Kassel. Questions about treatment options for an individual condition and the legal obligation of health insurers to provide benefits do not always reach the Federal Social Court (BSG). From a legal perspective, these are usually not questions of “fundamental importance”, as the BSG made clear in a decision published on Thursday, August 15, 2024.
The plaintiff from Hesse suffered from loss of smell due to encephalitis. He asked his health insurance company to pay and then reimburse the costs of an acupuncture treatment with stimulation current (Physiokey combined acupuncture). The cash register rejected this. Apart from chronic pain in the lumbar spine or knee joints due to osteoarthritis, acupuncture is generally excluded from the catalogue of services offered by statutory health insurance.
The man’s lawsuit before the Social Court of Wiesbaden and the Social Court of the State of Hesse (LSG) in Darmstadt was unsuccessful.
No right to legal aid
The LSG did not allow the BSG to review the application. The LSG also rejected the application for legal aid in respect of a non-admission complaint. Rightly so, as the BSG has now ruled. There is no apparent deviation from the BSG’s case law here, nor any procedural error.
The dispute also lacks “fundamental significance.” The plaintiff unsuccessfully argued that recent research has shown that acupuncture is effective when there is no sense of smell.
But “the question of treatment options for an individual disease” is “generally not a legal question of ‘fundamental’ importance,” the BSG emphasized. The same applies to the question of whether there is a health insurance entitlement to treatment aimed at a specific therapy.
This means that none of the three possible grounds for granting the appeal are met. Since a non-admission claim had no chance of success, the BSG rejected the application for legal aid. (mwo)
Decision of the Federal Social Court, Ref.: B 1 KR 20/23 BH