Michael G. has been missing his right hand since he was 15 years old. He previously had a prosthesis, but without any functions - a "decorative hand", as he said. So that he can work better and because he wants to keep his job until he retires, he applied for a myoelectric forearm prosthesis with gripping function around two years ago. The PVA let him test the prosthesis for a fortnight in a rehabilitation centre - only to tell him that he didn't need the prosthesis at all - application rejected! This was incomprehensible to Ombudsman Bernhard Achitz: "Michael G. needs the prosthesis for his job, which is why the PVA has to approve it. There are always calls for people to stay in work for longer, but when it comes down to it, social insurance puts obstacles in the way."
"You become a fully-fledged person again"
After the Ombudsman Board took up the case, the PVA approved the prosthesis after all. Michael G. is very happy with it, and he also demonstrated how well it works in the ORF programme "Bürgeranwalt" on 14 March. "It makes you a fully-fledged person again," he said. Volkanwalt Achitz is also generally pleased that the PVA has given in, "but it should have been quicker, because it was always legally clear that social insurance would have to pay for the prosthesis." This is because Michael G. needs it to stay in work for longer and carry out a higher-value activity. From the perspective of the UN Convention on the Rights of Persons with Disabilities (CRPD), however, it wouldn't matter whether he needed the prosthesis for work or private reasons anyway. "The UN CRPD demands that people with disabilities are enabled to participate fully in everyday life and in society."
Conflict of interest among business representatives in social insurance?
Achitz is calling for the PVA and other social insurance institutions to make more decisions in the interests of their policyholders. "The self-administration of social insurance exists to ensure exactly that. However, since the insured, i.e. predominantly employees, no longer have the majority in the self-administration, but rather the business representatives, certain conflicts of interest can be assumed: They may prefer to make savings in the health insurance funds so that the reductions in non-wage labour costs they are demanding can be better argued." In the current prosthesis case, however, the PVA would have saved a lot of money if it had approved the prosthesis for Michael G. immediately. This is because a suitable model would have cost around 18,000 euros less in 2024 than it does today.
Details of the original rejection: PVA refuses prosthetic hand - Ombudsman Achitz: "Prime example of poor administration" - https://www.ots.at/presseaussendung/OTS_20250518_OTS0004
In May, the Ombudsman Board demanded a prosthetic hand for Michael G. - now he finally has it.