Patient insurance from 2021 onwards
Provisions on the compensation of patient injuries and patient insurance are laid down in the Patient Injuries Act, which has been valid since 1 May 1987. However, legislation on patient insurance is about to change, as the old Patient Injuries Act has been repealed and will only be valid until the end of 2020. The provisions of the Patient Injuries Act will still be applied to all patient injuries that occur or have occurred prior 1 January 2021.
In the future, provisions on patient insurance and the duties of the Patient Insurance Centre are set out in the following acts:
- Patient Insurance Act (potilasvakuutuslaki, 948/2019),
- Act on the Patient Insurance Centre (laki Potilasvakuutuskeskuksesta, 949/2019)
- Act on the Traffic Accident and Patient Injuries Board (laki liikenne- ja potilasvahinkolautakunnasta, 959/2019).
The renewal will bring no significant changes to the core principles of patient insurance. This website provides more information on the changes to patient insurance from 1 January 2021 onwards.
Patient insurance from 1 January 2021 onwards
Application of the Patient Insurance Act: Treatment provided in Finland, treatment abroad and telemedicine
Throughout its validity, patient insurance has only covered medical care provided in Finland’s territory and territorial waters. From the beginning of 2021, the new Patient Insurance Act will be applied not only to health and medical care provided in Finland, but also to health and medical care provided abroad, if a public healthcare unit has arranged treatment abroad and it is necessary for ensuring the patient’s health.
In the future, situations where a public healthcare unit sends patients to be treated abroad, because the treatment is not available in Finland and it is medically justifiable to seek treatment abroad, are also covered by patient insurance. In other words, this refers to situations where a delay in treatment or lack of treatment would pose an immediate danger of a significant decrease in the health of the patient or would likely lead to the death of the patient.
The prerequisite is that the patient has been sent to be treated abroad with an explicit decision from the public service provider due to, for example, the fact that treatment for an extremely rare condition is not available in Finland. One of the reasons for this may be that the medical device required for treatment is not available in Finland at all, or that there is only a small number of devices in use, and the patient’s state of health is such that they cannot wait for one them to become available.
The patients are also covered by the Patient Insurance Act during transportation abroad for the treatment referred to above and during their trip back.
The Patient Insurance Act does not apply to situations where a patient goes abroad to be examined or treated independently, even if, in accordance with the relevant EU regulation, they have a prior authorisation for seeking treatment abroad. The Act also does not apply to situations where a Finnish patient is treated abroad at, for example, a Finnish embassy, UN force, etc. even if both the patient and the person administering the treatment are both Finnish.
Sending patients abroad to receive experimental treatment does not fall within the scope of the Patient Insurance Act; instead, the treatment must be based on established medical knowledge and administered in accordance with it.
Telemedicine and patient insurance
For treatment to be considered to have been given in Finland, in principle, it is required that both the patient and the provider of health and medical care are physically within the borders of Finland. The new Patient Insurance Act brings no changes to this general rule, except for the part of patients sent abroad to receive treatment (see section Treatment provided in Finland above).
In established compensation practice, situations where a healthcare provider operating in Finland acquires healthcare services from abroad are also regarded as healthcare services. For example, when an interpretation of an X-ray image taken in Finland takes place abroad or when a Finnish healthcare provider consults foreign parties without the patient having an independent treatment relationship in the other country, are deemed treatment provided in Finland.
As a rule, all examinations and treatment that only partly take place in Finland, e.g. if the patient and the physician are in different countries while the treatment is administered, are excluded from the scope of application of the Act. Situations like these are likely to become more frequent in the future as health and medical care services are increasingly offered to patients by means of telemedicine, i.e. using the various opportunities offered by communication technology.
However, the scope of application of the Act is interpreted to include situations in which either the patient or the healthcare professional providing the treatment is temporarily staying abroad for non-treatment related reasons and the treatment is arranged with a remote connection. This is typically the case when the treatment relationship has started when both parties are in Finland and, after the treatment visit and examinations, further treatment is agreed upon during telephone consulting or using electronic communication equipment. The fact that the patient has travelled abroad for a vacation after the treatment visit and answers their physician’s call during their vacation, has no effect on their patient security.
The prerequisite is that a treatment relationship has clearly been formed in the manner required by law with a healthcare provider registered in Finland. If the treatment is organised in the form of treatment provided abroad, the Patient Insurance Act is not applicable.
Application of the Patient Insurance Act: Treatment provided for those in need of urgent care
It is always the professional duty of a healthcare professional to aid those in need of urgent care. Such care is usually required and provided unexpectedly and outside any healthcare units, such as in a street, public transportation or in other public spaces.
The previous legislation on patient insurance did not apply to such urgent care, even if the treatment was administered by a healthcare professional.
