Expenses towards treatment, medicine, aids, etc.

Under the Workers’ Compensation Act you are entitled to reimbursement of necessary expenses towards:

Expenses for treatment while the case is pending
Medicine
Expenses in connection with tooth injuries
Expenses for aids – for instance prostheses, glasses, or similar aids that you need because of your recognised industrial injury
Compensation for future treatment expenses, medicine, aids, etc.
Expenses in connection with processing of the claim – for instance transport and meals in connection with medical examinations

The expenses incurring while the case is pending are dealt with separately.

Your employer’s insurance company pays the necessary expenses towards treatment, medicine, aids, etc. Therefore you should always send the invoices to the insurance company. If you send the invoices to us, this will delay reimbursement as we have to forward the invoices to the insurance company.

While we are processing your claim, your employer’s insurance company will pay the invoices in connection with your treatment.

You cannot get reimbursement for a treatment which is not reasonable in view of the effects of your injury.

Usually you cannot get reimbursement of treatment expenses if the treatment is given a long time after the injury or if several treatments have been given already.

Insurance companies only cover part of the treatment expenses if the need for treatment was caused by factors not related to the industrial injury.

Before you start on a treatment or buy some aids, we advise you to ask the insurance company if they will pay.

If you and the insurance company disagree on reimbursement, we can decide the question for you. You need to ask the insurance company to send the documents of the case and the invoices to us if you want us to make a decision on this question.

1. Expenses for treatment while the case is pending

You can only get reimbursement of expenses for treatment and physical retraining if your injury has been recognised as an industrial injury and the treatment is approved by the national health insurance. In addition the treatment must –

Be necessary to obtain the best possible cure
Have a time correlation with the injury
Not be fully covered by others, for instance the national health insurance

Examples of treatment expenses that may be covered
The following expenses may be covered:

Physiotherapy
Sessions with a psychologist
Treatment by an authorised chiropractor
Acupuncture performed by a doctor
Plasters and dressings purchased because of the industrial injury

Examples of treatments that will not normally be covered
The following expenses will not normally be covered:

Tension treatment (is only covered if an element of other treatment covered by the insurance company)
Gymnastics and physical training (is only covered if an element of other treatment that the insurance company pays for)
Massage (is only covered if an element of other treatment by a physiotherapist or chiropractor)
Swimming (is only covered if in specially heated water and if swimming has been prescribed by a doctor as a necessary part of the treatment)

Examples of treatment expenses that will not be covered
The following expenses will not be covered:

Treatment in private hospitals and clinics
Treatment that only has a temporary, relieving effect on your symptoms
Retraining after brain damage, such training not having a permanent curative effect
So-called "alternative treatment” in the form of acupressure, kinesiology, natural medicine, etc.

2. Expenses for medicine

You can only get reimbursement of medicine expenses if:

The medicine is sold by pharmacists in the country where you live
The medicine is necessary for the treatment of the effects of the industrial injury
The medicine expenses have not already been covered by the national health service or others
The quantity of medicine is reasonable in view of the effects of the industrial injury

You can get reimbursement of painkiller expenses because you will get well sooner if you are not in pain. Sedatives are only covered if they are also painkillers.

Examination of the claim
You need you keep receipts or other documentation that you have paid for your medicine.

You have to be able to show:

What type of medicine you have paid for
When you bought the medicine
How much medicine you have bought
How much the medicine cost
Any subsidies paid for your medicine

You need to send the receipt to your employer’s insurance company, who will first decide whether or not to cover the expenses.

While we are processing your claim, your medicine bills will be paid. When deciding if your injury qualifies for recognition as an industrial injury, we also make a decision on compensation for future medicine expenses.

3. Injuries to teeth

If you injure your teeth because of an industrial injury, your treatment will be covered under the Workers’ Compensation Act.

Before your treatment can be covered, your employer’s insurance company or the National Board of Industrial Injuries will have to give their approval.

The employer’s insurance company will cover expenses for treatment of tooth injuries on the basis of a quotation. This means that your dentist needs to make an offer, describing the type of treatment necessary.

If a healthy tooth is injured because of an industrial injury, the whole treatment will be covered. If a tooth was defective before the industrial injury, you can only get reimbursement of that part of the dental treatment which was caused by the industrial injury. We make deductions, for instance, in case of cavities, fillings, crowns, or paradentosis.

Examples – cover of tooth injuries
Example – we cover dental treatment in full
Christian was a social worker. In the workplace a violent client knocked out one of his teeth. Christian’s dentist offered to repair the tooth for DKK 11,000. We covered the amount in full in accordance with the invoice.

Example – we cover the dentist’s invoice in part
Frederik fell at work and knocked out a tooth. The tooth that Frederik knocked out was affected by paradentosis. Therefore we found that only two thirds of the expense should be reimbursed under the Workers’ Compensation Act, one third of the injury having being caused by paradentosis.

