Reimbursement of Medical Treatment Expenses Incurred Due to Accident at Work or Occupational Disease
Types of insurance indemnity:
1) Compensation of additional expenses incurred to an insured person if the said expenses are covered from the health care service minimum or social support state programme:
- medical treatment;
- purchase of treatment means, including medication;
- patient’s fees and manipulative treatment;
- medical and social rehabilitation;
- transportation costs for visiting a medical establishment (by public transportation or if due to inaccessibility of public transportation or due to the health condition of the insured, by own vehicle according to the route, distance and fuel consumption of the respective vehicle);
- prosthetics, purchase and repairs of assistive equipment (orthopaedic prosthesis);
- payment for guide’s services;
- professional rehabilitation;
2) Increase of compensation for the loss of the ability to work due to payment for care of the insured person if such person is in need of permanent care by another person.
Increased compensation is paid until the end of the period of disability, loss of the ability to work and need for special care. IF after the end of the period of the loss of the ability to work the person is no longer in need of permanent care, the amount of compensation for the loss of the ability to work is calculated according to general provisions.
The compensation is granted according to the Law On Compulsory Social Insurance in respect of Accidents at Work and Occupational Diseases.
Procedure on the compensation of additional costs incurred due to an accident at work or a diagnosed occupational disease is stipulated by Chapter IV 1 of Cabinet Regulation No. 50 of 16 February 1999 Procedures for the Granting and Calculation of Insurance Compensation of Compulsory Social Insurance against Accidents at Work and Occupational Diseases.
The benefits’ claiming rules
The following documents shall be submitted if insurance indemnity is requested:
- application on the request for indemnity;
- statement on the occupational disease, which shall be issued according to the respective laws on investigation and registration procedures of occupational diseases.
A deed regarding the accident at work is sent by the State Labour Inspectorate to State Social Insurance Agency in electronic format.
For the compensation of health care service costs (including stationary medical rehabilitation), medical treatment means’ costs and patient’s fees:
- completely filled in medical documentation (“Excerpt from patient’s medical card of a stationary/ambulatory treatment establishment” and/or “Excerpt-epicrisis”) bearing information on the services provided and the necessity thereof;
- payment documents approving the said costs (cheque, receipt, etc.) bearing full name of the service and medical treatment means, incl. medication;
- report from the treating physician indicating the need for medical rehabilitation services.
For the compensation of costs of professional rehabilitation services:
- education documents proving the receipt of professional rehabilitation services;
- payment documents confirming the said costs.
For the compensation of transportation costs for the visitation of a medical establishment:
- medical documentation form “Excerpt from patient’s medical card of a stationary/ambulatory treatment establishment” indicating the dates of visit and the provided health care services by the medical establishment (for the compensation of the transportation costs of the guide, a remark by the treating physician stating the need for a guide is mandatory);
- documents proving the transportation costs (public transportation tickets, cheques or receipts from the fuel station);
For the compensation of costs of the purchase (which are not purchased from the state budget means) and repairs of assistive equipment:
- statement by the treating physician or occupation therapist on the need of the respective assistive equipment.
Information on the disability of a person, loss of the ability to work, need for special care, need for retraining suiting the present health condition or acquiring a new profession is provided to VSAA by the State Medical Commission for the Assessment of Health Condition and Working Ability in digital format.
An application you can submit in one of the divisions of the State Social Insurance Agency (SSIA):
- sent by post or submit by a notary authorized person’s intermediation.
By signing the application, the person requesting the benefit confirms that the information provided in the application is accurate.
The allowance may be requested through an authorised person, provided that the representation rights have been granted in accordance with Article 38 Paragraph one of the Administrative Procedure Law. Representation of a natural person shall be drawn up as a notarised power of attorney, or a natural person may authorise his or her representative at the VSAA office, if both the representative and the authorising person are present.
The rates of the benefits
Total sum for the compensation for medical treatment and rehabilitation costs shall not exceed twenty-fifth fold of the state social security benefit on the day of the occurrence of the insurance case (on the day of the accident at work or diagnosis of the occupational disease), i.e. EUR 1600,75.
Time for claiming
Application for compensation of additional costs must be submitted within 6 month from the date when the document attesting particular costs was issued.
Time for decision
Decision on compensation of additional costs or refusal is taken by SSIA within one month from the date when the application and attesting documents were submitted.
Receipt of the benefit
Compensation for medical treatment and rehabilitation costs due to an accident at work or an occupational disease is transferred on the beneficiary’s a bank account or an account of the Postal Accounting System (PAS).