Compensation criteria

Pharmaceutical insurance compensates for necessary extraordinary expenses and other losses arising from pharmaceutical product damage. It does not compensate for expenses or losses that would have been incurred even without such damage. This means that no compensation is payable for the costs of treating the illness or injury that was originally examined or treated, or for the costs of obtaining the pharmaceutical product that caused the damage.

The compensation payable under pharmaceutical insurance will be determined in accordance with the Tort Liability Act (vahingonkorvauslaki, no. 412 of 1974) and any applicable norms and guidelines of the Traffic Accident Board. Previous pharmaceutical product damage assessments of the Finnish Insurance Complaints Board also affect compensation decisions. The costs and expenses related to an injury are generally compensated in full. The injured party must also take all available steps to prevent further injury.

Pharmaceutical insurance is a secondary compensation system

Pharmaceutical insurance is a secondary compensation system that supplements statutory coverage. Benefits paid or receivable from statutory insurance or other public funds are accordingly always deducted from the insurance compensation payable. Claimants must submit their own claims for such compensation and benefits to the competent insuring parties – such as the Social Insurance Institution of Finland (Kela) or a pension fund – even while also seeking compensation from the Finnish Mutual Insurance Company for Pharmaceutical Injury Indemnities.

Eligible medical and other expenses

Expenses for medical treatment and care

Pharmaceutical insurance covers the necessary extraordinary costs of medical treatment and care arising from injury. These costs may include extraordinary inpatient and outpatient charges, medical fees, the cost of home care arising from the injury, and expenses incurred for laboratory examinations, medicines and physical therapy.

The costs of medical treatment and care are generally reimbursed at public health care rates, unless there are special justifications for using private health care services in exceptional circumstances.

Other expenses incurred due to injury

Other eligible costs arising from an injury may include the travelling costs incurred in the course of additional treatment and care, the costs of extraordinary wear and tear on everyday clothing, and additional expenses incurred over a period of home care.

An additional clothing allowance may be payable when the injured party sustains extraordinary wear and tear of everyday clothing, for example due to using a prosthesis, crutches, a wheelchair or various support bandages. However, no compensation is payable for a period of institutional care.

Care allowances and compensation for increased home care costs are intended to cover extraordinary expenses incurred over a period of home care. No compensation is payable for a period of institutional care.

Temporary and permanent incapacity

Temporary incapacity (pain and suffering)

Compensation for temporary discomfort covers acute pain, suffering and other discomfort sustained by the injured party immediately after the injury occurs. The compensation payable will depend on such factors as the severity of the injury or illness, the recovery time, the therapeutic measures applied, and the need for hospitalisation. Pain conditions that become chronic are covered by the system of compensation for permanent handicap.

Permanent handicap

Permanent functional handicap (disablement) caused by pharmaceutical product damage falls under the scope of compensation for permanent handicap. Government Decree (no. 768 of 2015) stipulates a scheme of incapacity categories ranging in severity from 1 to 20. The compensation payable depends on the nature of the injury and the age of the injured party, together with the occupation and hobbies of the injured party in certain special cases.

The compensation payable for each incapacity category will be determined on the basis of guidelines issued by the Traffic Accident Board.

Permanent cosmetic handicap

Compensation for cosmetic injury is payable for any permanent disfigurement, such as scarring due to pharmaceutical product damage. The compensation payable depends on the size, shape, colour, position and visibility of the scar. It also varies according to the age of the injured party, with greater sums paid to younger injured parties.

The compensation will be determined on the basis of guidelines issued by the Traffic Accident Board.

Loss of income

Pharmaceutical insurance compensation may be payable for income lost by an injured party working in the capacity of an employee or self-employed person due to an incapacity to work caused by pharmaceutical product damage. The assessment of working capacity allows for the remaining working capacity of injured parties and their prospects of vocational rehabilitation. It also includes an investigation of the impact of any underlying illness or disability on working capacity. Compensation may also be payable on the basis of partial incapacity to work. The ability of an injured party to boost working capacity through medical or occupational rehabilitation must also be investigated.

The actual income loss suffered will govern the compensation payable for a reduction in income due to impaired working capacity arising from pharmaceutical product damage. The calculation of compensation begins with an estimate of the earnings that the injured party would have received if the pharmaceutical product damage had not occurred.

Compensation is only payable insofar as the statutory benefits otherwise available do not cover the loss sustained. This means that any per diem allowances and pensions payable pursuant to such statutes as the Health Insurance Act (sairausvakuutuslaki, no. 1224 of 2004), the Traffic Insurance Act (liikennevakuutuslaki, no. 460 of 2016), the Workers’ Compensation Act (työtapaturma- ja ammattitautilaki, no. 459 of 2015), earnings-related pensions legislation, the National Pensions Act (kansaneläkelaki, no. 347 of 1956) and the Patient Injuries Act (potilasvahinkolaki, no. 585 of 1986) will be deducted from the compensation payable. If the injured party works part-time after the injury, for example, then the earnings derived from this employment or self-employment will also be deducted from the compensation payable. This means that compensation is paid on the basis of a reduction in earnings.

Death

Reasonable funeral costs and associated direct expenses may be reimbursed in the event of death. This compensation covers such items as the costs of a burial plot, coffin, gravestone, funeral service, flowers, obituary notices and mourning clothes. The costs of compiling an estate inventory are not reimbursed, as they are not regarded as eligible funeral costs under the established interpretation of tort law.

Funeral cost assistance obtained from other sources may be deducted from the compensation payable under pharmaceutical insurance. Funeral costs are reimbursed to the death estate or to the person who incurred the said costs out of pocket.

Necessary compensation for maintenance is payable to eligible beneficiaries in the event of death. The beneficiaries eligible for maintenance are a surviving spouse and minor children, together with children in education under 21 years of age in certain cases. This compensation is only payable insofar as other income and statutory benefits of the beneficiary, such as survivors’ pension, do not guarantee the necessary maintenance.

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