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Applying for supplementary health treatment benefits as part of social compensation

Injured parties can receive supplementary health treatment benefits. You can find out more here.

  • Basic information

    Injured parties whose entitlement to medical treatment has been established will receive medical treatment benefits from January 1, 2024.

    Upon application, injured parties will receive supplementary benefits for recognized consequences of injury in addition to health treatment benefits if these are necessary, taking into account the nature and severity of the individual case and the special needs of the injured party. The health insurance funds should notify the competent administrative authority of cases in which the provision of supplementary health treatment benefits by the competent administrative authority is indicated.

    Supplementary benefits are in particular

    • special psychotherapeutic services which
      • go beyond the treatment procedures recognized under the benefits catalog,
      • exceed the permitted maximum number of hours for the respective procedure and the treatment frequency per week or
      • are provided by psychotherapeutically active doctors or psychotherapists who do not participate in SHI-accredited medical care, or by alternative practitioners who provide evidence of qualification in the field of psychotherapy,
    • special dental, implantology, oral surgery and orthodontic services as well as additional services for dental prostheses (costs that exceed the scope, material or design required due to the damage are to be borne by the injured parties themselves),
    • special curative education services after the age of 18,
    • special prescription medicines or special non-prescription pharmacy-only medicines,
    • special medical and non-medical services over and above the general hospital services as part of inpatient treatment.

    Please note that your social compensation provider will decide whether and to what extent you will receive support.

    Requirements

    • As the injured party, you have suffered a health impairment in Germany or, under certain conditions, abroad (§ 15 SGB XIV) due to a damaging event.
    • The health impairment has resulted in physical, psychological, mental or sensory impairments that have already been recognized as consequences of injury with a degree of damage.
    • With regard to these recognized consequences of injury, you have a need for supplementary health treatment benefits over and above the health treatment benefits due to your specific individual case.

  • Procedure

    When you apply for social compensation benefits, the social compensation institution will check whether you are entitled to supplementary health care benefits. The authority will examine your application and decide whether and to what extent benefits will be granted. You will receive a notification of the decision and, if applicable, information about the benefits granted as well as other necessary evidence.

    You can apply for social compensation benefits in writing.

    • If necessary, you can make an appointment with your contact person at the pension authority or at your responsible office.
    • You will then discuss whether you are entitled to social compensation benefits and what support services can be offered.
    • If necessary, the case management team can discuss the further procedure and possible entitlements to benefits with you that go beyond the general duty to provide information and advice.
    • If you are entitled to social compensation benefits, your contact person will discuss the next steps with you.
    • The contact person will provide you with the relevant documents. If necessary, complete the documents, enclose the required evidence or supporting documents and send the documents back to your contact person.
    • Your claims will be determined ex officio on the basis of the documents. The authority will inform you of the result in the form of a decision, which is usually sent to you by letter.
    • If entitlements to benefits have been determined, you will receive an approval notice. If no entitlements are determined, you will receive a rejection notice.
    • The eligible costs and approved cash benefits will be transferred to the account you have specified.

  • Competent Department

  • Fees / Costs

    gebührenfrei

  • Deadlines & processing time

    What deadlines must be paid attention to?

    There is no deadline.

    How long does it take to process

    The prerequisite for processing is that all mandatory information has been provided. The processing time varies depending on the competent authority and the individual case. It is not possible to give an exact time and it depends on the complexity of the individual case.

  • Legal Bases

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This page has been automatically translated by DeepL. We cannot guarantee that the translation is correct.

The official information in German is complete and correct. 07.11.2025

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