When can a written application be rejected?
Negative decision by the health insurance company
What do I have to consider in the event of an objection?
If you want to defend yourself against a negative decision, you must submit a written objection to the health insurance company. You have one month to do this after receiving the notification. First of all, you do not have to justify the objection, just object to the decision. It is important that you refer specifically to the notification and the file number. An objection is only valid in writing. It is best to send it to the health insurance company by registered mail. An objection by phone or email is not valid.
If the objection has been filed with the health insurance company, it is always advisable to collect individual medical reasons and documents with the help of a doctor and to justify the objection in detail.
Based on this objection, a second notification will be issued by the health insurance company. The health insurance company has the option of approving the benefit with a remedial notice or rejecting it again with a notice of objection.
What do I have to consider in the event of a lawsuit?
If the objection is rejected, you can file a complaint with the social court within one month. It is often advisable to involve a lawyer specializing in social law.
If your objection is not decided within three months and no notice of objection is issued, you can also file a lawsuit (a so-called action for failure to act).
Private patients do not have to go through a formal objection procedure, but can instead bring an action in the civil courts within three years of the negative decision. It often makes sense, however, to explain your point of view to private long-term care insurance, similar to a contradiction, and to justify it with medical certificates, etc., because private health insurers usually also review their decision themselves.
It may take some time to clarify whether the health insurance company has rightly rejected the application.
We recommend sending both the objection and the lawsuit either by registered mail with acknowledgment of receipt or by fax to the health insurance company or the court. This enables you to prove that the objection or the claim was received within the deadline. You can also submit your complaint / objection in person to the court with witnesses.
The legal action procedures are usually free of charge for those affected (no court fees). If you hire a lawyer, there may be legal fees. There is the possibility of applying for legal aid for this. After submitting such an application, the court examines whether the requirements are met.
Where can I get further help?
If you need help with a lawsuit, you can contact the social associations such as the VDK or the SoVD. Otherwise you should consult a specialist lawyer for social law.
Some consumer advice centers offer advice on the subject of aids and support you with legal questions relating to the application for aids and an objection to the health insurance company.
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