Facts
The case concerns a complainant who has been receiving psychotherapy since May 1975. The compensation fund and the appeals commission have determined that there is no congenital defect and therefore a cost approval for the psychotherapy based on Art. 13 of the Disability Insurance Act (IVG) is not considered.
The legal service derives the asserted claim from Art. 12 para. 1 IVG. This provision stipulates that insured persons are entitled to medical measures that are not aimed at the treatment of the condition itself, but are directly aimed at vocational integration and are suitable to permanently and significantly improve or preserve earning capacity.
In the case of non-working minors, medical measures can already serve the purpose of vocational integration and be covered by the Disability Insurance if, without these measures, a healing with a defect or otherwise stabilized condition would occur, which would likely impair vocational training or earning capacity or both.
Considerations
The requirements for the granting of medical measures to minors are, according to the administrative practice, among others, fulfilled in the case of severe mental disorders, provided that after intensive professional treatment of 360 days' duration, no sufficient improvement has been achieved and, according to specialist medical findings, further…