[Reimbursement claims of severely handicapped patients in accordance with paragraph 53ff. SGBV--evaluation of social court verdicts].
Sickness insurance bodies pay in case of necessity of nursing the seriously handicapped without having legally defined this term. The medical advisor of the sickness insurance (MDK) examines the necessity of nursing seriously handicapped persons. The article analyses existing social court judgements particularly concerning their consequences on the method of the medical adviser's assessment. The medical expert has to investigate those medical and social facts that are relevant for the administrative and judicial decisions and can appey the regulations of the major associations of the sickness insurances in case of necessity of nursing seriously handicapped persons. The adoption of not properly defined legal concepts from other sections of social legislation is discussed.
Medizinischer Dienst der Krankenversicherung Niedersachsen, Celle.
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D003363:Cost Control / Q000331:legislation & jurisprudence; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence*; D004608:Eligibility Determination / Q000191:economics / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005858:Germany; D006699:Home Care Services / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D007353:Insurance, Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged
Anspruch auf Leistungen bei Schwerpflegebedürftigkeit sections 53ff. SGBV--Auswertung von Sozialgerichtsurteilen.