Medical care and medical rehabilitation
Compensation paid from the workers compensation insurance as medical care:
- 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.
Medical rehabilitation provided as medical care includes:
- Rehabilitation counselling and rehabilitation guidance;
- Assessment of functional ability and ability to work and rehabilitation needs;
- Rehabilitation evaluations mapping the rehabilitation opportunities;
- Therapies aimed at improving and maintaining functional capacity and other necessary measures to promote rehabilitation;
- Medical rehabilitation aids;
- Adaptation training; and
- Episodes of medical rehabilitation in institutional or outpatient care.
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.
The injured person will be paid compensation for the first medical appointment and the consequent individual medical appointments and the related minor medical interventions (x-rays, plaster cast) without a payment commitment, and the injured person can seek medical attention from a public or private care facility.
A payment commitment is required for treatments that cost more than 310 euros (such as MRI, endoscopic examination, surgery) 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 injured person will be compensated for the client fee charged, if the treatment meets the criteria specified in the Workers’ Compensation Act.
With regard to the above-mentioned treatments, the insurance company is entitled to assign the injured person to a different care facility, for example its contractor. In that case, the injured person will be paid compensation in accordance with the payment commitment issued by the insurance company. Despite the insurer’s right to assign the injured person to a different facility, he or she is always entitled to receive treatment given by a public health care provider. In that case, the injured person will be compensated for the client fee he or she has been charged.
Compensable medical rehabilitation aids mean standard-level appliances, supplies, programmes or other similar solutions that support, maintain or improve the injured person’s 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.
In addition to medical rehabilitation, workers’ compensation insurance also compensates for other rehabilitation, such as assistive devices that are not medical rehabilitation aids but are required in the activities of daily living.
To receive compensation for medical expenses, the injured person must apply within one year to the insurance company to be compensated for the medications paid. Alternatively, the insurance company can provide the injured person with a payment commitment for the compensable medication required in the treatment of an occupational accident or disease.
Subject to certain conditions, compensation is paid to a public sector health care provider for the fee for the actual cost of medical treatment that covers the actual expenses arising from the provision of medical care. Read more on the fee for the actual cost of medical treatment