Care degree contradiction explained simply
Step 1: Submit by the deadline
The deadline for lodging an objection is one month from notification of the decision. If the letter does not contain any legal information, the deadline is extended to one year. If in doubt, use the date of the postmark and keep the letter in a safe place.
Tip: Send the objection in good time - by post, fax or e-mail. You can submit a detailed explanation later.
Important: Once the deadline has expired, the decision is legally binding. A change is then only possible after six months with a new application - except in the case of a significant deterioration in health, e.g. after a stroke.
Step 2: Justify the objection
Go through the report point by point. Make a note of any deviations from your actual care situation and add any medical documents or notes.
- Have all restrictions been recorded correctly?
- Are medical documents missing?
- Do your notes match the report?
- Describe in your justification why the classification is not correct and which points are missing or have been assessed incorrectly - you will find helpful tips on this in the next section.
Tip: Also check the points rating in the report:
- Care level 1: from 12.5 P
- Care level 2: from 27 P
- Care level 3: from 47.5 P
- Care level 4: from 70 P
- Care level 5: from 90 P
A small miscalculation can already mean an incorrect care level.
Step 3: Use specialist support
Get advice from:
- Care advice (§ 37.3 SGB XI)
- General practitioners or specialists
- Nursing staff from an outpatient service
These experts can check the report and help with the wording.
Step 4: Reassessment
The objection is usually followed by a new assessment by the Medical Service or Medicproof. Prepare yourself well - with notes, certificates and an honest description of your everyday situation.
Step 5: If the objection is rejected
If the objection is unsuccessful, you can file a complaint with the social court. The proceedings are free of charge, only lawyers' fees may be incurred. A specialist lawyer for social law can check whether a lawsuit is worthwhile - even retroactively for up to four years.
Free template
Here we provide you with a free template that you can easily fill out. Free online template for the care degree objection
Important tips for stating reasons for an objection
Good reasons are important for a successful objection. Here are some tips to help you:
Check expert opinion:
Compare the MD's report with the actual care situation and note any deviations.
Everyday life as proof:
Give specific examples - such as assistance with washing or the regular use of a walking frame.
Keep a care diary:
A detailed care diary can provide good documentation of the care and assistance required and is a strong source of evidence.
Seek help:
If you have any difficulties, you can contact care advice centers, care support centers or a lawyer for social law.
Important note
- Postal dispatch by registered letter with acknowledgement of receipt (recommended, as you will receive reliable proof of timely receipt)
- Sending by fax with transmission protocol (the protocol serves as official proof of receipt)
- Personal submission to the care insurance fund (be sure to obtain a written confirmation of receipt)
- Important: Telephone or electronic submission (e-mail, online form) is not permitted.
Free online template for your care degree objection
Create an objection to the care degree assessment
Fill in all fields to generate your objection as a PDF file
Important information on the objection
Note deadline: Objection must be submitted within 4 weeks
Submit justification later: Detailed justification may follow later
Request inspection: Request MDK report
Legal basis: Section 25 (1) SGB X
Frequently Asked Questions
Here you will find answers to the most important questions about appealing against the care degree decision
Submit an objection in writing to your care insurance fund within one month. If you have not yet received the report, request it at the same time.
An informal letter is sufficient. Indicate that you do not agree with the decision and state your insurance number. You can submit the detailed reasons later.
You have one month from the date of notification of the decision. If the legal notice is missing, the deadline is extended to one year.
The objection can be submitted by the person in need of care themselves or by authorized representatives, legal guardians or lawyers.
Yes, a justification increases the chances of success. Describe which restrictions or medical findings were not sufficiently taken into account in the expert opinion.
Go through the report point by point. Make a note of any deviations from your actual care situation and add any medical documents or notes.
You can get free help from care advice centers (§37.3 SGB XI), care support centers, social associations (e.g. VdK, SoVD) or your health insurance company.
As a rule, the long-term care insurance fund has <strong>up to three months</strong> to decide on your appeal.
This is often followed by a repeat assessment by the Medical Service or Medicproof. A new decision is then made on this basis.
You can file a complaint with the social court within one month. The proceedings are free of court costs, only lawyers' fees may be incurred.
With heart by your side
