The purpose of this compensation is to help people whose health has been damaged by an occupational accident or occupational disease to cope in everyday life and to make sure they have an income. Direct proprietary damage and loss of profit caused due to damage to health are subject to compensation.
The obligation to pay compensation for damage lies firstly with the employer through whose fault damage to health was caused. The Social Insurance Board may be contacted if the employer has been wound up and has no legal successor. In that case, the state assumes the obligation to pay compensation.
You are eligible for compensation if you meet all of the conditions hereunder:
- An occupational health doctor has diagnosed you with an occupational disease or the Labour Inspectorate has registered an occupational accident you were involved in (i.e. you have a statement confirming you have been diagnosed with an occupational disease, setting out the period when the disease developed and employers working for whom may have caused this, or an occupational accident report stating where and under which circumstances the occupational accident happened);
- Your work ability has been assessed (person of working age) or you have been determined to have a disability (person of pensionable age);
- Due to your health you are unable to continue working at your position and your income has decreased or you have none; you incur additional expenses in connection with damage to health arising from an occupational injury/disease;
- The company’s fault in causing of damage has been established.
Please note that a claim for damages must be submitted to the employer who is at fault for causing of damage. If the employer refuses to pay compensation, you can file a claim for compensation with the court.
You have the right to contact the Social Insurance Board if the employer has been wound up without a legal successor.
You are eligible for a monthly compensation due to decreased income if:
- you have no income due to damage to health – you are not employed
- due to damage to health you are working part time or at another position and your income has decreased
Calculation of amount of compensation
The compensation is calculated based on your average income of 12 months of full-time work preceding the determination of your occupational disease or your occupational accident. Those months you were on sick leave or on vacation are not included in the calculation. We also take into account:
- the increased cost of living;
- the percentage of loss of capacity for work due to the occupational disease;
- the percentage of the extent of fault on the company’s part;
- work ability allowance, pension for incapacity for work or survivor’s pension granted to you;
- if you are employed, the amount of your wage.
To take the increased cost of living into account we index or in other words we multiply the income of every month taken into account with an index. We get the index by dividing the minimum wage at the time the compensation is granted by the minimum wage at the time your wage was paid.
Example 1: If the income of the year 2016 is taken into account and compensation is granted in 2018, the index used in the calculation is 1.16 (minimum wage in 2018 (500 euros) / minimum wage in 2016 (430 euros) = 1.16).
To calculate the compensation we multiply your indexed average income with the percentage of loss of capacity for work due to the occupational disease and the percentage of the extent of fault on the company’s part.
Example 2: If your average indexed income is 500 euros and it has been determined that you have suffered 60% loss of capacity for work due to the occupational disease and the extent of fault on the company’s part is 100%, the compensation will be 500 x 60% x 100% = 300 euros.
From that we will subtract any work ability allowance, pension for incapacity for work or survivor’s pension granted to you.
Example 3: If the amount compensated to you is 300 euros and the work ability allowance granted to you is 160 euros, the amount of compensation is 300 - 160 = 140 euros. We will compensate the share of companies that have been wound up. If it is 100%, the amount of compensation = the amount compensated to you, so 140 euros x 100% = 140 euros.
If you are employed, we will deduct from the indexed average income the part of your wage that exceeds the calculated income corresponding to your remaining work ability.
We will find your remaining work ability by subtracting from 100% the percentage of reduction of your occupational work ability:
100% - lost work ability % (e.g. 40%) = remaining work ability (e.g. 60%).
We will find the possible income corresponding to your remaining work ability by multiplying the indexed average income with the percentage of the remaining work ability:
Indexed average income x remaining work ability % = possible income.
Example 4: Maie works part time. Her wage is 500 euros, her work ability has reduced 40% due to an occupational disease and she has been granted 160 euros of work ability allowance. Based on her earlier income we see that her lost average income is 700 euros. One of the companies involved in the development of her occupational disease has been wound up – that company’s share that we will assume is 54%.
We will calculate Maie’s possible income considering her remaining work ability.
Her remaining work ability is 60% (100% - lost work ability of 40% = 60%).
Her possible income is: lost average income of 700 euros x remaining work ability of 60% = 420 euros.
