🩺 Care level assessment: process and objection
In brief
Whether care leave, family care leave or your own pension insurance as a carer – almost all your rights depend on your relative's determined care level (usually at least care level 2). The care insurance fund determines the care level on application, usually after an assessment by the Medizinischer Dienst (medical service, for people with statutory insurance) or MEDICPROOF (for people with private insurance). This page describes the process from the carer's point of view – you will find the detailed application process from the point of view of the person in need of care themselves in the module Seniors: Applying for a care level.
Step by step
- Submit the application (by/for your relative)The application for long-term care insurance benefits is made informally to your relative's care insurance fund; as an authorised person or legal guardian you can do this on their behalf.
- Point out the faster timeline if you have announced care leaveIf you have already announced care leave or family care leave and your relative lives at home without palliative care, the assessment under § 18c SGB XI must take place within 2 weeks – actively point this out to the care insurance fund.
- Prepare for the assessment appointmentPrepare yourself and your relative for the home visit: a care diary, a medication plan and typical everyday situations help to present the actual need for support realistically.
- Check the notice of decisionCheck the care insurance fund's notice of decision (Bescheid) and the underlying assessment report carefully, especially if the care level awarded is lower than expected.
- Lodge an objection if necessaryLodge an objection (Widerspruch) in writing within one month of notification and request the full assessment report so that you can understand the reasoning.
Deadlines
- If the regular 25-working-day deadline is exceeded for a reason not attributable to the person in need of care, then according to the available sources a flat-rate compensation claim of €70 per week of delay begun arises (§ 18c SGB XI) – have this claim actively checked in the event of delays.
- An objection has no automatic effect on benefits already being paid; lodge it on time anyway, even if the substantive review takes longer.
- The shortened 2-week deadline applies only under certain conditions (care at home without palliative care plus announced care leave/family care leave) – it does not apply automatically to every application.
In depth · legal basis, figures and practice – for advisers and professionals
How the assessment works (§ 18 SGB XI)
After receiving the application, the care insurance fund commissions the Medizinischer Dienst (for people with statutory insurance) or an assessment service commissioned by the private compulsory long-term care insurance (MEDICPROOF) to carry out the assessment. The commissioning must take place in secure electronic form within 3 working days of receipt of the application (§ 18 Abs. 1 SGB XI). The care insurance fund must regularly decide within 25 working days of receipt of the application.
Shortened deadlines
If the applicant is in their home environment without palliative care and care leave under § 3 PflegeZG has already been announced or family care leave under § 2a FPfZG agreed, the assessment must take place within 2 weeks of receipt of the application. This is particularly relevant for family carers who have to make their leave dependent on a care level determined promptly.
Objection
The care level decision is an administrative act; an objection can be lodged against it within one month of notification (§ 84 SGG, general social procedure law – SGB XI itself contains no separate objection deadline). It has proved worthwhile to first request the full assessment report in order to understand the scoring in the six areas of life (modules) of the assessment instrument before substantiating the objection. If the care insurance fund does not remedy the objection, objection proceedings follow and, if necessary, a claim before the social court.
Link to the Seniors module
The full application process from the point of view of the person in need of care – including the assessment modules and score thresholds of care levels 1 to 5 – is covered in detail by the topic page Applying for a care level in the Seniors module.
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.