🏥 Medical rehabilitation in chronic illness
In brief
Medical rehabilitation is meant to remove or reduce the consequences of a chronic illness and thereby avoid, as far as possible, impending reduced earning capacity or need for care – the principle "rehabilitation before pension, rehabilitation before care". Depending on the situation, either the health insurer (§ 40 SGB V) or the Deutsche Rentenversicherung (§ 42 SGB IX) is responsible for medical rehabilitation; which body actually pays often only becomes clear during the procedure.
Step by step
- Have the need for rehabilitation certified by a doctorThe treating practice certifies the medical necessity and the need for rehabilitation.
- Submit the applicationSubmit the application informally or with a form to the health insurer or the Deutsche Rentenversicherung – which body you approach first is initially not decisive.
- Wait for the clarification of responsibilityThe body approached first must check within two weeks whether it is responsible and otherwise forward the application without delay to the body it considers responsible.
- Use your right to chooseWhen choosing the rehabilitation facility you have a right to express wishes and to choose (Wunsch- und Wahlrecht), which the body must take into account in its decision.
- Complete rehabilitation and aftercareAfter the rehabilitation measure, aftercare programmes are available to stabilise the results achieved.
Deadlines
- If the application is passed back and forth between several bodies without anyone taking responsibility, this is unlawful – after the deadlines expire, the body approached first or the paying body remains obliged under § 14 SGB IX.
- A rehabilitation application can be "reinterpreted" by the pension insurance as a pension application and vice versa – if in doubt, have the procedure explained to you before you sign which type of claim you actually want to assert.
- Whether specific deadline extensions apply when expert opinions are obtained may be regulated differently depending on the rehabilitation body; if in doubt, ask the responsible office.
In depth · legal basis, figures and practice – for advisers and professionals
Two possible funding bodies
Medical rehabilitation benefits from the health insurer are governed by § 40 SGB V; they come into consideration mainly where no gainful employment is affected or no other responsibility exists. Benefits for medical rehabilitation from the pension insurance are governed by § 42 SGB IX (in conjunction with Book Six of the Social Code) and come into consideration where earning capacity is endangered or reduced and the insurance-law conditions are met.
Clarification of responsibility under § 14 SGB IX
So that applications are not passed back and forth between bodies, § 14 SGB IX provides a staged deadline model: the rehabilitation body approached first determines within two weeks of receiving the application whether it is responsible under the benefit law applicable to it. If it does not consider itself responsible, it forwards the application without delay to the body it considers responsible; that body may then no longer question responsibility in relation to the applicant. After responsibility has been established, the benefit application must be decided within three weeks, or, where an expert opinion is needed, within two weeks after the opinion is available.
The principle "rehabilitation before pension, rehabilitation before care"
§ 8 SGB IX establishes the priority of rehabilitation benefits over pension benefits for reduced earning capacity and over care benefits, insofar as rehabilitation can still avert or reduce the need for care or the degree of reduced earning capacity.
A question about your situation that this page does not answer? Write to us or use the contact form – we will tell you which office is responsible and what to bring. Free of charge, without individual legal advice.