Order on Insurance Companies' Access to Process Claims for Payment of Expenses for Medical Treatment and Assistive Devices under the Work Injury Insurance Act

Order on Insurance Companies' Access to Process Claims for Payment of Expenses for Medical Treatment and Assistive Devices under the Work Injury Insurance Act

Pursuant to Section 15, subsection 6, of the Work Injury Insurance Act, cf. Statutory Order No. 1186 of 19 August 2022, it is hereby prescribed:

Section 1. Insurance companies shall process claims for payment of expenses for medical treatment and assistive devices, etc., in connection with reported accidents and pay such expenses to the extent that the claim can be met, cf. Section 15 of the Work Injury Insurance Act, subject to subsection 4. This applies to expenses incurred during the processing of the case and future expenses.

Subsection 2. With the consent of the injured party, the insurance company may obtain medical and other information concerning the injured party for use in the processing of the case.

Subsection 3. For the purposes of this Order, "insurance company" means:
1) an insurance company that underwrites work accident insurance under the Work Injury Insurance Act,
2) a self-insured municipality, region, or state authority as well as the Church of Denmark, cf. Section 48, subsection 5, of the Work Injury Insurance Act,
3) an employer who has obtained exemption from the obligation to take out insurance, cf. Section 88 of the Work Injury Insurance Act, or
4) the Guarantee Fund for Property Insurance Companies, cf. Section 5 c of the Act on a Guarantee Fund for Property Insurance Companies.

Subsection 4. For reported accidents resulting from work-related vaccinations against COVID-19 carried out in the period from 27 December 2020 to 31 December 2022, the Labour Market Work Injury Insurance shall process claims, cf. Section 15 of the Work Injury Insurance Act. Insurance companies shall forward these notifications to the Labour Market Work Injury Insurance without further assessment. The rights and obligations of insurance companies under this Order shall apply correspondingly to the Labour Market Work Injury Insurance.

Section 2. The injured party shall receive written notification of the result of the insurance company's assessment of the claim under Section 1, subsection 1.

Subsection 2. The notification must state that the case may be submitted to the Labour Market Work Injury Insurance for decision if the injured party so wishes. The injured party must be notified when the case is sent to the Labour Market Work Injury Insurance.

Subsection 3. Subsections 1 and 2 apply correspondingly when the injured party requests a reopening of the case under Section 41 of the Work Injury Insurance Act.

Section 3. Insurance companies must obtain Medical Certificate I before the case is sent to the Labour Market Work Injury Insurance.

Subsection 2. Subsection 1 does not apply when:
1) it is clear from the available basis that there will be no question of treatment expenses or other compensation,
2) the insurance company has obtained medical information during its case processing that can replace Medical Certificate I,
3) compensation is denied because the person in question is not insured under the Act, or
4) the case has already been sent to the Labour Market Work Injury Insurance with a view to a decision on other matters under the Act.

Section 4. This Order enters into force on 1 July 2024 and has effect for the processing of claims for payment of expenses for treatment and assistive devices, cf. Section 1, subsection 1, that take place on the date of entry into force or later.

Subsection 2. Statutory Order No. 942 of 21 June 2022 on insurance companies' access to process claims for payment of expenses for medical treatment and assistive devices, etc., under the Work Injury Insurance Act is repealed.

Ministry of Employment, 23 May 2024
Ane Halsboe-Jørgensen
/ Sine Frederiksen

23 May 2024. No. 502.
Ministry of Employment,
The Danish Working Environment Authority, file no. 20225001199 BE009907

Lovtidende A
2024 Published on 25 May 2024