Compensation criteria

The Patient Injuries Act and the Patient Insurance Act can be applied to a case of injury if the case meets the preconditions set for the application of the Act. A positive decision means that in addition to the injury meeting the preconditions for the application of the Act, there are grounds for compensation.

Eight compensation criteria are listed in the patient insurance legislation: 

A bodily injury may be compensable under Patient Insurance when any of the compensation criteria referred to in the Act is met.

Not all adverse events that occur in connection with medical treatment and health care are compensated for, only bodily injuries that fulfil the conditions prescribed in the patient insurance legislation. Most negative claims decisions are due to the fact that the injury sustained could not be avoided despite fully appropriate treatment. For example, it is not always possible to achieve satisfactory treatment results due to the severity of the illness or injury. Such consequences are not eligible for compensation if the actions taken were in line with the standards required of an experienced medical professional, and yet the injury could not be avoided. Such an injury may, however, become compensable as an unreasonable injury in cases where the injury is sustained as a severe and sudden consequence of the treatment given.

Even if a sufficient level of competence is not always achieved by a medical professional, this does not necessarily mean that a patient will incur a compensable bodily injury as a result. For example, a correct diagnosis is occasionally reached only after some delay, even though proper examinations could have enabled an earlier diagnosis. The injury is not compensable if the delay had no effect on the content, prognosis or outcome of the treatment.

Injuries not covered by patient insurance