ROUTE

When your health fund says no

The fund’s deadline and deemed approval when it lapses, one month to object, and a social court that is free for insured people.

✓ Checked: 01/08/2026

A refusal from a health fund feels final, yet in the German system it is only the first stage. More than that: the fund has a hard deadline to decide, and missing it is read by the law expressly in your favour — the service then counts as approved.

1

STEP

The fund must decide in time — or the service counts as approved

A health fund has three weeks to decide, or five where a medical opinion is obtained. Miss the deadline without giving sufficient reason, and the law treats the service as approved.
2

STEP

Refusal received: one month to object

You have one month from notification to object to the fund’s decision. The objection is informal, but medical documents are the best way to support it.
3

STEP

The social court: free of charge for insured people

If the objection is rejected, a claim to the social court remains. For insured people the proceedings carry no court fees, and a lawyer is not required.

› More about this route

This three-step route covers the whole chain: the decision deadline with its deemed-approval rule, the objection with its one-month window and absence of formality, and finally the social court, which charges insured people nothing.

The most valuable part is also the least known. The law gives the fund three weeks, or five where an expert medical opinion is obtained — and if it gives no sufficient reason for the delay, the service counts as approved once the period expires. A rare case where official silence benefits the individual.

WHERE PEOPLE MOST OFTEN LOSE MONEY AND TIME

Applying verbally or by phone. The deadline runs from the application, and without proof of the date its expiry is practically impossible to establish.
Treating a refusal as final. A different body decides the objection, and with medical reasoning decisions change regularly.
Writing an emotional objection with no documents. What decides it is not the wording but a medical opinion addressing the specific grounds of refusal.
Not bringing a claim because courts seem expensive. For insured people the social court charges no fees and a lawyer is not required.

FREQUENTLY ASKED QUESTIONS ABOUT THIS ROUTE

What happens if the fund misses the deadline?▾

The law expressly provides that, absent notification of a sufficient reason, the service counts as approved once the period expires. Before acting on that basis, record the expiry in writing.

What is a refusal usually based on?▾

Often on an opinion from the medical service, which you are entitled to request. Reading it pays: refusals frequently rest on incomplete information that your treating practice can address directly.

What does the social court cost?▾

For insured people there are no court fees and no requirement to instruct a lawyer — you can bring the claim yourself, including through the court’s filing office. Interim relief exists for urgent cases.

WHAT USUALLY COMES NEXT

Switching Health Insurance FundHundreds of euros a year for one application: when switching pays, the special termination right after increases, and the procedure where the new fund does everything.Caring for a relative and workingTen emergency days without employer consent, leave of up to six and twenty-four months, an interest-free loan and insurance.Workplace injuryAn accredited doctor instead of your own, the employer’s report, benefits beyond sick pay including rehabilitation — and one month to object.