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LSG Lüneburg: medical reasons necessary for reimbursement of costs
Statutory health insurance companies can be obliged to pay full costs for a real hair part for medical reasons. At least women with pathological, partial hair loss, which can be rated as "disability", can benefit from this, the Lower Saxony-Bremen State Social Court (LSG) decided in a judgment published on Monday, May 20, 2019 (file number: L 4 KR 50 / 16).
A 55-year-old woman from the county of Bentheim was right. She suffers from psoriasis, which increasingly leads to circular hair loss. In order to be able to hide the bald spots, she applied to her health insurer for the cost of a hand-knotted real hair part in the amount of 1,290 euros.
The cash register only wanted to pay a maximum of 511 euros. This is enough for good care. It is an indirect disability compensation. In such cases, the health insurance companies are only liable for the “basic compensation for disabilities”. The woman could wear a synthetic hair wig for an unobtrusive appearance. A custom-made real hair piece is not necessary, especially since it is not primarily in the public eye, but in the private sphere. Temporary wearing of the synthetic hair wig is therefore not a problem.
In a judgment of March 26, 2019, the LSG ordered the health insurance fund to pay the full cost of the custom-made human hair part. In principle, the health insurance company only has to provide care for disability compensation that "does not make hair loss immediately recognizable". The health insurance company also does not have to ensure that the insured person's original appearance is restored.
In individual cases, however, it may be necessary for medical reasons that an insured person receives a tailor-made real hair part. This is the case here. Because wearing a wig favored by the health insurance would lead to the fact that the remaining hair of the woman also falls out due to her psoriasis. A synthetic hair wig for a fixed amount is therefore not an appropriate supply.
By contrast, according to a decision of the Federal Social Court (BSG) in Kassel on April 22, 2015, men with hair loss are unlucky when it comes to the cost of replacement hair (Az .: B 3 KR 3/14 R; JurAgentur report from the judgment day). At least in old age, hair loss is common in men and therefore does not have a stigmatizing or disfiguring effect. A “disability” that the health insurance company has to compensate for is therefore not to be expected, according to the BSG in the case of a pensioner who suffers from complete hairlessness due to illness. With the BSG judgment, he has to pay for his wigs himself.
The LSG Lüneburg did not have to decide whether men in an appropriate health situation could be advised to accept the loss of rest of the hair caused by a wig in psoriasis or to shave their hair completely themselves. fle / mwo