Claims handling

The claims handling process is made up of the following steps.

Recording of notice of injury
When a new notice of injury arrives at the Finnish Pharmaceutical Insurance Pool, the case is recorded and given a handling code.

Required documentation
Once the injury notice is recorded, the Finnish Pharmaceutical Insurance Pool acquires documentation extensive and thorough enough for handling the claim, on the basis of information recorded on the notice of injury. The Finnish Pharmaceutical Insurance Pool asks the treating institution direct for the required documents even if the notice of injury were accompanied by patient records. Enclosed in the Pool's request is a copy of the notice of injury, sent for information to the treating institution. Although the process is time-consuming, it is worth while to get as extensive a set of documents as possible for use as the basis of claims handling.

Statement from medical adviser
Once the required patient documentation is obtained, the case is assessed from the medical perspective. This usually translates into a specialist opinion from a medical adviser.

Pool's decision
On receipt of the information and specialist opinions required for deciding on the case, the Finnish Pharmaceutical Insurance Pool issues a written decision on the case. In its decision the Pool takes a stand on whether the reported injury is compensable under the terms and conditions governing pharmaceutical injuries insurance. The ensuing acceptance or denial is sent to the claimant and to the policyholder, the Finnish Cooperative for the Indemnification of Medicine-Related Injuries. The decision is accompanied by appeal instructions.

Payment of compensation
In its acceptance, the Pool informs the claimant as to what kind of compensation is paid and attaches a claim form to this acceptance. The claimant is also given further details of next steps to be taken in the matter. Compensation for pain and suffering is paid at the time the notice of injury is accepted if only possible on the basis of the information available.

24.03.2015