According to section 2, subsection 1, paragraph 6d of the Patient Insurance Act, urgent care is considered health and medical care in the same sense as treatment given by a healthcare provider within its premises, and personal injuries caused during it can be compensated under the same conditions as patient injuries in general.
A healthcare professional does not need to take out a separate patient insurance for any treatment falling under such general obligation to assist or professional duty. All healthcare professionals who provide urgent care as referred to in the Act are covered by patient insurance directly by virtue of the Act. This is regardless of whether their other professional activities are covered by a patient insurance policy, or whether they engage in professional healthcare activities in general (for example, pensioners or healthcare professionals who work in duties not related to healthcare). Even if a professional has a patient insurance policy for their professional activities, these ‘urgent care’ injuries are not compensated under the insurance policy covering their professional operations; instead, the compensations are funded from the pay-as-you-go system.
Claiming compensation: In what time do you need to apply for compensation?
The injured party must submit a written notice of injury to the Patient Insurance Centre. The injury is reported on a ready-made form that can be filled on the website of the Patient Insurance Centre. If a person wants to fill in the notice of injury form by hand and submit it by post, the form can be printed from our website, or a copy can be requested from the Patient Ombudsman of the place of treatment.
Two periods of time should be kept in mind in relation to patient insurance, three years and ten years. If the notice of injury is not filed within the time limit, no compensation can be claimed.
Three-year limitation period
The consequences of the patient injury may become apparent with a delay, due to which the limitation period for filing a notice of injury is generous. The notice of injury must be submitted to the Patient Insurance Centre within three years of the date the patient becomes aware or should have become aware of the patient injury and its consequences.
The period starts to run even if the injured party had not been fully aware of the causal connection of the injury to the health or medical care provided. It is sufficient that the injured party has understood or, on the basis of the information available to them, should have understood that the injury was the result of an examination carried out on them or the treatment they have received. In addition, the period starts to run whether or not the injured party has detailed information on the medical diagnosis of the injury.
Ten-year limitation period
Compensation must be applied for no later than ten years after the date the injury occurred.
Special reason
A reported patient injury may be taken under investigation in up to three years of the injury. Injuries that occur after 1 January 2021 can be investigated even after 10 years from the date of the injury with special reason.
The three-year period may be exceeded, for example, if there was a justifiable reason, based on information provided by healthcare professionals or due to the continuation of treatment, for the patient to believe that the injury will not result in any permanent damage or consequences, and the patient did not file a notice of injury within the three-year period due to this.
The new Act will change this, as it will allow for patient injuries to be investigated even after the ten-year deadline for a special reason. For example, a child suffering an injury or an illness due to a patient injury that later in the child’s life causes incapacity to work or additional treatment costs, and a serious condition or injury prevents the injured party from filing the notice of injury and the child’s parents did not file one within the ten-year time limit, could be deemed as a special reason.
The injured party not being aware of the Patient Insurance Act or their right to seek compensation, does not qualify as a special reason. The injury suffered being particularly severe also does not count as a special reason.
Compensation criteria in the Patient Insurance Act: Devices permanently installed in the patient
A new compensation criterion provides additional protection for patients.
If a medical device permanently installed in the patient in a healthcare unit is not as safe as it can be expected to be and causes a personal injury to its carrier, the injured party can be compensated under the Patient Insurance Act. The time when the device was released on the market, the foreseeable level of use of the device and other factors are considered when assessing the device’s safety.
The device must be installed on or after 1 January 2021.
For the injured party to be eligible for compensation, the device must have been installed on 1 January 2021 or after. Compensation for defects and issues with safety for devices installed before this date should be sought from the manufacturer in accordance with the Product Liability Act.
Medical devices installed permanently
The most common medical devices that are installed permanently in the patient are artificial joints, pacemakers, materials used to fix bone fractures, and different kinds of implants. The devices are installed in a patient with a surgical procedure or by another medical method, and they are intended to be left in place permanently or for a longer period after the procedure. A device is permanently installed if part of it is external to the body or when some part of it can be replaced if necessary by undergoing a new procedure. This includes, for example, a device that releases medicine in the person’s body.
The Act does not apply to medical devices intended for short-term use or that are easily detachable. Such devices include removable or dissolvable materials used to close wounds, external hearing devices, teeth alignment devices, or removable dental prostheses, prosthetic limbs or orthopaedic supports.
The device is not safe
Medical devices must be safe. They must be suitable for their intended purpose and, if used properly, they must achieve their planned functionality and level of performance. If a device does not meet these requirements and the use of the device causes a personal injury, compensation can be obtained from patient insurance.
The device is not safe if it clearly falls short of its intended service life. When assessing the service life, the patient’s state of health and other characteristics as well as the expected level use for the device are considered. For example, the service life of a very active person’s joint prosthetic may be shorter than the service life of a similar joint prosthetic installed in a less active person.
