Compensation for costs and expenses
Medical care compensated by workers’ compensation insurance includes:
- necessary medical treatment for the injury and medical rehabilitation,
- examination costs and compensation for pay for the period of examination, if it is found in the examination that the claim does not meet the criteria for a claim event covered by workers’ compensation insurance
- compensation for pay for a period of physiotherapy.
Covered medical procedures
Workers’ compensation insurance covers the following medical procedures
- Treatment given or prescribed by a physician;
- Medication prescribed by a physician and the necessary health care supplies; and
- Medical rehabilitation provided as medical treatment.
Compensability of medical care depends on whether it is required by the injury or illness, and whether unnecessary costs have been avoided in its provision.
Initial medical appointment and consequent individual medical appointments and related minor procedures, such as X-ray examinations and plaster casts, are covered without a payment commitment. The employee may visit a public or private care provider for treatment.
A payment commitment is required for treatments costing more than 310 euros, such as MRI and endoscopic examination or surgeries, if the treatment is given at a private care facility. If the treatment is given by a public care provider, the provider will notify the insurance company and the employee will be compensated for the amount of client fee charged, provided that the treatment meets the criteria specified in the Workers’ Compensation Act.
The insurance company has the right to redirect the employee to another medical care provider, such as a contractual partner. In this case, compensation is paid in accordance with the payment commitment issued by the insurance company.
Despite the insurer’s right to redirect to a different facility, the employee is always entitled to receive treatment at a public health care provider. In this case, the employee is compensated for the amount of client fee charged.
The insurance covers the costs of medical rehabilitation aids. The aids must be standard-level appliances, supplies, programmes or other similar solutions that support, maintain or improve the employee’ ability to work or functional ability in the activities of daily living, or prevent deterioration of the ability to work or functional ability. Compensable medical rehabilitation aids include such assistive devices as elbow crutches, wheelchairs, orthoses and prostheses.
The employee is compensated for the costs of medication that result from the occupational accident or occupational disease. The employee must claim compensation for the costs of medication from the insurance company within one year after the costs were incurred.
Examination costs and income compensation for the period of examination
The insurance company must gain access to all the relevant information in a claim case in order to resolve the matter. Even if it is indicated by a medical examination that the injury has not been caused by an occupational accident or that the illness is not an occupational disease, the insurance covers the costs of the examination.
In the case of occupational accidents, examinations are carried out in order to determine medical causality between the injury and the accident. In the case of occupational diseases, the Finnish Institute of Occupational Health and other bodies may perform examinations in order to determine whether the illness is work-related.
The loss of pay caused by the examination is compensable, provided that the case does not involve an occupational accident or disease. Compensation is paid for up to seven (7) days.
Compensation for loss of pay during the examination period must be claimed separately. Compensation must be claimed within one year after the costs were incurred. The claim must include proof of the loss of income.
Income compensation for a period of physiotherapy
If the employee receives physiotherapy as the result of an injury or disease, compensation for loss of income is paid for the period of therapy.
If the treatment is given during a period of incapacity for work or outside the working hours, for example, no separate compensation is paid. Compensation is paid for up to thirty calendar (30) days per year.
The employee must claim compensation from the insurance company within one year after the costs were incurred. In the claim application, the employee must provide the insurance company with proof of the loss of income.