Rulings with far-reaching consequences: Federal Social Court changes case law on local mobility and focuses on self-determination and participation

With its rulings, the Federal Social Court clarifies that the entitlement to a motor-assisted mobility aid is not restricted by the range or speed of the product as long as the immediate vicinity of the home cannot reasonably be accessed independently and with one's own physical strength.

As a specialist lawyer, Jörg Hackstein also emphasizes the aspects of “participation” and “basic needs”, which must be met by the health insurance companies. “Insured persons are not only entitled to basic compensation in the sense of minimum care. The decisive factor is that the requested aid must make a significant contribution or at least provide significant relief in terms of accessing the local area in a reasonable and appropriate manner. For example, both an electric wheelchair and a push rim wheelchair with a power-assisted drive are suitable for covering a certain distance from A to B. However, the entitlement also includes being able to use one's own physical strength to complete everyday tasks. If an insured person still has sufficient physical strength to use their wheelchair independently with an assistive drive, they cannot be referred to a power wheelchair, even if this would be cheaper for the health insurance company. It is the task of the law on assistive devices to enable people with disabilities to lead as self-determined a life as possible and not to keep them away from all life-threatening dangers and thus leave them largely incapacitated."

However, the information still needs to be disseminated more widely: So far, the industry hasn't noticed much in the way of easier approvals as a result of the Federal Social Court rulings. If a person needs a specialized aid to compensate for a disability, then they are entitled to it. That's why it was and is important to carry out an extensive needs assessment, possibly video or photo documentation of the “trial and error” and, of course, a factually and professionally sound argument. The solidarity community can only pay for what is really needed. That said, there are also an increasing number of customers who buy such aids privately because they want to use them in their free time.

The need for and suitability of medical aids - including e-mobile products - will continue to be determined by qualified specialist retailers: “Real advice takes place in the specialized medical supply stores,” Simon Öhlschläger from the Stuttgart-based medical supply store Carstens is convinced. “Our specialist advisors know about the various reimbursement options and cost bearers; reimbursement via integration assistance, the integration office or the employment office may also be an option. They also know the possible alternative aids, as well as the types of illnesses and disabilities and the resulting restrictions. We have even worked together with Jobbike providers for special solutions, for example to enable a person with a walking disability to get to work using a custom-made bike.”