Costs dispute to school route accompaniment is not charged to the disabled

LSG Celle: Health insurance must first assume costs
Celle (jur). If disabled pupils apply for reimbursement of costs for accompanying school trips, disputes between the social assistance institution and the health insurance fund may not be carried out on the backs of those concerned. This has been decided by the Landessozialgericht (LSG) of Lower Saxony-Bremen in a decision announced on Tuesday, May 9, 2017, which obliges a health insurance company to provisionally reimburse the costs in the urgent procedure (Ref .: L 4 KR 65/17 B ER).

In the legal dispute, a multiple disabled and ill with epilepsy students in the district of Wittmund had applied for the reimbursement of costs for a necessary school-path accompaniment. In the handicapped and helpless student a degree of disability of 100 was recognized.

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However, the district did not want to pay and rejected the application. Not he, but the health insurance is responsible. Because the student suffers regularly, including during trips to school, to epileptic seizures. The Schulwegbegleitung is therefore necessary for medical reasons. Therefore, the social assistance institution forwarded the claim to the health insurance fund to the health insurance fund.

But even this did not want to raise the costs. She was not responsible, because it is not a medical assistance, but "supervision to ensure the student's participation in education". Thus the social assistance is in the obligation.

In its decision of March 13, 2017, the LSG has now obliged that the health insurance fund must pay the costs. It is indeed a matter of social assistance for which the district must stand up. The jurisdictional dispute between the individual carriers should not be at the expense of the severely disabled pupil.

The pupil is entitled to a general education and thus also to the necessary for him school escort, so the LSG. In the case of the jurisdictional dispute here, according to the law, the second-placed institution, ie the health insurance, is obliged to pay the costs. This could then bring back the money from the welfare agency again. fle / mwo