Compulsory Liability Insurance of Health Care Providers Act

This Act regulates the compulsory insurance of the civil liability of health care providers and compensation for harm caused to patients or other entitled persons in the course of the provision of health services (hereinafter liability insurance) and the procedure for the settlement of disputes concerning liability insurance.

(1) This Act applies to compensation for harm caused in the course of the provision of health services in the Republic of Estonia, including in the course of providing medical remote consultations, by an insurance undertaking if, as a result of the provision of health services, the patient has suffered bodily injury or harm to health or dies.

(2) The provisions of the Law of Obligations Act apply to liability insurance, taking into account the specifications of this Act.

An agreement which derogates from this Act or the Law of Obligations Act to the detriment of a health care provider, patient or other entitled person is void, unless the deviation is permitted by law.

(1) A self-employed person who provides health services and a legal person who has been granted an activity licence under the Health Services Organisation Act is required to enter into a liability insurance contract in order to insure the liability arising from the provision of health services.

(2) A health care provider is required to ensure that, at any time during the validity of the activity licence and during the provision of health services, their activities are covered by the insurance cover under the liability insurance contract, unless otherwise provided by law.

(3) Pursuant to § 520 of the Law of Obligations Act, an insurance undertaking is required to enter into a liability insurance contract or amend an existing liability insurance contract with a health care provider who holds a valid activity licence, who applies to the Health Board to amend an activity licence or to issue a new activity licence or whose suspension of economic activities terminates.

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(4) The Health Board is required to verify compliance with the insurance obligation of health care providers.

(1) A health care provider is required to submit to the Health Board information concerning the entry into or extension of a liability insurance contract, the insurance undertaking, the period of insurance cover and the sum insured. The obligation to submit data is deemed to have been fulfilled if, instead of the health care provider, it is submitted by the insurance undertaking or a person authorised by it.

(2) In order to prove the performance of the insurance obligation of the health care provider, the insurance undertaking or a person authorised by it submits the information specified in subsection 1 of this section through the data exchange layer to the health administration information system maintained by the Health Board.

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(3) The data specified in subsection 1 of this section is published together with other data concerning the activity licence on the website of the Health Board.

(4) The information specified in subsection 1 of this section, together with the instructions for submission of claims, must be published both in a visible place in the place of business of the health care provider and on its website, where one exists, in order to enable the patient to consult the information before receiving health services.

(5) An insurance undertaking is obliged to submit a report to the Health Board on liability insurance contracts concluded, claims for harm and insured events.

(6) The list of data in the report provided for in subsection 5 of this section, the procedure for submitting the reports and the procedure for granting access to the data is established by a regulation of the minister in charge of the policy sector.

(7) The insurance undertaking is granted access to the reports specified in subsection 5 of this section for the calculation of the insurance premium and assessment of the insurance risk.

(8) The information specified in subsection 5 of this section is published on the website of the Health Board in aggregated form and in a manner that does not allow the identification of a specific health care provider or insurance undertaking.

(1) An insurance undertaking who has the right to insure an insurance risk located in Estonia has the right to conclude a liability insurance contract. If a foreign insurance undertaking operates in Estonia, it has to appoint a contact person with whom the health care provider and the entitled person can contact in Estonian and at the contact point located in Estonia.

(2) The insurance cover arising from a liability insurance contract has to cover all health services for the provision of which an activity licence has been issued to a health care provider on the basis of the Health Services Organisation Act. Upon amendment, termination or suspension of the activity licence or issue of a new activity licence, a declaration of intent to enter into a new contract or amend an existing contract has to be submitted to the insurance undertaking.

(3) A liability insurance contract may be concluded for up to one year. The parties may stipulate in the contract that upon the expiry of the term, the liability insurance contract extends automatically by the term specified in the contract.

(4) The liability insurance contract terminates upon revocation, expiry and suspension of the activity licence. If the insurance contract covers more than one activity licence or the activity licence expires in part, the insurance contract remains otherwise valid.

(5) Health care providers are not allowed to enter into several contracts with overlapping periods of insurance. If several contracts with overlapping periods of insurance have been entered into, the contract concluded subsequently is void to the extent that it overlaps with the previously concluded contract.

