Order on Appeals Against Decisions by the Labour Market Work Injury Insurance

Order on Appeals Against Decisions by the Labour Market Work Injury Insurance

Pursuant to Section 44, Paragraph 9, of the Act on Work Injury Insurance, cf. Statutory Order No. 1186 of 19 August 2022, Section 55, Paragraph 9, of the Act on Insurance Against Consequences of Work Injury, cf. Statutory Order No. 943 of 16 October 2000, as amended by Act No. 488 of 7 June 2001, and Section 9, Paragraph 7, of Act No. 80 of 8 March 1978 on Compensation to Injured Defence Personnel and Others, as amended by Act No. 488 of 7 June 2001, the following is enacted:

Definitions

Section 1. In this Order, "insurance company" means:

1. an insurance company that underwrites work accident insurance under the Act on Work Injury Insurance or the Act on Insurance Against Consequences of Work Injury,
2. the State, the Church, a Region, a Municipality, or an employer that has not transferred the risk to an insurance company pursuant to the law, cf. Section 48, Paragraph 5, and Section 88 of the Act on Work Injury Insurance or Section 5, Paragraph 5, and Section 74 of the Act on Insurance Against Consequences of Work Injury, or
3. agencies and others that administer work accident policies on behalf of an insurance company.

Decisions and Persons Entitled to Appeal

Act on Work Injury Insurance and Act on Compensation to Injured Defence Personnel and Others

Section 2. Decisions by the Labour Market Work Injury Insurance under the Act on Work Injury Insurance and the Act on Compensation to Injured Defence Personnel and Others may be brought before the Appeals Board by:

1. the injured person or their survivors,
2. the insurance company in cases concerning accidents,
3. the Board of Directors of the Labour Market Supplementary Pension in cases concerning occupational diseases, cf. the Act on Work Injury Insurance,
4. the employer, insofar as it concerns decisions on the recognition of work injuries,
5. Forsikring & Pension in cases concerning accidents that the Labour Market Work Injury Insurance refers to Section 48, Paragraph 6, and Section 52 of the Act on Work Injury Insurance, and
6. the Guarantee Fund for Damage Insurance Companies in cases concerning work accidents that the Guarantee Fund for Damage Insurance Companies administers under the Act on a Guarantee Fund for Damage Insurance Companies.

Act on Insurance Against Consequences of Work Injury and Act on Compensation to Injured Defence Personnel and Others

Section 3. Decisions by the Labour Market Work Injury Insurance under the Act on Insurance Against Consequences of Work Injury and the Act on Compensation to Injured Defence Personnel and Others may be brought before the Appeals Board by:

1. the injured person or their survivors,
2. the insurance company in cases concerning accidents and harmful exposures,
3. the Board of Directors of the Labour Market Supplementary Pension in cases concerning sudden lifting injuries and occupational diseases, cf. the Act on Insurance Against Consequences of Work Injury,
4. the employer, insofar as it concerns decisions on the recognition of work injuries,
5. Forsikring & Pension in cases concerning accidents that the Labour Market Work Injury Insurance refers to Section 5, Paragraph 6, and Section 47 of the Act on Insurance Against Consequences of Work Injury, and
6. the Guarantee Fund for Damage Insurance Companies in cases concerning work accidents that the Guarantee Fund for Damage Insurance Companies administers under the Act on a Guarantee Fund for Damage Insurance Companies.

Act on Compensation and Allowance to Formerly Deployed Soldiers and Other State Employees with Late-Diagnosed Post-Traumatic Stress Reaction

Section 4. Decisions by the Labour Market Work Injury Insurance under the Act on Compensation and Allowance to Formerly Deployed Soldiers and Other State Employees with Late-Diagnosed Post-Traumatic Stress Reaction may, pursuant to Section 4 of this Act, be brought before the Appeals Board by:

1. the formerly deployed soldier or other state employee,
2. the survivors of the formerly deployed soldier or other state employee, and
3. the employing authority.

Special Provisions on Appeals Against Decisions on Recognition

Section 5. If a decision is brought before the Appeals Board regarding whether a reported work injury or service injury is covered by the law, the Labour Market Work Injury Insurance may only make a decision on the right to benefits under the laws mentioned in Sections 2-4 after a final decision has been made on the recognition issue.

Paragraph 2. If only part of the recognition issue is appealed, cf. Paragraph 1, the Labour Market Work Injury Insurance may, however, make a decision on the right to benefits for the parts of the recognition issue that are not appealed.