Maie’s current wage (500 euros) is higher than it would be based on her earlier average income and, considering her remaining work ability, her calculated “possible income” (420 euros).
Therefore, we will decrease the indexed average income by that amount (700 - (500 - 420) = 620 euros.
Amount compensated = decreased average income x loss of capacity for work %. 620 x 40% = 248 euros.
Since Maie is also paid work ability allowance, the amount of compensation is calculated by subtracting the work ability allowance from the amount compensated: 248 - 160 = 88 euros.
Finally, we will multiply that amount with the percentage of the company that is subject to compensation by us
88 x 54% = 47.52 euros
The Social Insurance Board will pay Maie compensation in the amount of 47.52 euros per month.
We also compensate for expenses related to occupational disease or occupational accident treatment:
- Expenses on prosthetic appliances and medical devices
- Expenses on prescription medicinal products
- Expenses on rehabilitation
- Expenses on travel to a medical institution
- Expenses on caring for an injured person
Whether additional expenses are related to an occupational disease or occupational accident is assessed by our medical expert based on your needs.
You are entitled to compensation for medical treatment expenses if you have a valid decision concerning the assessment of work ability or concerning the determination of incapacity for work and the Social Insurance Board pays you compensation for damage.
We will compensate you for expenses according to the share of the company that has been wound up.
We will record the compensation percentage in a contract concluded with you.
You can file an application for compensation for additional expenses along with expense receipts no later than within three years after paying for the expenses.
Prosthetic appliances and medical devices
We will compensate for prosthetic appliances and medical devices on the basis of expense receipts if a medical expert deems them necessary for you. These include, for example, wheelchair rent, diapers, support insoles, knee wraps and so on. There is no limit to this compensation.
Prescription medicinal products
Subject to compensation are those prescription medicinal products that are necessary for the treatment of damage to health caused by an occupational disease or occupational accident. Other medicinal products (for example, blood pressure and heart medicines) are not subject to compensation.
As of 1 January 2019 we will start paying the compensation for medicinal products as a monthly fixed amount and additional documents for the compensation for prescription medicinal products need not be submitted. The limit for compensation for medicinal products is 8.50 euros per month (if 100% is compensated) or 102 euros per year. We will pay the compensation for medicinal products on the 12th day of every month.
All recipients of compensation for damage who have applied for compensation for medicinal products in 2017 or 2018 will start receiving the monthly compensation for prescription medicinal products without any additional application. For example, if you submitted to us invoices for medicinal products in 2017 and you have received additional compensation for the cost of medicinal products, you will continue to be entitled to compensation for medicinal products. We will pay you monthly compensation for medicinal products according to the amount subject to compensation by us without you having to submit any additional documents.
If you have not applied for compensation for medicinal products before but you wish to receive it in 2019, you are required to submit with your first application a document proving the expense (such as the invoice from the pharmacy). A medical expert will give their assessment as to whether or not the purchased prescription medicinal products are necessary in connection with your occupational disease or occupational accident diagnosis. If the medicinal products are warranted, we will start paying you a monthly fixed-amount compensation for medicinal products and you will not be required to submit any further expense receipts.
If at the end of the year it turns out that your expenses on prescription medicinal products exceeded the amount compensated by us (102 euros), you can submit to us an application for compensation for additional medicinal products (PDF).
Expenses on rehabilitation
You can go to rehabilitation from home (outpatient) or your rehabilitation can include overnight stay and meals (sanatorium). We compensate for rehabilitation expenses if a medical expert deems this treatment necessary for you.
In case of outpatient treatment we compensate for the cost of treatment for 14 days once a year with the limit of up to 300 euros.
In case of a treatment package at a sanatorium we compensate for the cost of the entire package for 10 days once a year with the limit of up to 700 euros.
During one calendar year you may use either 14 days of outpatient rehabilitation or 10 days of treatment at a sanatorium. You can choose the medical institution where you would like to be treated.
For rehabilitation you can ask us for a letter of guarantee in which we will assure that we will pay for the treatment the share subject to compensation by us. Just book a place in a medical institution and let us know should you require a letter of guarantee. Please tell us with which medical institution you have a booking and for when and for how many days. Please also specify whether you will be staying there overnight or be visiting from home.
Let our processing officials know if you need a letter of guarantee or send an e-mail to the address firstname.lastname@example.org.
