Schleswig-Holstein Regional Social Court, 27 February 2013, Ref.: L 9 SO 17\/11<\/b><\/p>\n
Pet\u00f6 therapy is the name given to the conductive support method developed in Hungary for people with mobility impairments. The aim is to make people with mobility impairments largely independent of outside help in their everyday lives.<\/p>\n
However, the therapeutic benefits of this method have not yet been proven, with the result that Pet\u00f6 therapy has not been categorised as a prescribable aid in the Therapeutic Products Directive.<\/p>\n
As part of medical rehabilitation, the costs of support can therefore not be covered by health insurance companies.<\/p>\n
The question therefore arises as to whether and under what conditions the costs can and must be covered by social welfare contributions. The Schleswig-Holstein State Social Court had to deal with the clarification of this question in the above-mentioned judgement.<\/p>\n
The plaintiff, born in 2001, suffered from a cerebral myelination disorder, cerebellar atrophy, progressive spasticity, global developmental delay and bilateral hip dysplasia.<\/p>\n
On presentation of a cost estimate for Pet\u00f6 therapy, the plaintiff's parents initially applied to the defendant health insurance fund to cover the costs of the desired therapy. The health insurance company refused to cover the costs.<\/p>\n
The parents then submitted an application to the defendant social welfare organisation to cover the costs of Pet\u00f6 therapy.<\/p>\n
This was also rejected on the grounds that Pet\u00f6 therapy is a medical rehabilitation programme. As long as it was not included in the health insurance companies' catalogue of remedies, the therapy costs could not be covered by integration assistance.<\/p>\n
The claimant appealed against this decision to the Schleswig Social Court. This was successful. In turn, the defendant appealed against this to the Schleswig-Holstein Regional Social Court.<\/p>\n
The LSG followed the view of the defendant and ruled that the plaintiff was not entitled to have the costs of Pet\u00f6 therapy covered by the defendant in accordance with Section 3 para. 1 SGB XII in conjunction with Section 15 para. 1 sentence 4, 2nd alt. SGB IX by the defendant.<\/p>\n
However, this does not follow from the fact that the defendant is not the competent service provider pursuant to Section 14 para. 1 sentence 2, para. 2 sentence 1 SGB IX. The defendant is the competent service provider here.<\/p>\n
In the new version of the Therapeutic Products Directive of 20 January 2011, the support according to Pet\u00f6 was again classified as a non-prescribable aid because the therapeutic benefit had not been proven. The health insurance funds were therefore unable to cover the costs as part of medical rehabilitation.<\/p>\n
The costs of Pet\u00f6 therapy could be covered as part of integration assistance in accordance with Sections 53 et seq. SGB XII. In this respect, Section 54 Para. 1 No. 1 SGB XII in conjunction with Section 12 No. 1 of the Integration Assistance Ordinance could be considered as a basis for entitlement for recognition as social rehabilitation.<\/p>\n
Here, curative education services for children who have not yet started school would be considered in accordance with Section 55 (2) No. 2 SGB IX.<\/p>\n
However, the prerequisite is always the necessity and suitability in the individual case and the prospect of success to be determined individually.<\/p>\n
The distinction between medical rehabilitation benefits and social rehabilitation benefits is made according to the purpose of the benefit; the decisive factor is which needs are to be satisfied with the aid or measure.<\/p>\n
The purposes of the benefits may overlap. Social rehabilitation is therefore always involved if the requested benefits go beyond the benefits of statutory health insurance and have objectives that go beyond the purposes of statutory health insurance, e.g. in accordance with Section 55 (1) SGB IX, in order to enable or ensure participation in life in society.<\/p>\n
With regard to Pet\u00f6 therapy, it is irrelevant that its focus is a medical measure in the sense of a remedy if it also improves cognitive processes and significantly improves the school situation.<\/p>\n
If, in individual cases, therapy also serves to improve participation in life in the community, but if the medical purpose of the benefit is clearly in the foreground, then it should be categorised solely as medical rehabilitation.<\/p>\n
According to these principles, Pet\u00f6 therapy is used almost exclusively for medical rehabilitation. The application for assumption of costs was based on the opinion of the treating orthopaedist Dr K, in which it was stated, among other things, that within the framework of a block of conductive treatment according to Pet\u00f6, an attempt should be made to bundle the motor skills acquired in the previous therapy under the idea that the plaintiff would then walk freely or at least use the possibilities of the rollator.<\/p>\n
The initial situation and the results of the therapy summarised by the doctor in the final report also showed that the therapy was almost exclusively aimed at promoting motor skills.<\/p>\n
Furthermore, it was apparent from one of the medical reports that there had essentially been a slight improvement in motor skills, although it should be noted that Dr K, as an orthopaedic surgeon, had not given a focused opinion on the learning of improvements beyond motor skills.<\/p>\n
However, it can be inferred from these reports as a whole that the goals of integration into society, the promotion of intellectual and socio-emotional skills such as language, culture, technology and psychosocial behaviour as well as the promotion of practical life skills, which were also pursued in principle with Pet\u00f6 therapy, had obviously not - yet - played any significant role for the plaintiff.<\/p>\n
Even if motor skills make it easier to integrate into society, goals to this end should first have been formulated and possible, and it should have been demonstrated that approaches were in place to work towards these goals and that they could be achieved. This was not the case here.<\/p>\n
The aim of integration assistance to eliminate or alleviate a disability or its consequences and to integrate the applicant into society through Pet\u00f6 therapy was neither formulated nor evident in this case. It was therefore not possible to assume the costs in this case.<\/p>\n
Source: Schleswig-Holstein LSG<\/p>\n