Zuschuss zum Zahnersatz bei der Krankenbehandlung der sozialen Entschädigung Erstattung

Injured parties whose entitlement to medical treatment has been established will receive medical treatment benefits from January 1, 2024.

Instead of the provision of dentures, injured parties can receive an appropriate allowance for the procurement of dentures due to recognized consequences of injury if

1. they have an extended denture made due to further tooth loss not caused by the injury and
2. the extended denture is a non-divisible benefit.

Please note that your regional association (LVR or LWL) will decide whether and to what extent you will receive support.

If necessary, you must provide evidence:

• Medical evidence of the consequences of the injury and treatment history, for example:
  • Dental report
  • Treatment and cost plan for the planned treatment

• As the injured party, you have suffered a health impairment in Germany or, under certain conditions, abroad (§ 15 SGB XIV) due to a damaging event.
• The health impairment has resulted in physical, psychological, mental or sensory impairments that have already been recognized as consequences of injury with a degree of impairment.
• You have already been recognized as having lost or damaged a tooth.
• You would like to have an extended dental prosthesis made due to further tooth loss or damage that is not the result of an injury.
• Carry out a claim check before starting treatment.

When you apply for social compensation benefits, the locally responsible regional association will check whether you are entitled to reimbursement of an allowance for dentures. The regional association in whose district you have your place of residence or habitual abode is responsible. You will receive a notification of the decision and, if applicable, information on the benefits granted as well as other necessary evidence.

You can apply for social compensation benefits online or in writing.

• If necessary, you can make an appointment with your contact person at the Landschaftsverband Rheinland (Social Compensation Department Tel: +49 221 809 5401; e-mail: SER@lvr.de) or Landschaftsverband Westfalen Lippe (Office for Social Compensation Law Tel: +49251 591 01; e-mail: SER@lwl.org).
• We will then discuss with you whether you are entitled to social compensation benefits and what support services can be offered.
• If necessary, the case management team can discuss the further procedure and possible entitlements to benefits that go beyond the general duty to provide information and advice with you.
• If you are entitled to social compensation benefits, your contact person will discuss the next steps with you.
• The contact person will provide you with the relevant documents. If necessary, complete the documents, enclose the required evidence or supporting documents and send the documents back to the Landschaftsverband responsible for your application.
• Your entitlement will be determined ex officio on the basis of the documents. The authority will inform you of the result in the form of a decision, which is usually sent to you by letter.
• If entitlements to benefits have been determined, you will receive an approval notice. If no entitlements are determined, you will receive a rejection notice.
• However, you also have the option of submitting the application online. To do this, you must complete the online application and upload the necessary supporting documents
• The eligible costs and approved cash benefits will be transferred to the account you have specified.

Submit your documents before treatment to find out whether a subsidy can be paid. The prerequisite for processing is that all mandatory information has been provided.

Appeal: An appeal can be lodged against a decision within one month of its notification. Further information regarding the procedure and the competent authority to which you can lodge an appeal can be found in the notification of your application. The appeal can be submitted in writing and electronically.

• Subsidy for dental prostheses in the case of medical treatment for social compensation Reimbursement
• Eligibility requirements: A recognized consequence of injury that requires a dental prosthesis
• Costs: the application is free of charge
• Discretionary benefit, no legal entitlement
• Responsible in NRW: Landschaftsverband Rheinland (LVR) and Landschaftsverband Westfalen-Lippe (LWL)