(1) An insurance undertaking issues a policy to a health care provider in accordance with the provisions of subsection 1 of § 434 of the Law of Obligations Act.

(2) In addition to what is provided for in subsection 2 of § 434 of the Law of Obligations Act, the policy must indicate all the activity licences in respect of which the activities are covered by liability insurance.

An insured person is a health care provider holding a valid activity licence on the basis of the Health Services Organisation Act.

An entitled person is a patient, dependant, successor or other person who has the right to demand compensation for harm from the insurance undertaking on the grounds and in accordance with the rules provided by the Law of Obligations Act, taking into account the specifications provided for in this Act.

(1) An insured event is a violation of the obligation of a health care provider if

1) bodily injury, harm to health or death of a patient has been caused by the provision of health services;

2) the health care provider is liable for the harm caused on the basis of the Law of Obligations Act; and

3) the harm has been caused as a result of the circumstances provided for in subsection 2 of this section.

(2) On the basis of this Act, harm caused as a result of the following circumstances is compensated for

1) carrying out or failing to carry out diagnosis, treatment or any other similar act, provided that with the care normally expected in the provision of health services at the general level of medical science, the harm is likely to have been avoided;

2) infection obtained during diagnosis, treatment or any other similar act, provided that with the care normally expected in the provision of health services at the general level of medical science, the harm is likely to have been avoided;

3) injury or harm sustained during transport of the patient by the health care provider;

4) failure of a device used in the course of diagnosis, treatment or any other similar act for which the health care provider is liable on the basis of subsection 2 of § 770 of the Law of Obligations Act;

5) the incorrect medicinal product, the incorrect dose of the medicinal product administered to the patient by the health care provider in the course of provision of the health services or the medicinal product which has become unfit because of the act or omission of the health care provider or any other misuse of the medicinal product;

6) breach of the health care provider’s obligation to maintain records;

7) violation of the organisational obligation of a health care provider upon provision of a health service which is directly related to the performance or failure to perform diagnosis, treatment or any other similar act.

(1) The sum insured is 100 000 euros per entitled person and 300 000 euros per insured event. The sum insured per annual period of insurance following the conclusion of a liability insurance contract is 3 000 000 euros. The sum insured provided for in the second sentence of this subsection is reduced after the occurrence of each insured event and the insurance undertaking is liable for harm caused by a later insured event only up to the part of the sum insured which is left over from the compensation for the earlier harm.

(2) The sum insured for non-pecuniary harm is 30 000 euros per entitled person and 100 000 euros per insured event. The insured amounts applied in the event of harm to health of a patient or causing bodily injury are provided for in subsection 3 of § 19 of this Act. Compensation for non-pecuniary harm is deemed to be included in the sum insured provided for in subsection 1 of this section.

(3) If the total amount of claims for harm exceeds the sum insured specified in subsection 1 or 2 of this section, the compensation is divided among the entitled persons in proportion to the extent of the harm suffered by each entitled person. The compensation paid cannot be recovered from the entitled person.

(1) In the event of an insured event, the entitled person may claim compensation for harm from the insurance undertaking who has entered into a liability insurance contract with the health care provider if the health care provider is liable to the entitled person on the basis of the Law of Obligations Act.

(2) Upon application of the excess of a health care provider provided for in a liability insurance contract, the insurance undertaking compensates the entitled person for the harm without applying the excess.

(3) On the basis of this Act and the liability insurance contract, the entitled person is only compensated for the following harm caused by the insured event

1) medical expenses, including the cost of medicinal products;

2) costs incurred as a result of an increase in patient needs, including the costs of aids and medical devices;

3) harm caused by partial or no work ability or temporary incapacity for work;

4) funeral expenses;

5) harm caused by loss of maintenance;

6) other pecuniary harm which is subject to compensation pursuant to §§ 129 and 130 of the Law of Obligations Act;

7) non-pecuniary harm subject to compensation under § 134 of the Law of Obligations Act.

