Judgments Cancellation of sickness benefit due to missed rehabilitation measure

Cancellation of sickness benefit due to missed rehabilitation measure
Stuttgart (jur). If a health insured person does not apply for a granted rehab measure without giving reasons, the sickness benefit can be canceled. Because the insured is obliged to cooperate here, the Landessozialgericht (LSG) Baden-Württemberg in Stuttgart ruled in a recently published judgment of 21 June 2016 (Ref .: L 11 KR 455/16).

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In this case, the plaintiff was on 10 December 2010 for a mental illness written off. His health insurance paid sickness benefit after the end of the remuneration payment by the employer. The employee was finally terminated on April 1, 2011.

According to an opinion of the Medical Service of the health insurance companies (MdK), the earning capacity of the insured was at risk. He was therefore asked at the end of 2011 to submit a medical rehabilitation application. The rehabilitation measure was also approved by the pension insurance institution. But the man did not take the rehab without mentioning a specific reason.

As a result, the health insurance company failed to pay sickness benefits. Only for compelling reason should an insured person postpone or refrain from a medically necessary and expedient measure.

Only in the lawsuit did the man state that the rehabilitation clinic was 511 kilometers away from his place of residence. He would have had to go there by train at night to be able to arrive punctually at 10.00 to 12.00 in the clinic. This is unreasonable.

The LSG ruled that insured persons were obliged to cooperate. If a rehabilitation measure has been approved, it must actually be started. The sickness benefit could therefore be denied or withdrawn "until the cooperation was wholly or partly completed".

Normally, the sickness fund must make a discretionary decision in the refusal of sickness benefit. However, this was not necessary here, as the insured did not mention any reasons for not taking up his rehab. He was also referred to the consequences, if he does not appear in the rehabilitation clinic. The fact that the insured had to go to the rehab by train at night so that he arrived punctually the next day there was no "good reason" to give up the measure. fle / mwo