Instructions for health care providers
Establishing the insurance details
If the health care provider is not sure which insurer has underwritten the policy taken under the Workers’ Compensation Act, the health care provider must contact TVK to retrieve the relevant details from insurance register maintained by TVK. You can contact us by email at firstname.lastname@example.org or by telephone on +358 409 220 930 (weekdays 9:00-15:00).
The health care provider delivers all documents and invoices to the employer’s insurer.
If the health care provider cannot find any details of the insurer underwriting the policy at the time of the claim event, it must notify TVK so that the liable insurer can be found.
Notice to TVK
The health care provider can notify TVK of a claim event (accident or suspected occupational disease) that has taken place during uninsured work by sending TVK the following information:
- injured person’s name, address and date of birth;
- employer’s name and contact information;
- details of the claim event and medical report specifying the treatments given; and
- copy of the A1 / E101 form, if found (posted worker’s certificate).
If any of this information is missing from the notice, the matter cannot be processed and the documents will be returned to the health care provider.
Invoices for medical care with full-cost payment information can be sent directly to TVK.
Full cost responsibility (TÄKY)
When occupational accidents and diseases are treated by a public health care provider, insurance companies pay for the full cost of medical care itemised in the municipal invoice to the municipality or joint municipal authority responsible for providing the medical care service (the TÄKY fee). The injured person is compensated for the client fee he or she has been charged.
The TÄKY fee is payable if the claim event and medical care given are compensable under the Workers’ Compensation Act. To enable the insurance company to make the decisions on the compensability of the claim event and medical care, the care provider must provide the insurance company with the treatment record and employer details without delay. Without this information, the insurance company cannot make a decision about the compensability or pay the TÄKY fee.
If a treatment plan is made for the medical intervention, the TÄKY fee cannot be paid unless the treatment plan is sent to the insurer within four (4) days from the date when the entries concerning the plan must be made in the patient documents. Under section 18(1) of the Decree of the Ministry of Social Affairs and Health on patient documents (298/2009), the patient document entries must be made within five (5) days from the date when the patient leaves the clinic or the service event is otherwise closed. In the case of such further treatment, the insurance company may issue a payment commitment for a care provider of its own choosing.
The insurance company has the right to receive the patient document entries and notifications related to the TÄKY fee free of charge.
The TÄKY system will not be applied in the following cases:
- occupational accident occurred before 1 January 2005;
- occupational disease manifested before 1 January 2005; or
- medical care is given in a claim event compensable by the voluntary leisure-time insurances referred to in the Workers’ Compensation Act.