Apply for benefits within the framework of social compensation for the need for long-term care

If the recognized consequences of the injury lead to a need for long-term care, injured parties can apply for further benefits under certain conditions.

If the recognized consequences of your injury lead to a need for long-term care, you can apply for social compensation benefits for long-term care needs. These benefits are intended to ensure that you receive appropriate care and support both at home and in inpatient facilities.

You are also entitled to benefits for health disorders that are not a consequence of the injury but cause a need for care in connection with recognized injuries.

If you are in need of long-term care due to an injury, you can receive the following long-term care insurance benefits, among others:

• Care allowance,
• Outpatient or inpatient care,
• Care aids, for example wheelchairs or care beds,
• Measures to improve your living environment, such as a barrier-free bathroom, stair lifts or grab rails.

If the need for care due to the injury is only partially covered by the benefits provided by statutory long-term care insurance, supplementary social compensation benefits can be claimed to the extent necessary and appropriate.

Alternatively, there is the option of claiming long-term care benefits under the employer model.

The benefits are provided by the long-term care insurance funds or by the administrative authority. The specific entitlement depends on the individual care level, which is usually determined by the care insurance fund.

Your social security provider will decide whether and to what extent you receive support.

If necessary, you must provide evidence:

• Proof of need for care due to the recognized consequences of the injury, for example:
  • Care assessment
• If applicable, proof that the costs are not or not fully covered by statutory long-term care insurance, for example
  • Notification from the long-term care insurance company that benefits have not been granted

• You have suffered a health impairment in Germany or, under certain conditions, abroad (§ 15 SGB XIV) due to a harmful event.
• The health impairment has resulted in physical, mental, intellectual or sensory impairments that have led to a need for care.
• If applicable: The costs for your damage-related care needs are not fully covered by statutory long-term care insurance.

Appeal: An appeal can be lodged against a decision within one month of its notification. Further information regarding the procedure and the competent authority to which you can lodge an appeal can be found in the notification of your application. The appeal can be submitted in writing and electronically.

When you apply for social compensation benefits, the social compensation law institution will check whether you are entitled to benefits for care needs. have. You will receive a notification of the decision and, if applicable, information about the benefits granted as well as other necessary documents.

You can apply for social compensation benefits online or in writing.

• If necessary, you can make an appointment with your contact person at the pension authority or at your responsible office.
• They will then discuss with you 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.
• You also have the option of submitting the application online. To do this, you must complete the online application and upload the necessary supporting documents.
• The eligible costs and approved cash benefits will be transferred to the account you have specified.

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