After the claims decision
Why do so many of the notices of injury lead to negative claims decisions?
Whether the incident meets the criteria of a patient injury is defined in the Patient Injuries Act and in the Patient Insurance Act. A precondition for eligibility for compensation is that an experienced healthcare professional would have acted differently and the bodily injury could thus have been avoided.
If no bodily injury is sustained as a result of the incident, no compensation will be paid. For example, if a delay in diagnosis has no effect on the outcome of the treatment or the progress or prognosis of the disease, no compensation can be paid even if errors or shortcomings can be found in the treatment. Neither is the dissatisfaction or mental suffering caused to the patient as a result of the error compensable under the law.
What can I do if I am dissatisfied with the decisions and its ground?
If you consider that the 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.
Instructions for lodging an appeal are attached to each claims decision. If you are dissatisfied with the claims decision of the Patient Insurance Centre, you may request for a recommended decision from the Traffic and Patient Accident Board or refer the matter to a court of first instance. The Board will process the request free of charge.
How quickly will I receive compensation when the decision is made?
It will take one and a half months from the date of filing the claim for compensation on average before you receive compensation. A compensation claim form will be sent with the favourable claims decision to the person who filed the notice of injury. The compensation amount will be determined when the claims assessor has obtained the necessary additional information. When the compensation amount has been determined, a claims decision will be issued and the compensation will be paid to the account stated in the claim.
Is there a time limit for filing the claim for compensation?
File your signed claim for compensation with the Patient Insurance Centre no later than within three years of the receipt of the favourable claims decision.
What is the compensation amount based on?
The amount of compensation varies considerably depending on the nature and extent of the injury. Patient insurance will only cover the extra costs and losses caused by the patient injury. Costs and losses that would have been incurred regardless of the patient injury will not be compensated.
The compensation payable is determined by applying the provisions contained in the Tort Liability Act and the guidelines issued by the Traffic and Patient Accident Board.
What do the different incapacity categories mean?
Compensation for permanent incapacity can be paid out of patient insurance if the injury results in a permanent reduction of functional ability. Permanent incapacity will be assessed based on a medical statement in accordance with the handicap classification drawn up by the Ministry of Social Affairs and Health. You may also be requested to submit a medical statement for the purpose of assessing the incapacity.
In compensation matters, please bear in mind that no compensation will be paid for the incapacity that, in any event, results from the illness or injury originally treated. Only the additional damage resulting from a patient injury is eligible for compensation.
Why does age affect the compensation?
According to the provisions of law, the age of the injured party affects the amount of compensation payable for permanent incapacity. In other words, a younger and an older person will receive a different amount of compensation for a similar injury, because the compensation paid is intended as compensation for the incapacity suffered for the rest of the person's life.