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BriefDiener
DE

Krankenkasse (health insurance fund)

Krankenkasse refuses a benefit (Ablehnung): how to file a Widerspruch

What this letter means

With an Ablehnungsbescheid (decision of refusal), the Krankenkasse tells you that it will not cover a benefit you applied for, or will only cover part of it. This can concern medical aids (Hilfsmittel) such as a walking frame, hearing aids or a wheelchair (§ 33 SGB V), therapies or treatments.

The fund often bases its decision on an expert opinion from the Medizinischer Dienst (medical service). You have the right to inspect your file (Akteneinsicht) and to ask for this expert opinion (§ 25 SGB X).

You can file a Widerspruch (objection) against the refusal. The fund then checks the case again. If it does not change its decision, a Widerspruchsausschuss (objection committee) decides. After that, you can take the case to the Sozialgericht (social court), with no court fees for insured persons (§ 183 SGG).

What to do now

  1. 1Write down the date of the decision and work out when the deadline ends.
  2. 2Read the reasons for the refusal carefully.
  3. 3Ask for the expert opinion of the Medizinischer Dienst if the letter mentions one.
  4. 4File a Widerspruch in time to keep the deadline, even if you do not have the reasons ready yet.
  5. 5Ask your doctor for a written statement that responds to the reasons for the refusal.
  6. 6Send the reasons later with all documents.
  7. 7Write 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.

How you can reply

File a Widerspruch (objection)

In time to keep the deadline, with your doctor's reasons sent later.

Template: Widerspruch gegen einen Bescheid der Krankenkasse oder Pflegekasse

Ask for Akteneinsicht (inspection of your file) and the expert opinion

So that you know which findings the refusal is based on.

Template: Akteneinsicht bei einer Behoerde beantragen

Submit an Überprüfungsantrag (request for review)

If the deadline for the Widerspruch has passed and the decision was wrong (§ 44 SGB X).

Common questions

Do I have to give reasons for the Widerspruch straight away?

No. Filing the Widerspruch itself keeps the deadline. You can send the reasons later. Say by when you will do this.

The fund did not decide within three weeks. What applies?

If it did not tell you a sufficient reason for the delay, the benefit counts as approved once the time limit has passed (§ 13 Abs. 3a SGB V). Get advice before you get the benefit yourself.

Is a medical aid only paid for if it is listed in the Hilfsmittelverzeichnis (list of medical aids)?

No. According to the Verbraucherzentrale (consumer advice centre), the Hilfsmittelverzeichnis is not a complete list. What matters is whether you need the medical aid in your individual case.

Can I write my Widerspruch in English?

Write it in German. German authorities work in German, so a letter in German is the safest way to make sure it is understood and processed. The templates (Vorlagen) on this site are in German.

Sources (German law and official pages)

  1. § 33 SGB V: Hilfsmittel
  2. § 13 SGB V: Kostenerstattung
  3. § 25 SGB X: Akteneinsicht durch Beteiligte
  4. § 44 SGB X: Rücknahme eines rechtswidrigen nicht begünstigenden Verwaltungsaktes
  5. § 84 SGG: Frist und Form des Widerspruchs
  6. § 183 SGG: Kostenfreiheit für Versicherte und Leistungsempfänger
  7. Verbraucherzentrale: Krankenkasse lehnt Antrag auf Leistungen ab
  8. Verbraucherzentrale: Hilfsmittel, was tun bei Ablehnung der Krankenkasse?

Research as of: 10 November 2026