Application proceeding

In the structured social insurance system in Germany, various cost units provide benefits for participation. These include the provision of aids or the provision of technical working aids.

The concrete provisions for these services are regulated in the individual social security codes of the rehabilitation institutions (e.g. health insurance, pension insurance) or in the severely handicapped compensation levy ordinance that applies to the Integration Office. Several cost units can also be involved in a benefit.

Superordinate regulations for the determination of requirements, the participation planning procedure and the clarification of responsibilities that are binding for all cost units are summarised in the German Social Code Book IX (§ 14 ff.).

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

An application for an aid or technical working aid is always made in writing.

The important thing is,

  1. to make the application before the purchase or a barrier-free building measure and
  2. to wait for approval.

Different documents are required depending on the cost unit.

Usually the application includes

  • a medical prescription with a detailed and comprehensible justification
  • any expert reports or discharge report from the rehabilitation clinic and
  • at least one cost estimate.

If it is an application for workplace equipment, additional proof/copies must usually be submitted such as

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

Please note that medical aids are not included in the budget of the doctors. The applicant should point this out if doctors refuse to prescribe medical aids due to a limited number of prescriptions.

The cost estimate can be obtained from a service provider (e.g. a medical supply store) or a company that manufactures or sells occupationally relevant aids or technical work aids.

Tip: You will find the contact addresses of the manufacturers and distributors in our product descriptions.

The formal application procedure with the respective deadlines is regulated by the SGB IX (§ 14 ff.).

  1. If the rehabilitation institution to which the application is first sent is also responsible, it becomes the "performing rehabilitation institution" two weeks after receipt of the application.
  2. If this first rehabilitation institution is not responsible, it forwards the application to the second rehabilitation institution within two weeks, which becomes the providing rehabilitation institution if it is responsible.
  3. If this second rehabilitation provider is also not responsible, it can forward the application to the rehabilitation provider that it considers to be responsible by mutual agreement (turbo clarification). The latter becomes the paying rehabilitation institution, even if it is not responsible, and can no longer forward the application.
  4. As a rule, each performing 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) - in a uniform, timely and coherent manner.
  6. In complex cases, the provider of rehabilitation services must conduct a participation plan conference (with the applicant, rehabilitation providers and possibly the Integration Office, if the latter is also a provider of services).

Other important points:

  • The rehabilitation provider must inform the applicant about the status of the application and about the forwarding of the application.
  • The providing rehabilitation provider can split the application and forward it in part.
  • The providing rehabilitation provider has to make advance payments if other competent service providers do not pay 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 opinions).
  • The duration for several participating rehabilitation providers (§ 15 SGB IX) is six weeks from receipt of the application by the performing rehabilitation provider and eight weeks if a participation plan conference is necessary for complex cases.
  • If no written notification or an unjustified rejection is received after two months, the application is deemed to have been approved (fictional approval in accordance with § 18 SGB IX - reimbursement of benefits procured by the patient himself). However, this does not apply to institutions of integration assistance, institutions of public youth welfare, institutions of war victims' welfare and the integration offices.
  • If an application is rejected, an appeal can be lodged.