(4) The harm specified in this section is compensated only to the extent provided for in this Act and to the extent that the harm exceeds the allowance, benefit or pension paid by the state, including a public legal person or a local authority, to a patient or other entitled person on the basis of another law in connection with their treatment, harm to health, causing bodily injury or causing death. Except in the case provided for in subsection 3 of § 14 of this Act, the state, a public legal person and a local authority do not have the right of recourse against the insurance undertaking in respect of the provisions of the first sentence of this subsection.

(1) Upon calculating maintenance compensation, the insurance undertaking is guided by the following principles

1) a portion of two fifths is subtracted from the net income of the patient calculated on the basis of § 16 of this Act because the patient presumably used this portion for their own good;

2) a portion of three fifths of the net income of the patient calculated on the basis of § 16 of this Act is divided into equal portions between persons entitled to the compensation.

(2) The entitled person has the right to receive maintenance compensation differently from the principles set out in subsection 1 of this section if the entitled person proves that the patient would have maintained the entitled party to a different extent or that maintenance compensation should be divided between the entitled persons in a different way.

(3) The insurance undertaking has the right to pay maintenance compensation to the entitled person in a way different from the principles set out in subsection 1 of this section if the insurance undertaking proves that the patient would have provided the entitled person with maintenance to a different extent.

(4) If the number of entitled persons in the period of payment of the maintenance compensation changes, the maintenance compensation will be recalculated taking into account the provisions of this section.

(1) To the extent and in accordance with the rules provided for by this Act, the insurance undertaking will compensate the patient for the income subject to social tax, which the patient is deprived of due to having partial work ability or no work ability or temporary incapacity for work following the insured event, taking into account the extent of reduction of the patient’s work ability (hereinafter compensation for incapacity for work). It is presumed that in the event of temporary loss of the work ability the patient’s work ability is completely lost.

(2) The compensation for incapacity for work will be paid to a person as of attaining the age of 16 years.

(3) The insurance undertaking will compensate the employer of the patient for the sickness benefit paid out on the basis of subsection 1 of § 122 of the Occupational Health and Safety Act.

(4) The compensation for incapacity for work may be paid retroactively in a lump sum in the event of temporary incapacity for work.

(5) In the event of partial work ability or no work ability, the following persons are entitled to compensation for incapacity for work

1) a person specified in § 2 of the Work Ability Allowance Act, if it has been identified in accordance with the procedure established in the Work Ability Allowance Act that they have partial work ability or no work ability;

2) another patient if it has been identified in accordance with the procedure established in this Act that they have partial work ability or no work ability.

(6) A patient having partial work ability identified on the basis of the Work Ability Allowance Act is entitled to the compensation for incapacity for work if they meet at least one criterion set out in subsection 1 of § 12 of the Work Ability Allowance Act.

(7) If the patient is not entitled to the assessment of the work ability under the Work Ability Allowance Act, the insurance undertaking will assess the extent of work ability in the course of ascertaining the existence and scope of the obligation to pay compensation for incapacity for work, involving, where necessary, a person who has completed medical training in identifying the scope of the reduction of the work ability.

(1) Taking into account the state of health, the insurance undertaking identifies a reduction of the overall work ability of the patient on a scale of 10-100 per cent and a reduction of the work ability caused separately by an insured event on a scale of 10-100 per cent. Where necessary, the insurance undertaking involves a person who has completed medical training in identifying the scope of the reduction of the work ability. A reduction of the overall work ability starting from 40 per cent is deemed as partially impeding working.

(2) The insurance undertaking identifies a 100 per cent reduction of the work ability of the patient if

1) following an assessment of the work ability by the Estonian Unemployment Insurance Fund it has been established that the patient has no work ability, or

2) the Estonian Unemployment Insurance Fund does not assess the work ability of the patient and the patient is not able to work, given their status of health and the limitations of operation and participation arising therefrom as well as the prognosis and expected duration thereof.

(3) The insurance undertaking identifies a 40-90 per cent reduction of the work ability of the patient if

1) following an assessment of the work ability by the Estonian Unemployment Insurance Fund it has been established that the patient has partial work ability, or

2) the Estonian Unemployment Insurance Fund does not assess the work ability of the patient and the patient is partially unable to work, given their status of health and the limitations of operation and participation arising therefrom as well as the prognosis and expected duration thereof.

