Process description
Service requests
Compensation for damage caused to life or health, as well as for medical expenses from the Medical Risk Fund, shall be requested not later than within two years from the date of the discovery of the damage, but not later than within three years from the date of such being caused.
Submission of the application necessary for requesting the service.
The information to be included in the application shall be indicated in a simple and comprehensible form which the patient can fill in on his or her own. The evaluation of the application is carried out within the framework of the administrative process, namely, all necessary activities – the acquisition of information, the gathering of evidence and the carrying out of an expert-examination are ensured by the national regulatory authorities, so that the patient can represent himself or herself in the administrative process and does not need to invite a representative (lawyer, lawyer or other authorised representative), unless the patient specifically wishes to do so.
The following documents shall be attached to the application
1. Medical documents relating to the complaint specified in the application which are at the disposal of the patient;
2. Authorisation (to be submitted, if necessary, to produce an original *) if the patient is represented by an authorised representative;
3. The Certificate of Succession (to be submitted if necessary, the original must be presented *) if the patient is dead;
4. If it is requested to reimburse medical treatment expenses, which have been performed for the prevention or reduction of damage caused to health, the submitter of the claim for reimbursement shall, as a minimum, add:
4.1. personified corroborative documents certifying medical treatment expenses (must be submitted, if necessary, the original *), which certify the costs for advice provided by a medical practitioner, medical manipulation, diagnostic and laboratory examinations, the purchase of medicinal products and medical devices and medical rehabilitation (cheques, receipts);
4.2. medical documents which justify the performed health care services (extract/epicrice from a medical institution or a specialist of a doctor, (consultant) conclusion).
If the patient asks for reimbursement of medical treatment expenses, the declaration of medical treatment expenses (both pages) must be completed with an inventory of documents certifying payments. In the case of medical treatment expenses relating to one episode of health care, a separate form shall be completed:
an inventory of supporting documents.
The patient is entitled to reimbursement for:
- the harm caused to his or her life or health (including moral harm), which has been caused by medical practitioners working in a medical treatment institution or caused by conditions during medical treatment;
- expenses related to medical treatment, if medical treatment has been necessary in order to prevent or reduce the adverse consequences of the harm caused by a medical practitioner or conditions during medical treatment for the life or health of the patient.
Only medical treatment costs that have been performed to prevent or minimise the harm caused to the patient's health are reimbursable from the funds of the Medical Risk Fund, and not the costs incurred in paying for a health service that caused damage to the patient's health. Nor are any reimbursement of expenses other than medical costs/related to medical treatment, such as transport costs, payments made by insurers.
* if necessary, the Health Inspectorate may require the submitter to produce the original documents (e.g. illegible payment document (cheques), unclear status of the heir, etc.) in accordance with Section 6, Paragraph six of the Law on Legal Force of the Documents.Receipt of a decision
The citizen receives a decision on the claim for compensation.
It should be noted that the patient's claims for damage to his or her life or health, as well as for reimbursement of medical expenses, are examined and taken within six months of the submission of the claim for reimbursement to the Medical Risk Fund. If requesting, collecting and evaluating additional information is necessary, the period for examining medical expenses and taking a decision shall be extended to one year.