A device is not defective on the grounds that a device with better features enters the market after the device’s installation.
The final compensation liability remains with the manufacturer of the device.
Patient insurance is used to pay compensation for personal injuries caused by a device that is defective in terms of safety. The compensation is not intended to be ultimately covered by patient insurance and healthcare services. The Patient Insurance Centre has the right to claim the compensation paid for the device malfunctions from the manufacturer, importer or marketer of the device.
Paying out compensation: Vocational rehabilitation
The provisions on vocational rehabilitation only apply to patient injuries that occur on or after 1 January 2021.
In the future, vocational rehabilitation measures can be compensated under patient insurance for injured parties whose ability to work or acquire income has deteriorated due to the patient injury, or it is likely that material deterioration in their working capacity will occur later. If the need for rehabilitation is due to another disability or illness, the rehabilitation is not compensated under the patient insurance system.
The purpose of vocational rehabilitation is to assist the injured person in their return to working life and to support coping with work despite the limitations caused by the injury. The measures qualifying for compensation may be diverse, such as training for a new vocation or various support actions. The costs arising from vocational rehabilitation must be reasonable and necessary to reach the goals set for the vocational rehabilitation.
Vocational rehabilitation compensated based on the Patient Insurance Act is secondary in relation to other statutory compensations. Therefore, compensation for vocational rehabilitation must primarily be applied for, for example, from the injured party’s centre for pensions, Kela or a transport insurance or an occupational accident insurance company. The Patient Insurance Centre may, however, start the process to examine the possibility for rehabilitation if no other party has taken action or if the actions taken are not deemed sufficient by the Patient Insurance Centre.
Vocational rehabilitation is the right of the injured party, but the party must also, if possible, contribute to the realisation of their rehabilitation. If the vocational rehabilitation or the investigation of rehabilitation needs and opportunities is interrupted or the commencement of the rehabilitation is delayed for a reason attributable to the rehabilitee, and said reason is not a result of the compensable injury, the full payment of compensation paid for the duration of the vocational rehabilitation can also be interrupted.
Before a permanent compensation for loss of income is confirmed, opportunities for vocational rehabilitation must be investigated.
Unlike other decisions on patient injuries, appeals against decision concerning vocational rehabilitation should be lodged with the Insurance Court. The appeal must be lodged no later than within 30 days from the date of the decision.
Discontentment with the claims decision: Traffic Accident and Patient Injuries Board
If the claimant is dissatisfied with a decision on compensation issued by the Patient Insurance Centre, they may appeal against it in three ways:
- Filing a request for revision with the Patient Insurance Centre
- Requesting for a recommendation for a decision from the Traffic Accident and Patient Injuries Board
- Lodging an appeal with a court of law.
Request for revision
If a claimant considers that the claims decision issued for their case was based on insufficient documentation, they can send a written request for revision to the Patient Insurance Centre. The request must specify the extent to which the documentation was incomplete. In addition, any missing documents must be attached to the request or it must be indicated where said documents are available.
The request for revision must be made no later than within three years of the issue date of the decision of the Patient Insurance Centre.
Traffic Accident and Patient Injuries Board
The Patient Injuries Board and the Traffic Accident Board will merge and become the Traffic Accident and Patient Injuries Board on 1 January 2021.
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.
The processing of cases by the Board is free of charge.
In its handling, the Traffic Accident and Patient Injuries Board can investigate the grounds for the compensation, even if the request for a recommendation for a decision only related to the compensation amount. If a decision recommendation issued by the request of the injured party finds that no grounds for compensation exist, the Patient Insurance Centre cannot reclaim already paid compensation from the injured party.
Court of justice
An appeal against a claims decision may be lodged with a court of law.
Cases related to patient injuries are handled by the District Court of Helsinki or by at the District Court of the locality where the appellant is domiciled or a permanent resident or the district court of the locality of the place of treatment where the injury occurred.
The appeal against the Patient Insurance Centre must be lodged within three years of the date the injured party or the claimant is informed of the claims decision and the deadline of three years.
If the matter is brought to the attention Traffic Accident and Patient Injuries Board, the period for lodging the appeal will be interrupted for the duration of the proceedings at the Board. After the Board has processed the case, the period for lodging will recommence with the same length that remained before the interruption. The period will not be interrupted if the processing of the case at the court of law or at the Traffic Accident and Patient Injuries Board is interrupted or terminated before a decision has been made. In this case, the period for lodging an appeal expires no earlier than one year from the end of the processing. The period for filing an appeal may only be extended once, following this procedure.
Insurance Court
If the claimant is not satisfied with the decision relating to vocational rehabilitation issued by the Patient Insurance Centre, revision can be sought from the Insurance Court. The appeal must be lodged no later than 30 days after the injured party has been informed of the Patient Insurance Centre’s decision.