COVID-19 vaccine-related injury compensation

infograavika

What is an insured event?

The occurrence of four circumstances together is considered an insurance event:

  • the person has been vaccinated with COVID-19 vaccine in Estonia;
  • the person has suffered severe injury which has lasted at least four months, or the person dies;
  • the person’s treatment is documented in the health information system;
  • the State Agency of Medicines has established an association between the vaccination and the subsequent injury caused to the person.
What vaccines does vaccine insurance cover?
Covid-19 vaccines: 
Pfizer ComirnatyAstraZeneca Vaxzevria
Pfizer (kids) ComirnatyJanssen
Moderna SpikevaxNovavax NUVAXOVID
Moderna (kids) SpikevaxVLA2001 Valneva

The injured person or his heir.

Applying as a successor

When applying as a successor, please attach the autopsy report (if an autopsy was performed):

  • In case of pathoanatomic autopsy (performed at a medical institution), attach the pathoanatomic autopsy report (all pages)
  • In case of forensic autopsy (performed by the Estonian Forensic Science Institute), attach the autopsy report (not just an extract from the autopsy report)
Filing an application on the basis of guardianship or power of attorney 

If the applicant is under guardianship or has been assigned a legal representative, proof of guardianship or representation must be provided when submitting the application.

An application for compensation from a vaccine injury of a minor (up to 18 years of age inclusive) and an adult ward must be submitted by a legal representative (for example, a parent, guardian, an authorized representative of the guardianship and guardianship authority).

The application must be accompanied by either:

  • a document certifying the right of representation of a legal representative (for example, a birth certificate of a child, a court decision), or
  • power of attorney of local government (a general power of attorney is sufficient if a court decision on the care of a particular person is also submitted).

Power of Attorney sample

The document does not need to be submitted if its data is entered in the Estonian Population Register.

To determine the most appropriate section with application statements for your case, answer 5 questions:

  1. Applying on the Patient Portal (digilugu.ee)
  2. Submitting an application on a completed form
 How long does the application process take?

info

The application can be submitted by all persons who have been vaccinated in Estonia and have suffered serious injury to their health after vaccination, including persons without health insurance.

For Covid-19 vaccinations given after December 27, 2020, we will accept backdated claims for vaccine injury until May 1, 2023. If the application is not submitted by this deadline, the Health Insurance Fund is released from the obligation to compensate for injuries based on retroactive insurance cover.

After that, the application must be submitted no later than one year after the occurrence of the insured event.

Yes, in this case, the application must be filled out on a form, signed digitally and sent to the Health Insurance Fund. Proof of injury must be submitted as an attachment to the same letter.

If you have been treated abroad, then along with the application, you must provide copies of the treatment documents and their translation into Estonian.

Tervisekahjustuste hüvitatavad summad raskusastmete kaupa: 

  1. 2,000 euros in the event of a serious injury of moderate severity;
  2. 10,000 euros in case of severe injury to health of moderate severity;
  3. 25,000 euros in case of serious injury to health;
  4. 50,000 euros in case of very serious injury to health;
  5. 100,000 euros in case of extremely serious injury or death.
  6. Detailed information:  https://www.riigiteataja.ee/akt/128042022014 

The Health Insurance Fund refuses to pay compensation for health injury caused by a vaccine if:

  1. the described event is not an insured event;
  2. the patient has intentionally caused the insured event;
  3. the patient did not or does not comply with the treatment prescribed by the doctor and medically justified after the occurrence of the insured event, as a result of which recovery is difficult;
  4. the patient did not appear at the appointed time for an appointment with a doctor without a good reason after the occurrence of an insured event;
  5. the entitled person has provided to Estonian Health Insurance Fund with incorrect information about the insured event;
  6. the patient refuses to participate in an examination or medical checkup scheduled by the Health Insurance Fund.

 

The Health Insurance Fund has the right to file a claim against a person who has received compensation for vaccination damage if:

  1. after payment of compensation, it turns out that the applicant was not entitled to receive it;
  2. after payment of compensation, it appears that the injured party, guardian or heir has received full compensation from the manufacturer of the vaccine.

A person whose application is dismissed or whose rights were violated in administrative proceedings has the right to file a challenge with the Estonian Health Insurance Fund within 30 days from the delivery of the administrative act or to file an appeal with an administrative court under the conditions and pursuant to the procedure provided by the Code of Administrative Court Procedure.

The appeal must include

  • Reference to an administrative act to be challenged
  • Reason for the challenge (essentially indicate what you are not satisfied with)
  • Claim of the person filing the challenge (what do you want – are you requesting the review of the application due to additional information or additional documents)
  • Certification by the person filing the challenge that no judgment has entered into force and no court proceedings are being conducted concerning the matter subject to the challenge
  • Contact details of the person filing the challenge

Please submit as appendices

  • Relevant documents (evidence) proving the views of the person filing the challenge presented in the challenge

Possibilities for submitting an appeal:

  • Send an e-mail with a digitally signed application to info [at] haigekassa.ee
  • Send an application signed by hand by mail to Lastekodu 48, Tallinn 10113
  • To make an appointment at the offices of the Health Insurance Fund in Tallinn, Tartu, Pärnu and Jõhvi, call +372 669 6630 or https://www.haigekassa.ee/en/broneerimine