Insurance requires retiree's smoke waiver

Court: No extra oxygen for smoking pensioners

01/19/2014

The Sozialgericht Heilbronn has in a recent judgment denied a sick smoker a mobile device for the supply of oxygen. His health insurance and the judges think he had to stop smoking beforehand.

Smoker for over 50 years
Since the age of 14, the now 66-year-old pensioner Walter S. from Steinheim an der Murr in the district of Ludwigsburg claims to be a smoker. In recent decades, he consumed up to two boxes of cigarettes a day, today there are still ten self-made a day. In 1995 he had to be removed because of an apparently benign tumor, a piece of the lungs and about four years ago was the medical diagnosis: „chronic obstructive pulmonary disease“, better known as smoker's lung.

Apparatus for home
The health insurance company of Mr. S. financed him because of his shortness of breath an apparatus that can compensate for the lack of concentration in his blood by the supply of oxygen. Of course, the retiree used this so-called oxygen concentrator at most irregularly, partly because he was banished to his own four walls. Now the 66-year-old also wanted a mobile usable system, which helps him, for example, on walks to more air. His insurance, the commercial health insurance (KKH) refused to pay the costs after examination by the medical service.

Monthly therapy costs of 180 Euro
Loud „Swabian Tagblatt“ It was said as justification: „Who lowers the oxygen level in the blood by smoking, can not expect that we finance him lifting a device.“ S. defended against it with a complaint before the social court Heilbronn and submitted also an express request. At least until the final judgment he wanted to get the portable oxygen supply to ward off a possible shortness of breath provided. The „Stuttgarter Nachrichten“ The legal dispute involved treatment costs of 180 Euros per month.

Smoking incompatible with me Explosion hazard of the device
The Heilbronn judges had decided before the turn of the year (file reference S 9 KR 4030/13 ER) that the sick smoker has no claim to a mobile liquid oxygen system, as long as he does not stop smoking. The now legally binding decision emphasizes that the pensioner can await the outcome of the pending lawsuit, since the too low oxygen concentration yes with the existing apparatus „treated adequately“ could be. In addition, it was found that the requested device was not suitable, as long as S. does not stop smoking, because it exists „Danger of explosion while using fire.“ Thus, just a few weeks ago, a 52-year-old from Filderstadt who was dependent on a respirator had himself injured while lighting a cigarette, as the open flame led to a deflagration. The man had to be taken to a special clinic with severe burns.

Unclear when the main thing is being negotiated
At present one can still foresee, when in the main thing over the complaint (S 15 KR 4254/13) is decided, said Joachim of mountain, speaker of the social court. There is still no reply from the health insurance fund and it may be necessary to hear a doctor or obtain an opinion before a hearing - „or both“. (Ad)