Letter from the Krankenkasse (health insurance fund): refusal, contributions, Krankengeld

You can file a Widerspruch against a decision of the Krankenkasse within one month (§ 84 Abs. 1 SGG). A decision sent by post counts as delivered on the fourth day after it was posted (§ 37 Abs. 2 SGB X). If the Rechtsbehelfsbelehrung (information on legal remedies, usually at the end of the letter) is missing or wrong, the deadline is one year (§ 66 SGG).

File the Widerspruch in writing and sign it. A simple e-mail or a phone call is not enough. What counts is that your letter reaches the authority before the deadline ends. The date of the postmark is not enough. With an Einschreiben (registered letter) you can later prove that your letter was delivered.

You can first file the Widerspruch without reasons and send the reasons later. Write your reply in German. German authorities work in German, so a letter in German is the safest way to make sure your reply is understood and processed. The templates (Vorlagen) on this site are in German.

The Krankenkasse must decide on an application for a benefit no later than three weeks after receiving it. If it asks for an expert opinion, for example from the Medizinischer Dienst (medical service), the limit is five weeks (§ 13 Abs. 3a SGB V).

If it cannot keep to this time limit, it must tell you in good time and give reasons. If it does not do this, the benefit counts as approved once the time limit has passed. If you then get the benefit yourself, the fund must pay you back the costs (§ 13 Abs. 3a SGB V). Separate rules in SGB IX apply to medical rehabilitation.

Free or low-cost help is available from social associations (Sozialverbände) such as VdK or SoVD (for members). If you have little money, you can apply at the Amtsgericht (local court) for a Beratungsschein, a voucher for advice from a lawyer (Beratungshilfe under the Beratungshilfegesetz). For insured persons and benefit recipients, a Widerspruch and a court case at the Sozialgericht (social court) cost no court fees (§ 183 SGG).

Ask your doctor for a written statement explaining why you need the benefit. For a Widerspruch, this is often the most important document.