What happens in the processing of a private compensation claim?
In by far the most cases, Labour Market Insurance is asked to make a statement on the physical and occupational consequences of an injury.
Therefore, as a main rule, we need to investigate two areas before being able to make a statement – the medical and the occupational area.
If we are only asked to make a statement on the permanent injury rating, we only need to examine the medical aspect of the claim. Therefore the processing of the claim will not take as long. Even if we are only required to make a statement on loss of earning capacity, we also need medical documents in order to examine the correlation between the injury and the occupational consequences.
The medical aspect
In most cases we first ask the injured person to sign a consent form, allowing us to gather further information.
We typically gather medical certificates and medical records from hospitals and from the injured person’s own doctor as we need such information in order to examine the permanent injury rating and the date of maximum medical improvement.
In many cases we receive a private compensation claim from an insurance company. So usually there is already some information about the claim.
In spite of this, we may still gather further information. This is because we have an obligation to obtain the necessary and sufficient information before making a statement.
When a caseworker has the medical information that he or she needs, the claim is submitted to our medical consultants, depending on the nature of the injury, and they make an assessment to be used by us to determine the permanent injury percentage and the date of maximum medical improvement.
Depending on the type of injury, Labour Market Insurance is able to draw on medical consultants with different specialities such as neurology, orthopaedic surgery, general medicine, eye diseases, and psychiatry.
The occupational aspect
Once the medical aspect of the claim has been made clear, it is possible to examine the occupational consequences of the injury. We have to assess the occupational situation before and after the accident in order to make a statement on loss of earning capacity.
In order to do this, we often gather information from tax authorities, social and health authorities, the employer, and the injured person.
If the claim relates to a self-employed earner, we obtain the accounts, and the caseworker may get assistance from our consulting auditors in order to understand the accounts.
Once the earning capacity and the injured person’s income situation before and after the accident have been determined, the caseworker will be able to conclude the processing of the claim with regard to the question of loss of earning capacity.
It is now possible to submit the claim to an “earning capacity meeting”, where several caseworkers take part.
When the medical and occupational aspects have become clear, the caseworker makes the guiding statement.
In connection with a private compensation claim the parties are not heard before we make a statement. This means that the parties are not asked about any further comments on the information of the case before the statement is sent out.
However, the parties have a right to ask for copies of the documents of the case and are allowed to make comments to Labour Market Insurance while the claim is pending and after the injured person has received the statement.