LSG Lüneburg: medical reasons for a cost transfer is required
Statutory health insurance companies can be obliged for medical reasons to the full cost of acquisition for a real hair part. Can benefit, at least in women with a morbid, partial hair loss, the as a “Behinderung“ to rate is decided by the social court (LSG) of lower Saxony-Bremen on Monday, 20. May 2019, published judgment (Az.: L 4 KR 50/16).
Thus, a 55-year-old woman from the County got Bentheim right. She suffers from psoriasis, which results in her becoming a circle round hair loss. To the bald Spots to hide, they requested her health insurance Fund with the cost of acquisition for a hand-knit real hair part in the amount of 1.290 euros.
The cashier wanted to only take a maximum of 511 Euro. This is sufficient for a good supply. It was a indirect disability compensation. In such cases, the health insurance funds were only for the “base compensation of disabilities eintrittspflichtig“. The woman could wear a synthetic hair wig for a more discreet appearance. A custom-made human hair part was not necessary, since they move mainly in the Public but in the private environment. A time-wise to Wear the synthetic hair wig is, therefore, not a Problem.
By judgment of 26. March 2019, the LSG has condemned the Fund for the full cost of acquisition of the custom-made human hair part. The insurance company for the disability compensation must also ensure that, in principle, only a supply, “the hair loss is not immediately recognizable lässt“. The insurance company must also ensure that in the case of an Insured, the original appearance is restored.
In individual cases it could be necessary for medical reasons, an Insured person receives a custom-made real hair part. This was not the case here. Because of the insurance company preferred to Wear a wig, would lead to the remaining hair of the woman to fail because of their psoriasis. A synthetic hair wig to a fixed amount is therefore not appropriate for the purpose of supply.
Men with hair loss, according to a decision of the Federal social court (BSG) in Kassel, Germany, from 22. April 2015, however, at the cost of acquisition for replacement hair pitch – (Az.: B 3 KR 3/14 R; JurAgentur message of judgment day). At least in old age, hair loss in men is common and therefore seem not stigmatizing or disfiguring. Of a “Behinderung“, the need to balance the health insurance Fund, is not, therefore, the BSG in the case of a pensioner, of the disease, due to total hair loss suffers. With the BSG judgment, he must pay for his wigs even.
The LSG Lüneburg had not to decide, therefore, whether or not men can be referenced in the appropriate health situation to the fact, the with psoriasis a wig that is triggered, failure of the rest of the hair, or your hair yourself completely shave their head. fle/mwo