Here you can find the claims handling process at the Finnish Patient Insurance Centre. Each stage has been described in more detail under its own heading. Typically it takes at least seven months to receive a claims decision. Only in rare cases does the handling take over one year. At the moment, the average processing time is 7.5 months.
The time-consuming parts of the claims handling process are retrieval and careful study of all required information, reports and statements needed to prepare the claims decision.
Injury notification registration
When a new injury notification is received by the Finnish Patient Insurance Centre, it is registered and given a claim reference number.
After registration, the Finnish Patient Insurance Centre will obtain the documents and information necessary for decision-making. The documents will be requested on the basis of the information given in the notice of injury form. Patient records are requested directly from the healthcare providers, even if the patient has attached some of the documents with the injury notification.
Compiling the file takes time, but it is necessary that the documentation is as comprehensive as possible in order to ensure that a correct and reliable decision is made.
Statement from the healthcare provider
The Finnish Patient Insurance Centre will ask for a statement from the hospital or private healthcare provider where the injury was reported to have occurred in the injury notification. A copy of the injury notification will be attached to the request.
The Centre will request copies of patient records and other documentation, such as X-rays.
If the patient has been examined or treated as a result of the injury in other institutions, the Finnish Patient Insurance Centre will request copies of patient records, X-rays, and other possible material from these institutions, too.
Medical adviser's evaluation
When the requested documentation has been received, the case will be assessed from a medical point of view, and a statement from the Finnish Patient Insurance Centre's medical adviser will usually be obtained for handling the claim.
When the case has been examined, the Finnish Patient Insurance Centre will issue a decision in writing. It takes on average less than seven months from the filing of the injury notification to the issuing of the claims decision. Approximately half of injury notifications are resolved within a half a year and over 95 per cent within a year of the reception of the injury notification. At the moment, the average processing time is 7.5 months.
This decision will be sent to the claimant, the insured health care professional or healthcare provider, and to the policyholder. The claimant will also be notified in writing if the claim cannot be processed owing to the expiry of the limitation period or some other reason.
Approximately one third of reported injuries are compensable under Patient Insurance. These cases are transferred to the Finnish Patient Insurance Centre's claims assessors who will take care of the procedures for paying the compensation.
When a claim is accepted, a form for compensation will be attached to the primary claims decision to be filled in and returned to the Finnish Patient Insurance Centre. There is a separate form for cases involving loss of life.
In the form, claimants are asked to specify their claims and to give the information needed for assessing and paying out the compensation. This information should include doctor's prescriptions, receipts and documents on compensation or benefits received under other insurance schemes. Deliver your claim for compensation to the Finnish Patient Insurance Centre no later than three years after you have received a positive compensation decision. Compensation will be paid only for additional costs incurred by the patient injury.
The compensation will be determined when the claims assessor has acquired the necessary additional information. Additional information may be acquired, for example, about possible new treatment visits and compensations and benefits paid by other bodies. Once the compensation has been assessed, a claims decision will be drawn up and compensation will be paid.
Further claims for compensation may be received over a period of several years if the patient injury requires a long treatment period, or the period of incapacity for work is prolonged. Therefore, several decisions concerning the amount of compensation payable may be made in practice over the course of the claim period.
Request for revision
If the recipient considers that the claims decision has been based on insufficient documentation, they may send the Finnish Patient Insurance Centre a request in writing for a revision. In your request, you should report in detail why you find the decision to be unsatisfactory. Furthermore, any missing documents should be attached to the request, or the request should contain information on where these documents may be obtained.
Instructions for lodging an appeal are attached to each claims decision. If you are dissatisfied with the claims decision, you may refer the issue to the Patient Injuries Board or to the Court of First Instance. The Patient Injuries Board will process the request free of charge.
The task of the Patient Injuries Board is to issue recommendations in patient injury cases. A Board recommendation may be requested by the claimant, the party engaged in the health and medical care, or the Finnish Patient Insurance Centre. The Patient Injuries Board may also issue a recommendation during court proceedings on request of the court or the parties involved.
The Patient Injuries Act does not specify a time limit within which a patient should refer his or her case to the Patient Injuries Board. The Patient Injuries Board has adopted a practice of considering requests where the patient has lost the right of bringing the matter to court within the statutory three years as being effectively unfounded. Consequently, the Patient Injuries Board will not considered requests where the patient no longer has an opportunity to bring the matter to court.
In a situation where a claimant whose claim has been accepted requests a Board recommendation solely regarding the amount of compensation, the Board may evaluate the case in terms of the actual compensation criterion on its own initiative. This procedure is based on the Patient Injuries Act, Section 11 b.
The claimant may bring an action against the Finnish Patient Insurance Centre at the District Court of Helsinki or at the District Court of the locality where the claimant is domiciled or a permanent resident. The action may also be brought at the District court within whose jurisdiction the event occasioning the injury took place or the neglected event ought to have taken place or where the injury became apparent.
An action against Finnish Patient Insurance Centre must be brought within three years of the date on which the claimant has been informed of the decision and the limitation period in writing. The period for filing a suit is based on the Insurance Contracts Act (Vakuutusopimuslaki 543/1994).