Dissatisfaction with claims decision
If you are dissatisfied with the grounds of a decision or the amount of compensation issued by the Patient Insurance Centre, you can seek adjustment by filing a request for revision or an appeal.
Request for revision
If you consider that a claims decision was based on insufficient documentation, you may send a written request for revision to the Patient Insurance Centre. In your request, you should indicate in which respects the documentation was insufficient. Furthermore, any missing documents should be attached to the request, or the request should at least indicate where these documents may be obtained.
The request for revision must be mailed to the Patient Insurance Centre’s address or submitted electronically.
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 Traffic Accident and Patient Injury Board or to a court of law. The Board will process the request free of charge.
The task of the Traffic Accident and Patient Injury 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 Patient Insurance Centre. The Board may also issue a recommendation during court proceedings on request of the court or the parties involved.
Requests for revision to claims decisions issued by the Board must be submitted in writing. A recommendation for a decision may be requested by the injured party and other parties entitled to compensation, parties providing health and medical services, the policyholder and the insured party. Revision can be requested in relation the grounds of the decision and the amount of compensation.
Recommendations for a decision must be requested one year after the Patient Insurance Centre issued the claims decision. This deadline has been shortened, and claimants should take this into account. Previously, the Board did investigate injury cases after three years had passed from the date of the decision issued by the Patient Insurance Centre. It is important to note that the new deadline also applies to patient injuries that occurred before 1 January 2021 when the Patient Insurance Centre has issued the claims decision after 1.1.2021. You may always find the right deadline from instructions on what to do in case of discontentment that is attached to your claims decision.
In a situation where a claimant, whose claim has been accepted, requests a Traffic Accident and Patient Injury Board's recommendation solely regarding the amount of compensation, the Board may evaluate the case in terms of the compensation criterion on its own initiative as well. This procedure is based on the Patient Insurance Act, section 41.
Court of justice
The claimant may bring an action against the 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 the injury became apparent.
An action against the Patient Insurance Centre must be brought within three years of the date on which the claimant has been informed of the decision in writing. The period for filing a suit is based on the Patient Insurance Act, section 53.