(4) In the events specified in clause 2 of subsection 2 and clause 2 of subsection 3 of this section, the insurance undertaking will apply the list of work ability assessment criteria and conditions precluding work ability, which has been established on the basis of subsection 4 of § 5 and subsection 3 of § 6 of the Work Ability Allowance Act.

(5) The percentages expressing the scope of reduction of the overall work ability and the scope of reduction of the work ability due to an insured event and the procedure for determining the percentage will be established by a regulation of the minister in charge of the policy sector.

(6) To determine the percentage of reduction of the overall work ability and of reduction of the work ability due to an insured event, the patient must undergo a medical examination at the request of the insurance undertaking. If the patient’s work ability has decreased after the reduction of the compensation for incapacity for work, the patient has the right to demand their medical examination. The costs of the medical examination will be borne by the insurance undertaking.

(1) The basis for calculating the maintenance compensation and the compensation for incapacity for work (hereinafter in this section compensation) is the net income of the patient per calendar day, which is calculated by subtracting income tax and the unemployment insurance premium from the patient’s income that is subject to social tax and thereafter the result is divided into the number of calendar days in the period specified in subsections 2–7 of this section (hereinafter net income). The calculation does not include the calendar days when the patient was temporarily incapacitated for work.

(2) If the patient received income subject to social tax at the time when the insured event occurred, the net income will be calculated on the basis of the period preceding the insured event, during which the patient received, without interruption, income subject to social tax, but no more than 12 calendar months.

(3) If the patient did not receive income subject to social tax at the time when the insured event occurred, the net income will be calculated on the basis of the income subject to social tax in the 12 calendar months immediately preceding the insured event.

(4) If the patient operated as a self-employed person at the time when the insured event occurred, the net income will be calculated on the basis of the income declared in the income tax returns of the two years immediately preceding the insured event.

(5) If the patient earned income abroad in the 12 months immediately preceding the insured event, such a portion of the income earned abroad which would be subject to social tax in Estonia when earned in Estonia will be used as the basis for calculating the net income.

(6) If the patient was a conscript at the time when the insured event occurred, the net income will be calculated on the basis of the income subject to social tax which was earned in the 12 months immediately preceding the start of the conscript service of the patient.

(7) If the patient was on a parental leave at the time when the insured event occurred, the net income will be calculated on the basis of the income subject to social tax which was earned in the 12 months immediately preceding the start of the parental leave of the patient.

(8) If the net income calculated on the basis of subsections 1–7 of this section is smaller than the result of division of the minimum wage established by the Government of the Republic by 30, it will be deemed that the income of the patient subject to social tax is the result of division of the minimum wage established by the Government of the Republic by 30.

(9) Upon calculation of the compensation, the net income of the patient is indexed. Upon indexation, the net income is multiplied by the result of division of the last Consumer Price Index published by the Statistical Office by the Consumer Price Index published in the calendar month following the calendar month when the insured event occurred.

(10) The compensation per calendar month is the multiple of the net income per calendar month indexed in accordance with subsection 9 of this section and 30, less the total sum of the compensation granted to the patient per calendar month under other compulsory insurance or on the basis of law.

(11) Upon calculation of compensation, the scope of liability of the insurance undertaking is taken into account.

(12) In the case of compensation for incapacity for work, the patient’s income subject to social tax is calculated for the period with regard to which the compensation for incapacity for work has been calculated.

(13) The compensation will be recalculated once the entitled person becomes entitled to or would have been entitled to old-age pension. Upon recalculation of the compensation, 60 per cent of the net income of the patient before the insured event will be taken into account.

(1) The insurance undertaking will recalculate the compensation for incapacity for work once the circumstances serving as the basis for calculation of the compensation change or new circumstances that must be taken into account upon calculating the compensation become evident. If the insurance undertaking recalculates the compensation, the net income will not be reindexed.

(2) If as a result of the recalculation it becomes evident that the insurance undertaking has paid the compensation for incapacity for work in a smaller amount than it should have, given the changed or new circumstances, the missing portion of the compensation will be paid out along with the compensation payable for the next period.

