He can rejoice: the health insurance company must pay. Copyright by Adobe Stock/ajr_images
Thomas S. had been incapacitated for work for some time and received sick pay from his health insurance fund. He took part in a gradual reintegration measure in the company of his employer for two weeks with the consent of the health insurance fund.
Reimbursement of travel expenses by the health insurance?
Thomas S. During this time, the patient covered a total distance of 20 km from his place of residence to his place of work on ten days. After the reintegration was successfully completed, he applied to his health insurance company for reimbursement of travel costs based on the number of kilometers driven.
The health insurance company rejected the request. Reason: a gradual reintegration is not a service of the health insurance, for which it has to pay. A reintegration measure does not in principle constitute medical rehabilitation in which the health insurance fund or one of its institutions would be involved in any way.
Social court: reintegration measure constitutes rehabilitation measure
Thomas S. was not satisfied with this and – with the support of DGB Rechtsschutz GmbH Dresden – went to court. With success: the Social Court in Dresden disagreed with the health insurance company. It is true that the legal regulations governing the benefits of the health insurance funds do not explicitly state that this should also include gradual reintegration.
However, reintegration presupposes that the sick person, his or her doctor, the employer and the health insurance company work together. The aim is to enable the sick person to resume his or her previous employment. The gradual reintegration is therefore a measure of medical rehabilitation. The health insurance company also pays sickness benefit during this time.
Reimbursement of travel expenses yes, but not on the basis of a mileage allowance
The social court concludes that the health insurance fund should therefore also cover Thomas S’s travel expenses. to the business of his employer must reimburse. Thomas S. But could only claim the amount he or she would have paid if he or she had used the least expensive means of public transportation.
In the case of Thomas S. was a one-way ticket of price level 2 for the bus and thus about four euros for each trip. However, he could also demand this amount if he used his vehicle.
Result: Thomas S. Can rejoice as he recovers at least part of his travel expenses.
This is what we say about it:
It’s an old argument: until now, health insurance companies have refused to provide benefits such as travel expenses when a phased reintegration is carried out. In fact, a phased reintegration measure has a special status, as it is based on a contractual relationship between the insured person who is unable to work and the employer. The health insurance companies have always argued that this is a legal relationship similar to an employment contract and therefore the sick employees themselves have to take care of getting to their workplace at their own expense.
The Social Court of Dresden has put a stop to this by qualifying gradual reintegration as a medical rehabilitation measure. This means that the health insurance companies would not only have to reimburse the travel costs, but possibly also other costs incurred during the reintegration measure. However, the ruling of the Social Court of Dresden is not yet legally binding. If the defendant health insurance company appeals, the Saxon State Social Court would have to decide. We stay tuned.