If, in conjunction with appropriate examination, treatment or other corresponding processing, a severe injury occurs that 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 an unreasonableness assessment. 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 assessing 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 the patient’s 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. The continuation and worsening of an underlying condition is not taken into account; instead, unreasonable damage must be caused by the treatment provided.
Even severe complications are not compensated for if the risks were foreseeable by medical experts. An injury is also not compensated as unreasonable, if the injury occurs in relation to treatment administered to treat a condition that, if left untreated, could lead to the death or serious disablement of the patient.