Time Limit for Appeal

Section 6. An appeal against a decision by the Labour Market Work Injury Insurance must be submitted within 4 weeks after the appellant has received the decision. If the appeal is submitted by digital message, the appeal is timely if it is received by the Labour Market Work Injury Insurance or the Appeals Board before midnight on the last day of the time limit. If the appeal is submitted by physical letter, the appeal is timely if it is received before the end of office hours on the last day of the time limit.

Submission of Appeals and Re-evaluation

Section 7. The Labour Market Work Injury Insurance must re-evaluate a decision that is appealed. Therefore, appeals against decisions by the Labour Market Work Injury Insurance must be submitted to the Labour Market Work Injury Insurance.

Paragraph 2. Employers should, in cases concerning accidents, simultaneously with the submission of an appeal to the Labour Market Work Injury Insurance, notify the insurance company or the Guarantee Fund for Damage Insurance Companies thereof.

Paragraph 3. If the appellant sends their appeal directly to the Appeals Board, the Appeals Board shall immediately forward the appeal to the Labour Market Work Injury Insurance with a request for re-evaluation, unless the time limit for appeal has not been observed.

Paragraph 4. If there are conflicting appeals regarding the same decision from the injured person or their survivors and other persons entitled to appeal, cf. Section 2, items 2-6, and Section 3, items 2-6, the Labour Market Work Injury Insurance shall send the appeals to the Appeals Board with a statement that the Labour Market Work Injury Insurance cannot re-evaluate the case.

Paragraph 5. If an appeal is made against a decision that the Labour Market Work Injury Insurance has re-evaluated, cf. Paragraph 1, the Labour Market Work Injury Insurance shall send the appeal to the Appeals Board with a statement that the Labour Market Work Injury Insurance cannot re-evaluate the decision.

Paragraph 6. If the appeal is not submitted within the time limit, the Labour Market Work Injury Insurance shall immediately send the appeal to the Appeals Board with a statement that the time limit for appeal has not been observed.

Section 8. In the re-evaluation, the Labour Market Work Injury Insurance may take a position on both factual and legal as well as discretionary elements of the decision.

Section 9. If the Labour Market Work Injury Insurance, after re-evaluation, grants the appellant wholly or partially in their appeal, a new decision shall be sent to the parties to the case within 4 weeks after the expiry of the time limit for appeal. The new decision may be brought before the Appeals Board.

Paragraph 2. A new decision that grants the appellant wholly or partially in their appeal has effect from the time of the first decision.

Paragraph 3. If the Labour Market Work Injury Insurance assesses that the decision should not be changed, the case shall be sent to the Appeals Board, accompanied by a justification in the covering letter, within 4 weeks after the expiry of the time limit for appeal. The parties to the case shall be informed of the transmission to the Appeals Board and the justification for this.

Paragraph 4. If the Labour Market Work Injury Insurance cannot complete its re-evaluation within a time limit of 4 weeks after the expiry of the time limit for appeal, the parties to the case shall be informed thereof and of when the re-evaluation can be expected to be completed. If the delayed re-evaluation is due to the need to obtain new information or assessments for the purpose of the re-evaluation, the time limit for re-evaluation is calculated from the time the Labour Market Work Injury Insurance receives the new information.

Section 10. If an appeal, after a concrete assessment, must be considered urgent, the Labour Market Work Injury Insurance shall immediately re-evaluate the case and send a new decision regarding this to the parties to the case. If the Labour Market Work Injury Insurance assesses that the decision should not be changed, the case shall be sent to the Appeals Board immediately.

Entry into Force

Section 11. This Order enters into force on 1 January 2024.

Paragraph 2. Statutory Order No. 1271 of 28 November 2019 on Appeals Against Decisions by the Labour Market Work Injury Insurance is repealed.

Paragraph 3. This Order applies to appeals against decisions under the Act on Work Injury Insurance, the Act on Compensation to Injured Defence Personnel and Others, the Act on Insurance Against Consequences of Work Injury, the Act on Compensation and Allowance to Formerly Deployed Soldiers and Other State Employees with Late-Diagnosed Post-Traumatic Stress Reaction, and the Act on Compensation to Injured Defence Personnel and Others, which are made on or after the date of entry into force.

Ministry of Employment, 27 November 2023

Ane Halsboe-Jørgensen / Lotte Manniche Groth-Andersen