German social court rules ReWalk exoskeleton medically necessary for patient with SCI

Published: August 8, 2016  |  Source: healio.com  | Spinal Cord Injury:
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ReWalk Robotics logoReWalk Robotics announced the first ruling by the Social Welfare Court of Speyer which declared the ReWalk exoskeleton system was medically necessary and should be covered by insurance for a patient with spinal cord injury. The ruling, delivered in late July, overturns the original denial of the claim by the payer, a statutory health insurance entity, according to a press release.

The claimant, Philip Hollinger, is a 44-year-old man who sustained a spinal cord injury in a car accident in 2006. The accident left him paralyzed with a T6 level injury. He has used a wheelchair in the 10 years since the accident, according to the release.

Hollinger was introduced to ReWalk’s exoskeleton technology at the Rehacare trade show in 2013 and successfully completed the trial and training process. In 2014, he submitted a claim to his statutory health insurance for coverage of a ReWalk Personal system, the release noted. When the insurer denied his claim, he appealed to the Social Welfare Court of Speyer, which overturned the denial.

“Only an individual with a spinal cord injury can fully appreciate the moment of pure happiness when you are able to stand up and walk again,” Hollinger said in the release. “The decision [offers] hope to other people with SCI and confirms what I and other ReWalk users have experienced: This technology returns to me many of the things I have lost with my disability.”

The ruling included several key decisions regarding exoskeleton technology for patients with spinal cord injuries and will serve as precedent for future cases. According to the release, the court determined the following:

  • ReWalk is a medical aid that compensates for the malfunction of the body directly and, as such, does not require a positive recommendation by the German Joint National Committee or a listing in the German catalogue of medical aids;
  • The ReWalk exoskeleton technology is not comparable to wheelchairs, as ReWalk enables the insured to walk again. Therefore, the principle of efficiency pursuant to Book V of the German Social Security Code does not apply;
  • The reimbursement of a ReWalk Personal Exoskeleton System cannot be denied based upon the argument that the supply of a wheelchair is sufficient because a wheelchair does not compensate the malfunction of the body completely;
  • The insured still needs assistance when using the ReWalk Personal System, and this does not justify the denial of the payer to cover the cost of the system; and
  • The need of a wheelchair in addition to a ReWalk does not qualify as a basis for denial because the exoskeleton technology gives the insured the possibility to stand up for a few hours per day.

“This ruling is a milestone for insurance coverage of exoskeleton technology, both in Germany and around the world,” Larry Jasinski, ReWalk chief executive officer, stated in the release. “With each decision approving coverage of the ReWalk, we make key advances in the effort to ensure every eligible ReWalk user has access to and coverage of their system.”

Reference: http://rewalk.com/