One Month to Appeal, One Year If the Paperwork Is Wrong: A Practical Guide to Fighting a Rejected Medical Aid
Published on 10/13/2026 at 07:12 | Editorial boerse-global.de
When a health insurer or welfare office turns down a request for a walking frame, compression garment or hearing aid, the clock starts running — and it runs fast. Under Section 84 of the Social Courts Act (Sozialgerichtsgesetz, SGG), claimants generally have one month from receipt of the decision to lodge an objection. If the rejection letter fails to explain the appeal route correctly, that window stretches to a full year.
Filing an objection without any reasoning is enough to meet the deadline. Legal advisers nonetheless recommend following up with a detailed justification covering body shape, circumference differences, previous aids supplied and any pressure points, backed by medical statements. Should the objection fail, the next step is a claim before the social court.
Welfare offices and integration assistance
People receiving Bürgergeld — Germany's basic income support — can claim costs for special clothing when the need arises from illness or disability. The job centre may recognise such expenses either as an unavoidable additional requirement under Section 21(6) of Book II of the Social Code (SGB II), or approve them case by case as initial equipment under Section 24(3) SGB II.
Nothing gets approved without airtight paperwork. Claimants need a substantive medical certificate describing the health restrictions in concrete terms, a detailed breakdown of what is required, and cost estimates and invoices.
Providers of integration assistance — support for people with disabilities — face the same duty to examine additional needs. In one case, the Rhineland Regional Association withdrew its appeal before the Federal Social Court on 30 September 2026 (case number B 8 SO 1/26 R). The dispute concerned a rehabilitation buggy. Entitlement to such an aid derives from Section 113(2) No. 8 in conjunction with Section 84 of Book IX of the Social Code (SGB IX), not from the rules governing health insurance under Section 33 of Book V (SGB V). Crucially, owning a wheelchair already, or having other leisure options available, does not automatically rule out a claim to an additional aid.
What statutory health insurance covers
Members of the statutory health insurance system are entitled under Section 33 SGB V to an appropriate supply of medical aids without private top-up costs. Adults pay only the statutory co-payment of 10 per cent of the insurer's amount — at least 5 euros and no more than 10 euros per aid.
Hearing aids carry a co-payment of 10 euros per device, or 20 euros for a bilateral fitting. From 1 January 2027 that figure rises to 15 euros per device. Children and young people under 18, along with anyone exempted from co-payments, pay nothing extra.
Suppliers are obliged under Section 127 SGB V to inform patients about alternatives available at no extra charge before fitting begins, and to document a declaration of additional costs. A private top-up may only be demanded when the insured person expressly chooses features with no medical benefit. Germany's Federal Court of Justice backed this reading in 2015, ruling that cost carriers may only reduce payments for additional functions that are not medically necessary.
For hearing aids, Techniker Krankenkasse pays around 720 euros per ear. In private health insurance, reimbursement depends on the tariff and typically reaches up to 1,500 euros per ear; at an 80 per cent reimbursement rate, that works out to a maximum of 1,200 euros.
The aid scheme for civil servants (Beihilfe) run by the federal government, Bavaria and North Rhine-Westphalia classifies up to 1,500 euros per ear as eligible, with replacement after five years. The Federal Joint Committee's aids guideline requires that speech comprehension with a bilateral fitting improve by at least 20 percentage points in quiet and at least 10 percentage points against background noise.
Capping the burden, and what happens after a refusal
Section 62 SGB V sets out a co-payment exemption to limit financial hardship. The burden threshold stands at 2 per cent of annual gross income, or 1 per cent for people with severe chronic illness. The exemption applies only on application.
Counted towards the threshold are payments for prescribed medicines (10 per cent, minimum 5 euros, maximum 10 euros per pack), therapeutic and medical aids, hospital stays (10 euros per day for a maximum of 28 days per calendar year) and travel costs.
Where care allowance is concerned, there is no uniform supreme court ruling, so insurers treat it differently when assessing income. For recipients of Bürgergeld and basic security, insurers apply flat-rate maximum amounts.
The system's formal traps are not limited to deadlines. Missing documentation, an incomplete medical certificate or a supplier that never mentioned the no-extra-cost option can each derail a claim that would otherwise have succeeded — which is why advisers urge claimants to treat every rejection as the start of a paper trail rather than the end of the road.
