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Less objections and legal complaints in the basic health insurance

  
11 May 2018 | Press Release No. 16
  • The number of objections and legal complaints is declining, despite an increase in the number of those receiving services
  • The number of objections in joint facilities has declined by 2.5 percent
  • The number of legal complains against decisions has declined by 0.4 percent

In 2017, in the legal sector of the Social Security Code SGB II there were 639,100 objections and 111,600 legal complaints filed. This was 8,800 less objections and 3,400 less legal complaints than in the year 2016. At the same time, however, the number of those entitled to standard services rose by 137,100 persons, to 6.1 Mio, when compared with the numbers in 2016. 

Objection- and legal complaint numbers are low

The number of objections and legal complaints can only be determined for the 303 joint facilities (Job Centres affiliated with the BA). In 2017, these sent out around 20.8 million Notices of Performance. In contrast, 528,200 objections and 98,000 legal complaints were filed. This means that, mathematically, approximately 2.5 percent of the Notices was objected, and around 0.4 percent ended in filing a legal complaint.

What are the most common reasons for an objection or legal complaint?

At the top of the list, with 24 percent of all objections and 18 percent of all legal complaints is "cancellation and reimbursement" (Data related to all Job Centres incl. the authorised municipal insurance carriers). The reason for this is as follows: The cash benefits in the basic insurance are determined for each billing month, in the previous month. If the benefit entitlement changes or falls completely away in the actual billing month, a Notice of Cancellation- and Reimbursement will be sent. Most objections are filed against these decisions. 

Next, at the second and third places are notices of calculating income and assets, as well as the cost of accommodation and heating. The reasons for these are, above all, the extremely complex legal situation and the sometimes different case law across the federal states, which leads to legal uncertainty. The objections and legal complaints against sanctions represent, with five and four percent respectively, a relatively low portion of all filings.

Almost two third of all objections and 60 percent of all legal complaints were either rejected or withdrawn last year. This happens, frequently, due to providing previously missing documentation or pieces of information which necessitates a revised decision.

 

More information is available on: Objections and legal complaints based on the SGB II