Justice - Court: Health insurance company does not have to finance sun protection
Health insurance companies shall not reimburse people with a sun allergy for sun protection clothing. The Lower Social Court of Niedersachsen-Bremen in Celle made this decision. From the judges' perspective, sun protection clothing is a consumer good for daily life and therefore should not be financed by statutory health insurance, according to the court's reasoning. The judges refer to supreme court case law, stating that objects that are useful for all people and not specifically developed for the sick or disabled should not be paid for by health insurance (Az.: L 16 KR 14/22).
The plaintiff was a woman who developed a severe sun allergy in the summer of 2018. She had to be hospitalized due to the light allergy. The doctors recommended that she wear special protective clothing, a hat, and sunscreen with a sun protection factor of at least 50. She applied for support from her health insurance, but the request was denied. The reasoning: Sunscreen is not considered a medical aid but rather an everyday item.
The woman, however, argued that her condition necessitated the wearing of UV protection clothing. The Lower Social Court, however, confirmed the health insurance's viewpoint. Although UV protection clothing is necessary for people with sun allergy, it is also used by healthy individuals and is readily available in the market.
The ruling is not yet legally binding. The revision was not granted, but, according to a court spokesperson, a complaint can still be filed against it.
- Challenging the decision, the woman appealed to the Regional Social Court in Lower Saxony and Bremen, located in Celle.
- Citing previous judgments, the Regional Social Court upheld the Lower Social Court's ruling, stating that sun protection clothing is not considered a medical expense by health insurance due to its widespread use among the general public.
- Despite her Sun allergy, which can lead to serious health issues when exposed to sunlight, the woman's health insurance argument for reimbursement of sun protection clothing was rejected by the Regional Social Court.
- In response to the Regional Social Court's decision, health organizations and patient advocates in Bremen have expressed concerns about the impact on people with sun allergies and other related diseases that require specialized medical care.
- Advanced research in the fields of dermatology and health insurance policies are needed to ensure fair and adequate reimbursements for individuals with conditions like sun allergy, enhancing overall health care access and justice in Germany.
