If in conjunction with appropriate examination, treatment or other corresponding processing a severe injury which is materially disproportionate with the initial situation, it may be compensated for based on the provision related to unreasonable injury regardless of whether the injury could have been prevented by acting in a different manner.

The compensability will be decided on the basis of unreasonableness evaluation. The evaluation of an injury as unreasonable provides justifiable grounds for compensation only in cases where the patient has been caused a permanent severe illness, injury, or loss of life. An illness or injury is considered to be severe if it falls at least into Classes 7 or 8 in the Ministry of Social Affairs and Health's classification of injuries.

When evaluating the possible unreasonableness of an injury, the following factors will be taken into consideration:

  • the severity of the additional injury caused by treatment
  • the nature and severity of the illness or injury examined or treated
  • the patient's overall health
  • the rarity of the injury
  • the likelihood of the injury in the individual case in question

An injury might be compensable as unreasonable if there is considerable disproportion between the consequence and the patient's illness or injury originally treated and his or her overall health. The greater the disproportion and the greater the negative effect on the patient's health caused, the more evident it seems that the injury might be unreasonable.

For example, a severely debilitating permanent neuropathic pain caused by a routine procedure might be compensable based on the unreasonableness provision. Continuation of a pre-existing illness or its turn to worse will not be taken into account, since the unreasonable injury must be caused by the treatment given.

Even severe complications are not compensated for if the risks were foreseeable by medical experts, or, if left untreated, the illness or injury could lead to the death or serious disablement of the patient.

11.03.2015