Lawsuit Against a Health Insurance Company for Denial of Benefits
Social court action challenging the denial of benefits under the statutory health insurance scheme following an unsuccessful appeal process.
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Quick answer
- 1
Documents you need
Notice of Appeal from the Health Insurance Company · Identification card or passport
- 2
Responsible authority
The authority of your main residence
- 3
How to do it
In person or by post at the office
- 4
Costs
Varies by case
How to proceed
- 1
Wait for the decision on the appeal
A lawsuit filed in social security court requires that the administrative appeal process has been completed.
- 2
File a lawsuit with the Social Security Court
Within 1 month of the notice of objection being served.
- 3
Legal proceedings
The Social Security Court hears cases involving insured individuals without charging court fees.
Responsible authority
The authority of your main place of residence is responsible.Find authority →
The essentials before applying
Who is eligible?
Insured individuals whose appeal against a health insurance company’s denial of benefits has been rejected.
Income limit
Processing time
Nationwide: approx. approx. 10 months
Success rate
approx. 38.0 % (estimate)
Most common mistakes
- •The one-month deadline for filing a lawsuit following the notice of objection has been missed
- •No medical certificate attesting to the medical necessity has been included
Common reasons for rejection
- •Lawsuit not filed within the deadline
- •Appeal proceedings not yet concluded
Alternatives
- Check related services in the application assistant
- Use social counselling before applying
If rejected
Read the decision carefully: often submitting missing documents or reapplying helps more than an objection.
Questions & Answers
How much does it cost to file a lawsuit against a health insurance company if it denies a claim?▼
10–80 € depending on the certificate/procedure.
How long does it take to file a lawsuit against a health insurance company when benefits are denied?▼
Typically about 300 business days—depending on the agency and its workload.
Freshness & source
- Maintenance
- Continuously reviewed & updated
- Source
- Bundesamt für Justiz
- Data quality
- 100 %