The insurance company can also cover the costs if the person has a travel insurance policy or other private insurance policy. In this case, the patient must normally apply for retroactive reimbursement from the insurance company.
When a person coming from abroad is entitled to treatment in Finland based on EU legislation or an international convention on social security, the costs of the treatment provided in Finland are primarily covered by the country responsible for the person’s health care costs. In addition to this, a private insurance policy can cover costs that the patient would otherwise have to pay him/herself.
Example: Thomas from Ireland is on a holiday trip in Finland. He falls and breaks his arm. He has a European Health Insurance Card and a private travel insurance policy. With the European Health Insurance Card, Thomas will receive treatment for the client fee charged from municipal residents, and the treatment provider will apply for state compensation for the costs from Kela. Thomas can apply for reimbursement from his insurance company for any costs he pays himself, such as the client fees. The insurance company will then reimburse the costs in accordance with the contractual terms.
Finnish statutory motor insurance compensates personal and property damage sustained in traffic. EU legislation does not include provisions on compensation for traffic accidents, which means that Finland applies its national legislation to traffic accidents.
Personal injuries are compensated in accordance with strict liability, irrespective of the culpability of the injuring party. The place of residence or nationality of the injured party bears no consequence on the compensation of the costs.
- If patient from abroad suffers a traffic accident in Finland, public health care must apply for compensation for the costs from the insurance company responsible for the accident or clarify the matter through the Finnish Motor Insurers’ Centre (LKV). LKV coordinates the cooperation of insurance companies that grant motor insurance policies.
- If an insurance company or LKV will not compensate the treatment costs of a person from another country, the public health care provider can apply for state compensation from Kela to cover the costs. The application must be appended with a decision of an insurance company or the Finnish Motor Insurers’ Centre indicating that it is unable to process the claim or that the case in question does not involve a traffic accident eligible for compensation.
Traffic accidents are included in the fully-comprehensive compensation provided by insurance companies. This means that the insurance companies compensate public health care for the actual costs caused to it by the treatment of a person who has been injured in traffic. Travel expenses for a doctor’s appointment or hospital can also be reimbursed. Treatment in the private sector can be compensated based on a payment commitment.
Ultimately, the Finnish Motor Insurers’ Centre (LVK) safeguards the rights of a traffic accident victim and takes care of the consequences of neglected payment of the statutory motor insurance premium. A vehicle brought to Finland for temporary use must have a valid motor insurance.
Occupational injuries and diseases
The costs of occupational injuries and diseases are compensated in full, regardless of whether or not the person is covered by health insurance in Finland or has a municipality of residence in the country.
The employee must report any accident or occupational disease to the employer, who files a notice with the insurance provider. The compensation case becomes pending through the employer’s notice. The injured person or the care facility can also institute a case by filing a written notice with the insurance provider. The compensation process is described on the website of the Workers’ Compensation Center.
- The State Treasury compensates occupational accidents and diseases that occur at or due to work.
- Mela compensates the occupational accidents and diseases of agricultural entrepreneurs and grant holders.
- TVK compensates occupational accidents and diseases that occur under small employers or if the employer has neglected its obligation to insurance its employees. TVK is the body to contact when a worker from an EU or EEC country or Switzerland, Quebec in Canada, or Israel has been treated in Finland due to an occupational accident or disease.
If the employer does not have insurance coverage in Finland, it must provide TVK with the name and address information of the injured party, the name and contact information for the employer, and medical records or other medical accounts of the occupational injury and treatment provided. If public health care has form A1 or E 101 on the person in question, a copy of it must also be appended to the documentation.
Occupational diseases that have occurred abroad
If the person in question is suspected of suffering from an occupational disease and the latest exposure to it has most likely occurred in another EU or EEC country, Switzerland or a country with which Finland has a social security agreement, the doctor’s statement E can be sent to TVK. TVK will forward the matter to the competent country, which is usually the home country of the injured party. TVK cannot compensate the treatment costs until it receives payment confirmation from the country responsible for the costs of the person’s occupational disease.
Accident insurance cannot compensate treatment costs until it has been ascertained if the case pertains to an occupational accident or disease that is eligible for compensation. Clarifications from the employer and employee are required to resolve the matter.
- If sufficient clarifications are not received, the insurance provider will issue a suspension decision.
- If the case pertains to an occupational accident or disease that is not eligible for compensation or it has not been possible to determine the eligibility (suspension decision), the treatment costs cannot be compensated. The insurance provider will notify public health care of such situations.
If the employee is covered by insurance in another EU or EEC country, Switzerland or a country with which Finland has a social security agreement, TVK will request permission for payment from the competent body of the country in question before paying the compensations. Cooperation between bodies can be slow and obtaining the permission for payment can take time. Public health care should take this into account in the dates of the invoices.
If an insurance company or TVK will not compensate the treatment costs, the public health care provider can apply for state compensation from Kela to cover the costs. In this case, a written decision or notification of inability to process the application for compensation from TVK or the insurance company must be appended to the application.