On the basis of your request we will send the relevant institution a digital letter of guarantee. We will call you before the treatment starts to inform you that we have sent a letter of guarantee to the relevant medical institution.
We compensate for expenses on travelling from your place of residence to a medical institution and back in the amount of 0.10 euros per kilometre.
We compensate for travel expenses if the visit to the medical institution was necessary according to a medical expert. No expense receipts (bus tickets, petrol receipts) must be submitted.
If you visited a medical institution on the basis of a letter of guarantee, you need not submit an application concerning travel expenses. We compensate for travel expenses if the medical institution issues to us an invoice concerning the cost of your treatment package.
If you visited a medical institution at your own expense or saw a medical specialist, you must submit an application (PDF) for the compensation for travel expenses. Along with the application you must submit a medical certificate proving you kept your appointment. If there is no such certificate, you must submit an additional explanation stating the name of the physician and medical institution and the date of the appointment.
Example: On 03.09.2016 you had an appointment with a neurologist at the hospital and on 08.09.2016 you went to the same hospital for a mammogram. The distance between your place of residence and the medical institution is 5 km. We compensate for travel expenses to the neurologist and back in the amount of 5 km x 0.10 euros x 2 = 1 euro. The visit for a mammogram is not compensated for because it is not related to the treatment of the occupational disease.
Expenses on caring for an injured person
On the basis of an expense receipt we compensate for additional expenses on caring for an injured person irrespective of who cares for them. A document proving an expense may be, for example, a provision of care contract in a freely chosen format stating the amount paid for the care service. In case of a bedridden person or special medical care we pay compensation up to the minimum monthly wage of a hospital attendant; in case of other forms of care up to 60% of that rate. The need for care by another person is assessed by a medical expert.
In 2018, in case of special medical care, we compensate for expenses up to 705.60 euros, in case of other forms of care up to 423.60 euros per calendar month.
A person who due to an occupational accident has lost a family member on whose income they were dependant is also entitled to compensation.
You get compensation if you are deceased family member’s:
- Child under 18 years of age;
- 18–24-year-old child, provided you are engaged in full-time studies;
- Widower/widow, provided your work ability has been assessed;
- Widower/widow of pensionable age;
- Parent of pensionable age;
- Parent, provided your work ability has been assessed;
- Non-employed widow and you are pregnant;
- Up to a 3-year-old child’s parent or guardian and you are not working.
Example: Olev was killed in an occupational accident. His family includes a 7-year-old and a 17-year-old child and a mother of pensionable age. Both children and the mother of pensionable age are all entitled to compensation.
Please note that in addition to the compensation they may also be eligible for survivor’s pension. Read more: https://www.sotsiaalkindlustusamet.ee/en/pension-types-pensions-and-benefits#Survivor%E2%80%99s%20Pension
A claim for compensation for damage must first be submitted to the employer who is at fault for the causing of damage. If the employer refuses to pay compensation, you can have recourse to the court.
You can contact the Social Insurance Board for compensation for damage only if the employer who is at fault for damage to health caused by an occupational disease or occupational accident has been wound up without a legal successor.
If you file an application within three years as of the day the occupational disease was diagnosed, you were assessed to have reduced work ability or the company who was paying compensation was wound up, we will grant and pay the compensation for damage as of the time your right to it arose. If an application is filed later, we will pay compensation as of the day the application was filed.
Before submitting an application
If you are of working age (from 16 years of age to the attainment of pensionable age), your work ability must be assessed by the Estonian Unemployment Insurance Fund before you can apply for compensation for damage.
If you wish, we can submit your application for the assessment of work ability to the Estonian Unemployment Insurance Fund. If the Estonian Unemployment Insurance Fund has issued you a decision concerning reduced work ability, please contact us for applying for compensation for damage.
If the Estonian Unemployment Insurance Fund decides that your work ability has not reduced, you are not entitled to compensation for damage.
If you are of pensionable age, your work ability need not be assessed, but the degree of severity of your disability must be determined before applying for compensation for damage.
