Order on Payment of Expenses for Medical Treatment and Assistive Devices under the Work Injury Insurance Act

Pursuant to Section 15, subsection 5, of the Work Injury Insurance Act, cf. Statutory Order No. 1186 of 19 August 2022, it is hereby stipulated:

Section 1. Expenses related to the treatment of the injured party, including rehabilitation, and expenses for the acquisition or repair of assistive devices, including prostheses and glasses, are paid in accordance with the rules in this Order.

Definitions

Section 2. In this Order, the following terms are understood as:

1. "The injury has been reported": The injury has been reported either to the employer's work accident insurance company, including state and municipal insurance units and the Guarantee Fund for Damage Insurance Companies, or to the Labour Market Insurance.

2. "Treatment": Any form of medical and medically indicated healthcare, including rehabilitation, necessitated by a work injury, cf. Section 5 of the Work Injury Insurance Act.

3. "Assistive Device": Any assistive device, including prostheses, necessitated by a work injury, cf. Section 5 of the Work Injury Insurance Act.

4. "The case is under processing": The case is being processed in the employer's work accident insurance company, including state and municipal insurance units and the Guarantee Fund for Damage Insurance Companies, or in the Labour Market Insurance until a temporary or final decision has been made on all compensation and reimbursement questions under the Work Injury Insurance Act. If a decision on compensation etc. is brought before the Appeals Board, which remits the case to the Labour Market Insurance, cf. Section 68, subsection 2, of the Act on Legal Security and Administration in the Social Area, the case is considered to be under processing until the Labour Market Insurance makes a new decision on compensation etc. If the question of payment of expenses for treatment and assistive devices, cf. Section 41 of the Work Injury Insurance Act, is reopened, the case is under processing from the injured party's request for reopening or the Labour Market Insurance's notification of reopening until the Labour Market Insurance makes a new decision, cf. however Section 7, subsection 2. If the Labour Market Insurance, in connection with a previous decision in the case, has decided to reopen the case with a view to payment of expenses under Section 15 of the Work Injury Insurance Act, the case is under processing from the date set by the Labour Market Insurance for the reopening of the case, and until the Labour Market Insurance makes a new decision.

5. "Future expenses for treatment and assistive devices for a limited period": Expenses for treatment etc., which are estimated to be completed within a limited period, and expenses for assistive devices, which it is estimated that the injured party needs for a limited period.

6. "Permanent future expenses for treatment and assistive devices": Expenses for treatment etc., which are estimated to be permanent, and expenses for assistive devices, which it is estimated that the injured party has a permanent need for.

Expenses for treatment and assistive devices before the injury is reported

Section 3. Expenses for treatment and assistive devices relating to the period before the injury is reported may be paid if the conditions in Section 4 are met.

Expenses for treatment and assistive devices while the case is under processing

Section 4. Expenses for treatment may be paid if the treatment is a consequence of the work injury and is estimated to be necessary for the best possible recovery. It is assumed that the expense cannot be paid under the Health Act or as part of treatment at a public hospital. Rehabilitation must additionally be carried out as aftercare under medical supervision in immediate connection with the medical treatment.

Subsection 2. Expenses for prostheses, glasses, and other assistive devices etc. may be paid if they are necessary to secure the result of the medical treatment or rehabilitation, reduce the consequences of the work injury, or more precisely determine the extent of the loss of earning capacity and the degree of permanent disability.

Subsection 3. Expenses for the repair, possibly renewal, of an assistive device, cf. Section 2, no. 3, may be paid if the assistive device etc. has been damaged or destroyed as a result of the work or the conditions under which the work is performed. Glasses frames are normally replaced only within a maximum price limit, which is adjusted annually. The maximum price limit is only used in situations where the glasses are damaged or destroyed under the circumstances mentioned in the first sentence, cf. Section 15, subsection 4, of the Work Injury Insurance Act.

Subsection 4. The municipality has the right to reimbursement of the expense under subsections 2 and 3 from the work accident insurance company or the Labour Market Insurance, when the municipality, in connection with the work injury, has incurred expenses under subsections 2 and 3, which the injured party is entitled to have paid under this Order.

Expenses for future treatments and assistive devices

Section 5. Expenses for future treatments and assistive devices, cf. Section 2, nos. 5 and 6, may be paid if the conditions in Section 4 are met.

The Labour Market Insurance's decision on payment of expenses for treatment and assistive devices and the insurance companies' consideration of payment of expenses for treatment and assistive devices

Section 6. The Labour Market Insurance may make an independent decision under Sections 3-5.

Subsection 2. The insurance companies may decide on claims for payment of expenses covered by Section 15 of the Work Injury Insurance Act in accordance with the rules in this Order and rules issued pursuant to Section 15, subsection 6, of the Work Injury Insurance Act.

Subsection 3. Payment may be made directly to the provider or the supplier of the assistive device or to the injured party if this person has paid the provider or supplier. Payment is made upon invoice and may be made continuously.

Subsection 4. Expenses under Section 5 are paid to the injured party as a lump sum, cf. subsections 5-7.

Subsection 5. For future treatment expenses or assistive devices, cf. Section 2, no. 5, the lump sum amount is the average annual or monthly expense multiplied by the number of years or months the treatment is estimated to last.

Subsection 6. For permanent treatment expenses or assistive devices, cf. Section 2, no. 6, the lump sum amount is the average annual expense calculated at the time of the decision, converted according to Section 15, subsection 7, of the Work Injury Insurance Act.

Subsection 7. The lump sum amount for expenses for future treatment or assistive devices under subsection 5 may not exceed the lump sum amount for expenses for future treatment or assistive devices under subsection 6, unless there is a precise treatment estimate from the provider or the supplier of the assistive device.

Reopening

Section 7. Sections 3-6 apply correspondingly in cases that have been reopened under Section 41 of the Work Injury Insurance Act.

Subsection 2. In decisions in cases that have been reopened, the starting point for the Labour Market Insurance's decision is a decision under Section 15, subsection 3, of the Work Injury Insurance Act, cf. Section 6, subsections 5-6, of this Order.

Entry into force and transitional provisions

Section 8. This Order enters into force on 1 July 2024.

Subsection 2. The Order applies to decisions made on the date of entry into force or later.

Subsection 3. Statutory Order No. 900 of 24 June 2016 on payment of expenses for medical treatment and assistive devices under the Work Injury Insurance Act is repealed.

The Ministry of Employment, 29 May 2024

Ane Halsboe-Jørgensen / Sine Frederiksen