Frederik’s dentist offered to repair the tooth for DKK 12,000. The insurance company paid the dentist DKK 8,000 (two thirds), and Frederik had to pay the remaining DKK 4,000 himself.

Examination of the case
In order for you to get reimbursement for treatment of a tooth injury, we first need information about:

How your teeth were before the injury
How your teeth are after the injury

In order to get the information we need, we usually ask your dentist for the following:

A dentist’s statement or a completed claim form and a copy of all your dental records
X-rays of your injured tooth
A price estimate of the treatment of your tooth injury

4. Expenses for aids

While we are processing your claim, you can get reimbursement of expenses for aids, for instance a wheelchair, glasses, or a prosthesis.

If we are to cover an aid, one of the following conditions has to be met:

The aid ensures the result of the treatment or retraining
The aid reduces the consequences of the injury
The aid makes it easier to assess the permanent injury and loss of earning capacity

The aid normally has to be adapted to your needs and to compensate the loss or improve the function of for instance an arm or a leg.

Expenses for ruined aids
You can get reimbursement of expenses for an aid which is ruined at work, even if you have not had an industrial injury. This requires:

That the aid is of a type that is not covered by general rules (glasses, prostheses, etc.)
That the aid was used during work
That the aid was damaged due to work

Eyeglass frames are replaced up to a maximum amount, which is adjusted once a year.

Examples of ruined aids reimbursed under the Workers’ Compensation Act
Fisherman got reimbursement for dentures dropped in the water
Bent, who was a fisherman, dropped his dentures in the water while on board his fishing vessel. Bent lost his dentures due to the working conditions. We replaced the dentures.

Gardener got reimbursement for glasses that were hit by a piece of wood and broke
Karsten was a gardener and used reading glasses for reading work plans. He had put his glasses in a bag. The bag was hit by a piece of wood while Karsten was stacking firewood. The glasses were reimbursed.

Eyeglasses that broke because of a loose screw were not paid for
While Lise was at work, her glasses fell off and broke. The glasses fell off due to a loose screw in the arm of the glasses. Lise did not get reimbursement of her glasses because the loose screw and the damage to her glasses were not a consequence of her work or working conditions.

5. Compensation for future expenses towards treatment, medicine, aids, etc.

If we decide, in connection with an industrial injury, that you will have future expenses for treatment, medicine, aids, etc., you will get a lump sum to cover such expenses. Afterwards you will not get reimbursement of any further expenses, except where your claim is resumed.

We calculate your future expenses on the basis of the prices at the date when we make a decision.

The Act covers your future expenses for treatment for a limited period of time or permanently.

When calculating the compensation for permanent future expenses, we multiply your average annual expenses with a capitalisation factor.

The capitalisation factor depends on your age and date of injury. We use the same capitalisation factor when calculating conversion into a lump sum of compensation for loss of earning capacity.

Examples of reimbursement of future expenses
Future treatment expenses for a limited period of time
While we were processing Lise’s claim, Lise had physiotherapy. We had approved 10 treatments for Lise. Lise had had these 10 treatments when we made a decision on the claim. We decided that Lise was entitled to another 10 treatments after the conclusion of her case. The insurance company of Lise’s employers paid an amount which would cover the 10 treatments.

Permanent future medicine expenses
Ole lost part of one leg in an accident at work. He was 47 years and 3 months old when we made our decision. During the processing of the claim, the insurance company of Ole’s employer had covered the expenses for a lower-leg prosthesis which cost DKK 50,000. The lifetime of a lower-leg prosthesis is about 3 years. We calculated Ole’s annual average cost for a lower-leg prosthesis at DKK 16,667 per year (DKK 50,000/3 years). This amount we multiplied by the capitalisation factor 10.638 (as per 1st March 2015) for a person aged 47 years and 3 months. Ole received a payment of DKK 177,304 to cover his future lower-leg prosthesis replacements.

Permanent expenses for dental treatment
Frederik injured his teeth. He was 36 years and 11 months old when we made a decision. While we were processing the claim, Frederik received reimbursement of the expenses for dentures. Frederik’s dentures would have to be replaced after 15 years, at a cost of DKK 25,000. We calculated Frederik’s future average expenses for dentures at DKK 1,666 per year (25,000 DKK/15 years). This amount we multiplied by the capitalisation factor 15.642 (as per 1st March 2015) for a person aged 36 years and 11 months. Frederik therefore received DKK 26,076 to cover his future expenses for dental treatment.

Examination of future need for treatment
When making an assessment of your future need for treatment, we usually gather information as follows:

We ask your employer’s insurance company which expenses they have promised to pay for treatment, medicine, and aids
We will ask you if you have paid for any treatment, medicine, or aids
We will ask your doctor or others who have examined you about your future need for treatment

6. Expenses in connection with the processing of the claim

While your claim is being processed, your employer’s insurers will pay some of the expenses you have as a consequence of your injury. This may for instance be expenses for travel, meals, or lost earnings in connection with a medical examination requested by us.