For the determination of the degree of severity of disability you can submit to us a digitally signed application to the e-mail addressinfo at sotsiaalkindlustusamet dot eeinfo at sotsiaalkindlustusamet dot ee email@example.com, via mail to the address Endla 8, Tallinn, or at our customer service point. The application form is available at the address http://www.sotsiaalkindlustusamet.ee/ekspertiisi-blanketid.
Filing an application
In order to apply for compensation for damage you must submit to us:
- Application (PDF)
- In case of an occupational disease, a statement from an occupational health doctor with an occupational disease diagnosis and a list of related employers – this you can get from the North Estonia Medical Centre;
- In case of an occupational injury, an occupational accident report – this you can get from the Labour Inspectorate;
- Documents proving that you worked for the employer associated with the development of an occupational disease or occurrence of an occupational accident (for example, employment record book, contracts, etc.);
- If the company paid you compensation before being wound up, proof of payment of compensation by the company; If you also apply for compensation for additional expenses, attach expense receipts (invoices for medicinal products, rehabilitation invoices).
We will review your application and make a decision within 30 days as of the arrival of the last document necessary for making a decision.
In order to make a decision, we will contact various authorities ourselves to request the following information and documents:
- Opinion of a medical expert on the extent of damage to health caused by an occupational disease or occupational accident (percentage). If you are of working age, the medical expert will form an opinion on the basis of the information used for the assessment of your work ability. If you are an old age pensioner, the medical expert will use the source information for the determination of the degree of severity of your disability;
- Information concerning the company’s fault (from the Labour Inspectorate);
- Information concerning the company being wound up without a legal successor (from the commercial register or court information system);
- Court judgment if compensation has been ordered by a court judgment (from the court information system);
- Wage certificate (we request from your employer).
If you have any of these documents, you may also submit them to us along with your application to speed up the process of reviewing the application.
If you are entitled to compensation for damage from us, we will draw up a contract setting out the source information for the grant of compensation, the relevant calculation, the amount of the compensation paid and the terms and conditions thereof. We will send you the grant of compensation contract for signing via mail or e-mail.
If you agree to the contract, you must sign it and return it to us.
If you do not agree with our decision, you can file a civil action with a county court. The term for filing an action is three years as of becoming aware of the contract.
When is compensation paid?
We will transfer the compensation to the bank account set out in your application on the 12th day of each month. If that day falls on a day of rest or a public holiday, compensation is paid during the working day preceding the day of rest.
We will continue to pay compensation as long as the decision concerning the assessment of your loss of capacity for work / work ability is in effect and the percentage of loss of capacity for work as a result of an occupational disease or occupational accident has been determined by an opinion of a medical expert. When the decision concerning the assessment of work ability expires, you must contact the Estonian Unemployment Insurance Fund again for assessment of work ability.
If you are a dependent of a person who has died as a result of an occupational accident, we will keep paying you compensation for as long as you meet the conditions for the payment of compensation – you are the deceased family member’s:
- Child under 18 years of age;
- 18–24-year-old child and engaged in full-time studies;
- Widower/widow and your work ability has been assessed;
- Widower/widow of pensionable age;
- Parent of pensionable age;
- Parent and your work ability has been assessed;
- Non-employed widow and you are pregnant;
- Up to a 3-year-old child’s parent or guardian and you are not working.
Recalculation and termination of payment of compensation
We will grant you compensation for damage for the period of validity of the decision concerning the assessment of your work ability. If after that period the Labour Inspectorate assesses your work ability to still be reduced, we will keep paying you compensation for damage under the previous contract.
If the decision concerning the assessment of your work ability expires in connection with you attaining the pensionable age, we will start paying you compensation for damage indefinitely. It is not necessary to additionally have the degree of severity of your disability assessed. We will pay compensation indefinitely to all recipients of compensation for damage who are of pensionable age.
We will stop paying compensation when your income has improved to the extent that you no longer have any proprietary damage compared to the time before the occupational disease.
If you start working, you are required to notify us within one month as of the conclusion of the employment contract. You are required to notify us of the amount of your wage every month or once a quarter.
The amount of compensation granted to you is recalculated:
- Automatically when the percentage of loss of your capacity for work changes;
- Automatically when the amount of your pension for incapacity for work / work ability allowance changes;
- Automatically upon indexation by the pension index on 1 April each year;
- Automatically when your wage increases;
- On your application if the company who paid part of your compensation is wound up.