Hartz IV: No money without proof of effectiveness for the treatment

Hartz IV: No money without proof of effectiveness for the treatment

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For their medical care, Hartz IV recipients must primarily adhere to their health insurance. Additional funds from the job center can only be considered in the case of “inevitable” costs if the health insurance does not cover them, as the Bavarian State Social Court (LSG) in Munich decided in an urgent decision announced on Tuesday, June 20, 2017 (file number: L 7 AS 167/17 B ER). Without evidence of the effectiveness of a treatment, this is ruled out.

The applicant suffers from incorrect regulation of the masticatory muscles and the temporomandibular joint. This so-called craniomandibular dysfunction (CMD) is a collective term for various complaints. For example, misaligned teeth over the lower jaw and spine can lead to discomfort down to the legs. Conversely, an incorrectly positioned pelvis can cause complaints in the mouth.

In view of these multiple possible causes and complaints, the diagnosis is difficult and the effectiveness has not been proven for numerous healing methods offered.

In the event of a dispute, various complaints have been identified, which the patient attributes to a CMD. Due to her illness she had additional costs, for example for trips to more distant medical specialists or for medicines not paid by the statutory health insurance. For this, she claimed a so-called Hartz IV additional requirement.

As the LSG Munich emphasizes, health insurance is primarily responsible for the health care of Hartz IV recipients. "In order not to open the door to any desired medicine financed with tax funds", the Job Center can only assume costs if the costs are "inevitable, ie absolutely necessary". This is only possible if treatment is medically indicated, which in turn presupposes a connection between the disease and the need for treatment.

However, this is lacking here, according to the LSG in its already published decision of March 9, 2017. It is completely unclear whether the treatments claimed or desired by the patient promise improvement. The certificates rather suggested pain therapy, but this would probably be covered by the health insurance.

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