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.
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.
Required documents
- Notice of Appeal from the Health Insurance CompanyMandatory
The starting point for calculating the deadline.
Responsible authority
The authority of your main place of residence is responsible.Find authority →
Fees
Varies by case
Processing time
approx. 10 months
Official: max. approx. 12 months
Online application
In person or by post
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
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
The limit varies by household and region – see the table at the responsible authority or in the application assistant.
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.