(3) If upon recalculation it becomes evident that the insurance undertaking has paid the compensation for incapacity for work in a higher amount than it should have, given the changed or new circumstances, the excessive portion of the compensation will be deducted from the compensation payable for the next period.

(4) The insurance undertaking is not required to retroactively change the amount of the maintenance compensation.

(5) No compensation for incapacity for work is paid to the patient for the period of suspension of payment of the work ability allowance under § 18 of the Work Ability Allowance Act.

(1) The insurance undertaking will terminate the payment of the maintenance compensation at the time when the obligation to maintain the entitled person would terminate.

(2) The insurance undertaking will terminate the payment of the maintenance compensation and the compensation for incapacity for work in the event of the death of the person entitled to receive the insurance compensation.

(3) The insurance undertaking will terminate the payment of the compensation for incapacity for work if the work ability of the patient restores to the level preceding the insured event.

(4) The insurance undertaking will terminate the payment of the compensation for incapacity for work if the patient’s income subject to social tax increases at least to the level preceding the insured event. In doing so, the insurance undertaking will take into account the change of the Consumer Price Index published by the Statistical Office.

(5) The insurance undertaking will terminate the payment of the maintenance compensation or the compensation for incapacity for work if there is a legal ground for it.

(6) Payment of the compensation for incapacity for work to a person having partial work ability will be terminated before the expiry of the period of the identified partial work ability if the Estonian Unemployment Insurance Fund terminates payment of the compensation for incapacity for work to the person on the basis of subsection 1 of § 19 of the Work Ability Allowance Act.

(7) The compensation for incapacity for work is not paid to a person for the period during which the person is serving a sentence in prison or in jail or is in custody.

(1) The insurance undertaking will pay the entitled person one-off compensation for non-pecuniary harm, depending on the severity of the harm to health or bodily injury and other circumstances. If the harm to health or bodily injuries of the patient are of a different degree of severity, the compensation for non-pecuniary harm will be paid on the basis of the most severe category of harm to health or bodily injury.

(2) Upon compensation for non-pecuniary harm, among other things, the degree of severity of the harm to health and bodily injury, the depth of the functional disturbance and the length of treatment and loss of the capacity for work will be taken into account.

(3) Non-pecuniary harm is compensated to the entitled person to the extent of the following sums insured

1) in the event of minor harm to health or a minor bodily injury of the medium severity, up to 500 euros;

2) in the event of more serious harm to health or a more serious bodily injury of the medium severity, up to 2000 euros;

3) in the event of serious harm to health or a serious bodily injury, up to 5000 euros;

4) in the event of very serious harm to health or a very serious bodily injury, up to 15 000 euros;

5) in the event of extremely serious harm to health or an especially serious bodily injury, up to 30 000 euros.

(4) In the event of minor harm to health or a minor bodily injury, no compensation for non-pecuniary harm is paid.

(5) The classification and characteristics of the severity of harm to health and bodily injury specified in subsections 3 and 4 of this section will be established by a regulation of the minister in charge of the policy sector.

On the basis of this Act, an insurance undertaking does not compensate for the following in the event of an insured event

1) harm exceeding the sum insured specified in § 11 of this Act;

2) pecuniary harm caused by the deterioration of the patient’s future economic opportunities;

3) harm estimated to be less than 200 euros;

4) harm if health services were provided outside the Republic of Estonia;

5) harm provided for in § 132 of the Law of Obligations Act;

6) harm for which the producer, including a blood centre or the owner of a hospital pharmacy, is liable on the basis of § 1061 of the Law of Obligations Act or on the basis of the provisions concerning the unlawful causing of harm;

7) harm for which the entitled person has the right to receive compensation from the state, including a public legal person or a local authority, on the basis of another Act;

8) contractual penalties arising from contracts for the provision of health services or other contracts;

9) harm caused as a result of increased defence readiness, state of emergency, state of war, emergency situation or emergency, or in connection with the commission of a terrorist act;

10) loss of profit except loss of profit due to death, harm to health or bodily injury to the extent provided for in this Act;

11) costs related to the improvement of improper performance of the contract for the provision of health services or harm for which the patient claims compensation instead of improving improper performance;

12) in the event of harm, if the provision of health services is related to a clinical trial of a medicinal product or medical device or performance studies of an in vitro diagnostic medical device;

13) harm arising from a traffic accident and compensated for by an insurance undertaking of motor insurance;

14) harm caused by an event intentionally and unlawfully caused by a health care provider;

15) harm resulting from the provision of health services, provided by the health care professional outside the limits of the acquired specialty or for which the health care provider did not hold an activity licence.

