the person making the motion and oppisition, rehabilitation providers and fixation the integration office, if this is also a service provider).

Other important points:

  • The providing rehabilitation provider must inform the person making the motion and oppisition about the status of the motion and oppisition and about forwardings of the motion and oppisition.
  • The rehabilitation provider can split the motion and oppisition and forward it partially.
  • The 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 duration of the entire procedure is usually six to eight weeks (BGGout or BGG expert opinion).
  • In the case of several rehabilitation providers involved (§ 15 SGB IX), the duration is six weeks from receipt of the motion and oppisition by the providing rehabilitation provider and eight weeks if a participation plan conference is necessary in complex cases.
  • If no written notification or an unjustified rejection has been made after two months , the motion and oppisition is deemed to have been approved(fictitious approval according to § 18 SGB IX - reimbursement of self-procured services). However, this does not apply to providers of integration assistance, providers of public youth welfare, providers of war victims' welfare and the integration offices.