Sickness insurance benefit proceedings

The competent DSSA decides on the entitlement to the benefit.

If the conditions for award of the benefit are met, the benefit is paid to the insured and no decision is sent to the insured, only a written notification about the type of benefit paid, its daily amount, the amount of the daily assessment basis and the period for which the benefit was paid (the notification is given in the form of a message to the recipient on the account statement or in the form of a message on a postal order). If the insured person does not agree with the awarded benefit or its amount, he or she may submit a written application to the competent DSSA within 30 days from the date of payment of the benefit or from the date of delivery of the written notification of termination of the benefit’s payments.

If the conditions for entitlement to sickness benefits have not been met, the applicant shall be sent a decision rejecting the application, including the reasons for the rejection. An appeal may be lodged against a decision within 15 days of the delivery of the decision, at the DSSA that issued the decision. The appeal is then decided by the CSSA regional office.

If the applicant does not agree with the outcome of the appeal proceedings, he or she has the opportunity to bring an administrative action before the competent court.