(1) The entitled person must inform the insurance undertaking of the insured event in a form that allows for reproduction in writing, within four weeks of becoming aware of the insured event. If the entitled person is unable to comply with the notification obligation due to health reasons or for another valid reason, the time limit is extended by the corresponding period.

(2) If the health care provider has been notified of an insured event, the health care provider forwards this information immediately to the insurance undertaking. The health care provider must inform the insurance undertaking of the filing of a claim or action by an entitled person against it within one week of the date on which the health care provider became aware of the filing of the claim.

(3) An insurance undertaking has the right to obtain from a health care provider and other persons the explanations and documents necessary for ascertaining the existence and extent of the obligation to compensate for harm arising from this Act, including health data. The health care provider and other persons are required to submit the relevant information to the insurance undertaking immediately but not later than on the 30th calendar day after receipt of the application.

(4) The insurance undertaking is obliged to make a decision as to whether an insured event has occurred after receiving all the necessary evidence and documents, but no later than 180 calendar days after receiving a report on the insured event. The entitled person must be informed immediately of the recognition or non-recognition of an insured event.

(5) If, for good reason, the insurance undertaking is unable to comply with the due date specified in subsection 4 of this section, the insurance undertaking must inform the entitled person thereof in advance and explain what the good reason is, and also give the expected due date for termination of the necessary acts.

(6) The insurance undertaking is required to inform the entitled person of the further progress of the resolution of the insured event and of the evidence and documents which the entitled person must submit to the insurance undertaking in order to determine the amount of compensation for harm.

(7) In the event of non-recognition as an insured event, the insurance undertaking is obliged to state the reasons for the decision and to inform the entitled person of the complaints procedure and the right to appeal against the insurance undertaking's decision to the Liability Insurance Conciliation Committee provided for in this Act.

(8) In the event of recognition as an insured event, the entitled person submits an application to the insurance undertaking for compensation for the harm suffered. The insurance undertaking must determine within a reasonable time the amount of the harm to be compensated and compensate the harm accordingly.

(1) The insurance undertaking has the right of recourse against the health care provider to the extent of the amount of the excess.

(2) The insurance undertaking has a right of recourse against the health care provider if the insured event is caused in a state of intoxication caused by the use of alcohol, narcotic drugs or psychotropic substances or other intoxicating substances.

(3) If the health care provider fails to comply with the obligation to pay the insurance premium, the insurance undertaking has the right, under subsection 2 of § 521 of the Law of Obligations Act, to bring a recovery claim against the health care provider in proportion to the amount of the unpaid insurance premium.

(4) If upon entry into contract, the health care provider failed to notify the insurance undertaking of any of the facts known to the insurance undertaking or failed to notify the insurance undertaking of any increase in the insurance risk during the insurance period and the specified circumstance affects the amount of the insurance premium, the insurance undertaking has the right, after compensation for harm, to file a recovery claim with the health care provider to the extent by which the health care provider would have had to pay more insurance premiums if the insurance undertaking had known of the circumstance.

(5) If the insured event was caused by a health care provider who has an insurance obligation under this Act, whose harm was caused by a health care provider who entered into a contract for the provision of health services with a patient on the basis of § 132 of the General Part of the Civil Code Act or § 1054 of the Law of obligations Act, the insurance undertaking of the health care provider who caused the insured event has the right to file a recovery claim against the insurance undertaking of the health care provider who caused the insured event.

