Before a claims decision is made, the claimant will have an opportunity to express their opinion on the matter in writing and to submit an explanation on the demands and information which may have an effect on the decision. The hearing procedure is based on sections 34–36 of the Administrative Procedure Act.
In practice, a hearing means that the Patient Insurance Centre sends the claimant a copy of the account from healthcare services or a medical expert statement it has obtained, for example, and reserves the claimant an opportunity to file a written rejoinder. The claimant will be heard in respect of such clarifications obtained by the Patient Insurance Centre, which the claimant was not already aware of.
The rejoinder must be given as a separate document. In other words, no comments should be added to any forms or clarifications previously provided. Please note that the rejoinder must be given within the indicated time limit. After the expiry of the limitation period, the matter may be decided upon, even in the absence of a rejoinder. Send your rejoinder and any possible additional attachments the Patient Insurance Centre via mail or electronically.
No response to the letter of hearing is necessary, if the claimant has nothing to comment or add to the matter.
No letter of hearing will necessarily be sent at all, if a hearing is manifestly unnecessary, because, for example, the claim is accepted. In this case, the processing of the matter will directly proceed to the decision stage.