Opposition proceedings and legal action in social law

In most cases, benefit providers communicate their decisions (administrative act) in writing. If those entitled to benefits are only informed of the decision verbally, e.g. by telephone, they have the right to request the written decision. The decision must contain information on legal remedies, indicating which deadlines and formalities must be observed for the opposition.

Time limit for the statement of grounds for appeal

The objection can be substantiated immediately or marked with a note, e.g. "The substantiation of this objection will be made separately". There is no fixed deadline for substantiating the opposition. However, it should be submitted as quickly as possible in your own interest.

Delivery points for the letter of objection

An opposition can be submitted to the issuing authority, but also to any other domestic authority, an insurance carrier or a German consular authority. In the case of insurance for seafarers (Knappschaft Bahn See), it is also possible to submit the opposition to a German seamen's office (§ 84 Para. 2 SGG). In social law, the same applies to complaints. This means that a complaint can be submitted to any office of any health insurance fund. It may even be possible to file a claim at a consulate while on vacation.

Fiction of receipt

A notification from a public body (authority) is deemed to have been received by the addressee on the third day after the postmark date. This is important if an opposition or a complaint is to be filed within the deadline.

Beneficiaries can formulate a letter of objection freely or have it drafted by a lawyer. If the opposition is successful, the benefit provider will reimburse the legal fees.

As soon as the decision rejecting the benefit provider has been made, those entitled to benefits should possibly check together with expert help, i.e. usually with lawyers and, in the case of medical issues, also with doctors, whether the legal and medical assessment of the benefit provider is correct and whether all important aspects have been taken into account. In the case of medical issues, a doctor's statement can be helpful as evidence. Although the service provider may make a decision based on the file, it must take into account all relevant circumstances for the individual case and justify the decision.

If the benefit provider bases its rejection on an expert opinion, for example from the Medical Service (MD) or an external assessment, those entitled to benefits should request this and, if necessary, carefully review it with the specialist treating them. In the event of errors or inadequate consideration of the circumstances, those entitled to benefits should correct the facts. If the medical report was only drawn up on the basis of the files, those entitled to benefits should request a personal assessment. Beneficiaries have a right to inspect files in accordance with § 25 SGB X.

By submitting an opposition, they have already made it clear that they do not agree with the decision.

If the benefit provider does not make a decision on the opposition within three months, those entitled to benefits can file an action for failure to act (§ 88 SGG) with the social court without legal representation. The notice of rejection and the opposition must be sent to the social court with the action. As actions for failure to act are successful in many cases, the service providers will also reimburse the costs of legal representation.

According to § 18 SGB IX, beneficiaries can obtain a rehabilitation benefit themselves if the benefit provider does not provide a written notification stating the reasons after two months. The benefit is then deemed to have been approved. However, this regulation does not apply to the providers of integration assistance, public youth welfare and benefits for participation in social compensation.

If the service provider rejects the opposition, those entitled to benefits can take legal action before the social court. The administrative court is responsible for appeals against decisions made by the Integration Office/Inclusion Office.

The information on legal remedies in the notice of objection must state the competent social court and indicate that the action can be brought within one month. If the information on legal remedies is missing or incorrect, the time limit for lodging an appeal is extended to one year.

The period begins with the receipt of the notice of objection by the person entitled to benefits.

Persons entitled to benefits can submit the complaint in writing to the competent social court or submit the complaint orally for the record. The employees of the legal application office of the respective social court are responsible for this and can also help with the wording.

There are no court costs for proceedings before the social court. The state treasury will also pay for an expert opinion possibly commissioned by the court. If this is unfavorable for those entitled to benefits, they can consult another expert of their own at their own expense. If the claim is successful, the benefit provider must reimburse the costs of legal representation.

Beneficiaries can inspect the files in court and represent themselves. However, due to the complexity of the legal matter, legal representation before the social court is recommended.

If a benefit is refused, you can obtain this benefit yourself at your own expense and claim the costs incurred in opposition proceedings and legal action.

If you are not in a financial position to obtain the benefit yourself, but urgently need it and the outcome of the opposition proceedings and legal action is taking too long, you can apply to the social court for a temporary injunction . This does not formally require legal representation, but it is recommended. The normal opposition proceedings and legal action continue until they are legally concluded.

In this case, the court roughly examines whether there is a claim (entitlement to an order) to the benefit and whether there is a need for urgency (reason for an order).

The temporary injunction can be used to oblige the service provider to provisionally provide the requested benefit in order to avert unreasonable disadvantages for the beneficiary. Whether there is actually an entitlement to the benefit is clarified in opposition proceedings and legal action if necessary.

People who are unable to raise the necessary funds for legal representation for personal or economic reasons (e.g. receipt of citizens' allowance, basic benefits under SGB XII or BAföG) can receive legal aid.

Advice assistance includes advice and legal representation by a lawyer vis-à-vis third parties outside of court proceedings and is possible in social law from the point of opposition.

An application for advice assistance must be submitted to the local district court. Beneficiaries must provide evidence of their income and expenses and submit underlays relating to the specific legal dispute. In most cases, the rejection notice from the benefit provider is sufficient. The local court will issue a so-called advice assistance certificate, which can be used to obtain advice and, if necessary, legal representation. Counseling assistance can also be applied for directly via the legal representation after padding proof of income and assets. In the federal states of Bremen and Hamburg, legal aid is exceptionally only granted by public bodies - in Bremen, for example, by the Chamber of Employees and the Bar Association.

Legal aid (§ 114 ZPO) covers the costs of legal representation in court or the court costs for court proceedings.

However, it is only granted

• if the person entitled to benefits is not in a financial position to pay for legal representation,
• the action or application for an interim injunction has a prospect of success,
• the lawsuit does not appear to be frivolous and
• the costs incurred are not covered by legal expenses insurance or another body.

Depending on the financial circumstances of the person entitled to benefits, a distinction is made between legal aid without and with payment in installments.

The application for legal aid must be submitted to the trial court where the lawsuit is filed (§ 73a SGG, § 117 ZPO). In the application, those entitled to benefits must set out the subject matter of the dispute with the evidence and prove their personal and financial circumstances with supporting documents. The application is often submitted directly with the lawsuit through legal representation.

Legal advice is available, for example, from lawyers specializing in social law and from associations or self-help organizations for members. Some self-help organizations also offer an additional contract for legal representation with membership.