Compensation benefit through the eyes of the doctors' self-government: low amount, questionable valorization and unclear terms

The Law on Patients' Rights and Patients' Ombudsman has set lower and upper limits on the amount of compensation benefit for one medical event for one applicant - it is from PLN 2,000 to PLN 200,000 in the case of bodily injury or health disorder or infection with a biological pathogen, and from PLN 20,000 to PLN 100,000 in the case of a patient's death. These are to be values that are indexed annually for inflation. However, it is unclear what will happen to the valuation of individual benefits that are not equal to the minimum or maximum value.

- Since the law provides that the compensation benefit amounts stipulated therein will be indexed every year, the same indexing mechanism should be provided for in the proposed regulation. Neither the draft ordinance submitted for review nor the justification for this draft provides an explanation of the planned method of annual valorization of the compensation benefit amounts established by the ordinance. The lack of such a mechanism in the ordinance will result in the fact that in the event of inflation the maximum amount of compensation benefits provided for in the law will increase, but under the ordinance the applicant will be able to receive at most the amount prior to the valorization," the Presidium of the Supreme Chamber of Dentistry points out, and proposes that a provision be included in the ordinance to clarify this issue.

Also, the amount of benefits itself raises questions for the medical association. In some cases, they are lower than those set forth in the regulation on the rules for adjudicating permanent or long-term damage to health. In the case of loss of an arm above the elbow joint, the difference is as much as PLN 33,000. In the case of loss of a foot, the difference is even greater at 38 thousand zlotys.

"Compensation benefit amounts that are too low may hinder the functioning of the out-of-court health care compensation system and provide an argument for patients and their families to take their cases to the courts instead of the Patient Ombudsman," the doctors note.

The Supreme Medical Council also draws attention to the lack of clarity regarding the concept of incapacity. It is a term that is defined differently in different legal acts.

"In addition, it is necessary to indicate how and on the basis of what judgment in the course of proceedings for payment of compensation benefit will be determined the premise of inability to live independently or the need to provide constant care of the assistance of others in the case of persons under the age of eighteen, since the confirming certificates in social insurance institutions (i.e., ZUS and KRUS) are issued in relation to persons over the age of eighteen, and certificates of: significant degree, moderate degree and light degree of disability are issued at the competent authorities for people who are sixteen years of age or older. In the case of the compensation benefit application procedure, it should be made possible for people under the age of 16 to also receive the disability benefit," the position reads.