Content

application proceedings

In the structured social insurance system in Germany, various cost units provide benefits for participation. This also includes 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 (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 application with care as quickly and in a coordinated manner as possible, i.e. "as if from a single source".

An application for an assistive product or a technical work aid is always made in writing. The applications are available from the service providers (rehabilitation provider or integration office).

It is important

  1. to submit the application before the acquisition or the start of a barrier-free construction measure , and
  2. wait forthe approval.

Different underlays are required depending on the funding agency.

As a rule, the application includes

  • a medical 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 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 assistive products are not included in the medical budget. The person making 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 sells occupationally relevant 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 to which the application is first submitted is also responsible, it becomes the "providing 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 institution is also not competent, it can forward the application to the rehabilitation institution which it considers to be competent in 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 rehabilitation provider must decide on the benefit within three weeks of receipt of 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 partly responsible, the providing rehabilitation provider must involve them and carry out a binding participation plan procedure (§§ 19 - 23 SGB IX-neu) - uniformly, early and coherently.
  6. The providing rehabilitation provider must conduct a participation plan conference in complex cases (with the person making the application, 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 about the status of the application and about forwardings of the application.
  • The providing rehabilitation provider can split the application 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 (without or with expert opinion).
  • In the case of several rehabilitation providers involved (§ 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 necessary in complex cases.
  • If no written notification or unjustified rejection has been received after two months , the application 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.