Ergänzende Leistungen der Krankenbehandlung im Rahmen der Sozialen Entschädigung beantragen

Injured parties can receive supplementary health treatment benefits. You can find out more here.

Injured parties whose entitlement to medical treatment has been established will receive medical treatment benefits from January 1, 2024.

Upon application, injured parties will receive supplementary benefits for recognized consequences of injury in addition to health treatment benefits if these are necessary, taking into account the nature and severity of the individual case and the special needs of the injured party. The health insurance funds should notify the competent administrative authority of cases in which the provision of supplementary health treatment benefits by the competent administrative authority is indicated.

Supplementary benefits are in particular

1. special psychotherapeutic services which

1. go beyond the treatment procedures recognized under the benefits catalog,
2. exceed the maximum permissible number of hours for the respective procedure and the treatment frequency per week or
3. are provided by psychotherapeutic physicians or psychotherapists who do not participate in SHI-accredited medical care, or by alternative practitioners who provide evidence of qualification in the field of psychotherapy,

2. special dental, implantology, oral surgery and orthodontic services as well as additional services for dental prostheses (costs that exceed the scope, material or design required due to the damage are to be borne by the injured parties themselves),

3. special curative education services after the age of 18,

4. special prescription medicines or special non-prescription pharmacy-only medicines,

5. special medical and non-medical services over and above the general hospital services as part of inpatient treatment.

Please note that your social compensation provider will decide whether and to what extent you will receive support.

If necessary, you must provide evidence:

• Medical evidence of the consequences of the injury and treatment history, for example:
  • Hospital report
  • therapy report
  • Medical certificates
• Justification of the nature and severity of the individual case and the necessity of the supplementary benefit, for example by means of
  • Medical opinion
  • Statement from the health insurance company

• As the injured party, you have suffered a health impairment in Germany or, under certain conditions, abroad (§ 15 SGB XIV) due to a damaging event.
• The health impairment has resulted in physical, psychological, mental or sensory impairments that have already been recognized as consequences of injury with a degree of damage.
• With regard to these recognized consequences of injury, you have a need for supplementary health treatment benefits over and above the health treatment benefits due to your specific individual case.

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When you apply for social compensation benefits, the social compensation law institution will check whether you are entitled to supplementary health treatment benefits. The authority examines your application and decides on the granting of the benefit and its scope. You will receive a notification of the decision and, if applicable, information about the benefits granted as well as other necessary evidence.

You can apply for social compensation benefits online or in writing.

• If necessary, you can make an appointment with your contact person at the pension authority or at your responsible office.
• We will then discuss with you whether you are entitled to social compensation benefits and what support services can be offered.
• If necessary, the case management team can discuss the further procedure and possible entitlements to benefits with you that go beyond the general duty to provide information and advice.
• If you are entitled to social compensation benefits, your contact person will discuss the next steps with you.
• The contact person will provide you with the relevant documents. If necessary, complete the documents, enclose the required evidence or supporting documents and send the documents back to your contact person.

• Your claims will be determined ex officio on the basis of the documents. The authority will inform you of the result in the form of a decision, which is usually sent to you by letter.
• If entitlements to benefits have been determined, you will receive an approval notice. If no entitlements are determined, you will receive a rejection notice.
• However, you also have the option of submitting the application online. To do this, you must complete the online application and upload the necessary supporting documents
• The eligible costs and approved cash benefits will be transferred to the account you have specified.

The prerequisite for processing is that all mandatory information has been provided. The processing time varies depending on the competent authority and the individual case. It is not possible to give an exact time and it depends on the complexity of the individual case.

There is no deadline.

Further information can be found on the website of your country or your competent authority.

Appeal: An appeal can be lodged against a decision within one month of its notification. Further information on the procedure and the competent authority to which you can lodge an appeal can be found in the notification of your application. The appeal can be submitted in writing and electronically.

Responsible: Social compensation law institution

• Health treatment of social compensation Provision of supplementary benefits
• Eligibility requirements: One or more recognized consequences of injury
• Costs: the application is free of charge
• Discretionary benefit, no legal entitlement

The Hessian Offices for Care and Social Affairs (HÄVS) in Darmstadt, Frankfurt am Main, Fulda, Gießen, Kassel and Wiesbaden are responsible for this in the state of Hesse.

You can find the HAVS responsible for your place of residence under the following link: