Das Verfahren vor dem Sozialversicherungsträger

In the social security area, divergent legal views may arise between the social security provider and the insured. For instance, the insured may be of the opinion that they are entitled to certain benefits. The social security provider on the other hand may have a different view and not grant these benefits. As a rule the procedure in social law matters begins with the social security provider. Its ruling may then be contested (appealed) in the procedure in social law matters before the regional courts acting as labor and social courts (in Vienna: Labor and Social Court).

Initiation of the procedure

In health insurance matters, the procedure always starts with a request for a benefit or service (for example, a request for reimbursement of costs, section 361(1) ASVG.
The requests can be submitted to any social security provider thanks to the so-called cross-divisional service. As a rule the factual and local competent social security provider shall conduct the procedure in accordance with the General Administrative Procedures Act (AVG).

Decision of the social security provider

At the conclusion of the procedure, the social security provider must render a decision on the request: the requested benefit will either be granted or the rendering of the service will be denied. The procedure before the social security provider must be concluded with an administrative settlement before the decision of the social security provider may be appealed.

If a health insurance benefit or service is requested, the social security provider is only obligated to issue a ruling if it denies the requested benefit either wholly or in part and if the claimant expressly demands a ruling (section 367 (1) line 2 ASVG; section 70 ASGG (Labor and Social Court Act))!

Conclusion of the procedure

The procedure before the social security provider in benefits issues is concluded when the ruling takes legal effect. If you are not satisfied with the outcome of the ruling, you may contest it before the courts. 

The used references can be found in the List of sources.

Last update: 19 July 2019

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