Health insurer refuses a benefit — check objection and deemed approval
Therapy, medical aid or rehabilitation refused? Often the insurer has missed its own response deadline — in which case the benefit is already deemed approved.
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Quick check: what should you do?
3 short questions — no sign-up required.
Deadline at a glance
1 month from notification
§ 84 SGG
The objection to the refusal decision must be lodged within one month of notification — irrespective of this, it is worth checking whether the insurer has already missed its own response deadline (deemed approval).
It is an AI, not a person: nobody looks at your individual case, and we do not know who signs up or for what reason. That is why we give pointers, but no legal advice on the individual case. Guidelines and playbooks in the platform are only guardrails: the AI relies on the available sources and your information. AI can make mistakes — check important results, and if in doubt, ask a lawyer.
What we pay special attention to
Curated from real cases. The AI review flags exactly these points in your document.
The deemed approval under § 13 Abs. 3a SGB V is frequently overlooked.
Without an up-to-date medical statement, the decisive medical justification is often missing.
In urgent cases, valuable time passes without an application for interim relief.
What you can do here in 5 minutes
If the statutory health insurer (Krankenkasse) refuses a benefit applied for (with or without a report from the Medical Service, MD, formerly MDK), it is worth looking at the deadline first: if the insurer does not decide within 3 weeks (5 weeks with an MD report) and gives no sufficient reason, the benefit is deemed approved under § 13 Abs. 3a SGB V (Genehmigungsfiktion).
Upload the decision + the application date — our AI tools check the deemed approval and the medical reasoning and prepare the objection (Widerspruch).
Results in three steps
Check deadlines
Compare the date the application was received, the insurer's response and a possible deemed approval (§ 13 Abs. 3a SGB V).
Request the MD report
Request access to the file/the report, if one exists.
File the objection
A deadline-preserving objection with a medical statement on medical necessity.
- Check deadlines – Compare the date the application was received, the insurer's response and a possible deemed approval (§ 13 Abs. 3a SGB V).
- Request the MD report – Request access to the file/the report, if one exists.
- File the objection – A deadline-preserving objection with a medical statement on medical necessity.
- No medical assessment.
- No substitute for a doctor's statement on the necessity of the benefit.
- No representation before the social court.
Transparency
What the AI checks — and what only a lawyer can decide
An AI is only as good as the question. We show openly where your answer is reliable and where you should speak with a lawyer.
In urgent cases (interim relief, § 86b SGG) or where treatment costs are high.
More letters & checks
- Fine noticeAccused of a regulatory offense? At 2 weeks, the objection period is considerably shorter than for most other official decisions.
- Check T&C clausesExclusion of liability, notice period, automatic contract renewal — not every clause in standard terms and conditions is valid.
- Care level objectionThe long-term care insurer almost always follows the assessment of the Medical Service — if you object, you should check it module by module.
- Road traffic accidentAfter an accident, the other party’s insurer often settles too little — complete heads of damage and the correct liability ratio are worth a close look.