(1) Liability insurance conciliation committee (hereinafter conciliation committee) is a extra-judicial independent liability insurance dispute resolution body operating permanently at the Health Board and acting in accordance with the Conciliation Act, unless otherwise provided for in this Act. The conciliation committee is a conciliation body of the State within the meaning of the Conciliation Act.

(2) The Conciliation Committee adjudicates an appeal filed by a patient or another entitled person specified in § 9 of this Act in order to contest the decision of the insurance undertaking (hereinafter petition).

(3) An insurance undertaking has the right, by way of exception, to apply to the conciliation committee before making the decision specified in subsection 4 of § 21 of this Act if ascertaining the existence of an insured event and the obligation of the insurance undertaking to perform presupposes specialised medical knowledge and drawing conclusions based thereon, but the insurance undertaking has not, despite its efforts, managed to organise an expert assessment and involve a person with specialized knowledge or if persons with specialised knowledge have made contradictory assessments of the case. In such case, the insurance undertaking is deemed to be the petitioner and the entitled person is included in the conciliation proceedings by the commission.

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(4) In the case provided for in subsection 3 of this section, conciliation proceedings shall be deemed to have been commenced by an application of the insurance undertaking. The running of the time limit provided for in subsection 4 of § 21 of this Act is suspended during the conciliation proceedings.

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(1) The petition is reviewed by a conciliation committee composed of five members, except in the cases provided for in the regulation adopted pursuant to subsection 2 of this section. Each member of the conciliation committee must have a higher academic education and be a legal or medical expert.

(2) The bases for the establishment of the conciliation committee and its rules of procedure, including the procedure for the appointment and remuneration of members, will be established by a regulation of the minister in charge of the policy sector.

(3) By 1 February of each calendar year, the conciliation committee submits to the minister in charge of the policy sector a report of all the petitions submitted to the committee during the previous calendar year and the assessments of the consiliation committee.

(1) The procedure before the conciliation committee and its legal consequences are governed by the rules laid down in the Conciliation Act, with the specifications arising from this Act.

(2) The examination of the petition by the conciliation dommittee is free of charge for the applicant.

(3) The conciliation committee will examine the petition within a reasonable time.

(4) Members of the conciliation committee and specialist witnesses specified in § 24 of the Conciliation Act have the right to obtain data, including special categories of personal data, for the resolution of the dispute from persons who have information concerning the circumstances related to the insured event. The persons are required to submit the relevant information immediately but not later than on the 30th calendar day after receipt of the application.

(5) The insurance undertaking is obliged to participate in the conciliation proceedings.

(6) In the event of conciliation proceedings referred to in subsections 3 and 4 of § 23 of this Act, the insurance undertaking pays to the Health Board a reasonable fee for the conduct of the conciliation proceedings and the related expenses, calculated on the basis of the expenses actually incurred. The minister in charge of the policy sector may establish, by a regulation, the methodology for calculating expenses.

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The limitation period for a claim for compensation for harm filed by an entitled person on the basis of this Act, regardless of the legal basis of the claim, is three years from the time the person becomes aware of the violation of the obligation of the health care provider and the occurrence of harm, but not more than ten years after the occurrence of the insured event.

(1) Health care providers operating on the basis of an activity licence for the provision of health services at the time of entry into force of this Act are required to enter into a liability insurance contract within 30 calendar days as of the entry into force of this Act.

(2) If a health care provider has entered into a liability insurance contract within the term specified in subsection 1 of this section, the health care provider continues to operate on the basis of the current activity licence and adding a secondary condition to the activity licence does not result in the amendment of the activity licence.

(3) Harm is compensated on the basis of this Act in connection with an insured event which has occurred after the entry into force of this Act and taking into account the transitional period provided for in subsection 1 of this section.

By 1 January 2029 at the latest, the Ministry of Social Affairs carries out an ex-post evaluation of the impact and effectiveness of the implementation of this Act and, if necessary, submits proposals for the amendment of the provisions.

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[Provisions amending other acts have been omitted from this translation.]

(1) This Act enters into force on 1 November 2024.

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(2) Section 32 of this Act enters into force pursuant to the general procedure.

(3) Sections 28 and 33 of this Act enter into force on 1 May 2022.