Objection to the care grade (Pflegegrad)

One month from notification of the notice. The exact deadline, the form and the addressee are stated in the Rechtsbehelfsbelehrung of the notice – read it on the day of service, not later. If the instructions are incorrect or missing altogether, the deadline is extended considerably; that is a reason to look at the notice closely. If necessary, secure the deadline with a single sentence and submit the statement of reasons later: this is permitted, and it is the most common way people avoid missing the deadline.

No. It is enough to lodge the objection to meet the deadline – “I am lodging an objection to the notice dated … I will submit a statement of reasons later.” – and to submit the statement of reasons afterwards. You should do exactly that, because the actual first substantive step takes time: requesting and evaluating the copy of the assessment report. Combine both in one letter. Set yourself a deadline for the statement of reasons and ask the fund by when it expects it – that way the matter stays moving.

Because the notice only states the result, not how it was reached. The assessment report shows how each of the six modules was evaluated – mobility, cognitive and communicative abilities, behaviour and psychological issues, self-care, coping with illness- and therapy-related requirements, organising daily life and social contact. Only then can you say where the rating does not match your everyday life. You are entitled to the copy, it costs nothing, and you should always request it – even after an approval, because it is the basis for any later application for a higher care grade.

Module by module, with evidence. Take every rating that is wrong and set a concrete observation against it – with activity, frequency and date. So instead of “I am worse off”: “The self-care module notes ‘washing: largely independent’. In fact, daily help is needed with washing the back, blow-drying hair and putting on compression stockings; see the care diary from 3 to 16 August.” Enclose what the assessor did not have: new medical findings, a statement from the care service or the GP on a single module. Less but concrete carries more weight than a thick stack.

That depends on the timing. The objection contends that the condition at the time of the assessment was wrongly evaluated; if successful, the higher grade applies back to the original application. An application for a higher care grade is a new application and the right route if the condition has worsened since the assessment – for example after a fall or a hospital stay; it applies from the month of the new application. There is no waiting period for an application for a higher care grade. If in doubt, secure the objection deadline first, since that one runs out; an application for a higher care grade is still possible at any time.

No. The objection proceedings are free of charge and designed for insured persons to conduct them themselves. Free support is offered by social associations, where membership usually costs a few euros a month and includes representation, as well as the independent patient advice service and the local care support centres (Pflegestützpunkt). If you want legal assistance and have little income, there is Beratungshilfe: the personal contribution is €15.00 and can be waived in individual cases; the Amtsgericht (local court) issues the certificate of entitlement. For a later legal action at the Sozialgericht, insured persons do not pay court costs.

This cannot reliably be put in a single figure, and the percentages that circulate relate to different populations and say nothing about your case. What actually influences the prospects can be named concretely: whether you have evaluated the assessment report, whether your statement of reasons relates to individual modules, whether you bring new evidence that the assessor did not have, and whether someone who knows your everyday life is present at the second assessment. An objection without these four things has a hard time; one with them is a serious matter.

The Pflegekasse reviews it again and, as a rule, arranges a second assessment, often by a different assessor. Prepare for this just as you did the first time. A Widerspruchsbescheid is then issued. If it is in your favour, the new grade applies back to the original application. If it rejects the objection, you can take legal action at the Sozialgericht – free of court costs for insured persons, with the deadline and addressee stated in the Rechtsbehelfsbelehrung. There is no fixed processing time for the objection proceedings; ask about the status if nothing happens for a long time.