Dissatisfaction with claims decision
If you are dissatisfied with the grounds of a decision or the amount of compensation issued by the Patient Insurance Centre, you can seek adjustment by filing a request for revision or an appeal to Patient Insurance Centre, submit a request for a recommended decision to the Traffic Accident and Patient Injuries Board, or submit an application for summons to a district court.
Request for revision to the Patient Insurance Centre
If you consider that a claims decision was based on insufficient documentation, you may send a written request for revision to the Patient Insurance Centre. In your request, you should indicate in which respects the documentation was insufficient. Furthermore, any missing documents should be attached to the request, or the request should at least indicate where these documents may be obtained.
Please note that if you cannot present clarifications other than those you have already presented to the Patient Insurance Centre, the decision will not be revised on these grounds. If you disagree with a decision, you should immediately submit a request for a recommended decision to the Traffic Accident and Patient Injuries Board.
The request for revision must be mailed to the Patient Insurance Centre’s address or submitted electronically.
The request for revision must be made no later than within three years of the date you have got the decision from the Patient Insurance Centre.
Contact details of the Patient Insurance Centre
Traffic Accident and Patient Injuries Board
The Traffic Accident and Patient Injuries Board is an expert body specialised in compensation for traffic accidents and patient injuries. The board decides on cases submitted to it independently. When processing a case, the board will request access to the clarifications required to make a decision fromthe Patient Insurance Centre and the healthcare facilities concerned. The board may request expert statements from physicians specialised in different fields. Cases are processed in different divisions, representing legal and medical expertise.
Submitting a request for a recommended decision to the Traffic Accident and Patient Injuries Board is free of charge.
A recommendation for a decision may be requested by the injured party and other parties entitled to compensation, parties providing health and medical services, the policyholder and the insured party. Revision can be requested in relation the grounds of the decision and the amount of compensation.
A request for a recommended decision can be an informal written notification of discontentment with a claims decision issued by the Patient Insurance Centre. However, the request must indicate:
- the name, personal identity code and address of the claimant, and
- the claim reference number starting with PO or PL indicated in the Patient Insurance Centre’s claims decision.
A request for a recommended decision must be submitted within one year after receiving the Patient Insurance Centre’s claims decision in the case.
Traffic and Patient Accident Board (web page opens in a new tab, in Finnish)
In a situation where a claimant, whose claim has been accepted, requests a Traffic and Patient Accident Board's recommendation solely regarding the amount of compensation, the Board may evaluate the case in terms of the compensation criterion on its own initiative as well. This procedure is based on the Patient Insurance Act, section 41.
Legal action in a district court
The claimant may bring an action against the Patient Insurance Centre at the District Court of Helsinki or at the district court of the locality where the claimant is domiciled or a permanent resident. The action may also be brought at the district court within whose jurisdiction the event occasioning the injury took place or the neglected event ought to have taken place or the injury became apparent.
An action against the Patient Insurance Centre must be brought within three years of the date on which the claimant has been informed of the decision in writing. The period for filing a suit is based on the Patient Insurance Act, section 53.
If a case is being processed by the Traffic Accident and Patient Injuries Board, the time limit aborts during the processing period. Once the processing of the case by the Traffic Accident and Patient Injuries Board has ended, the three year time limit of bringing the action begins again.
The calculation of the time limit for bringing an action will continue if the processing of the case by the Traffic Accident and Patient Injuries Board or in court is interrupted or cancelled before reaching a decision. In this case, the time limit for bringing an action will be at least one year, even if a shorter period remained before the case was presented to the Traffic Accident and Patient Injuries Board. The time limit for bringing an action can only be extended once in the manner presented above.