Compensation for vaccine injury in the event of vaccination administered in Estonia
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?
- Vaccinations against Covid-19 administered from 27 December 2020;
- All vaccinations administered from 1 January 2023
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).
The document does not need to be submitted if its data is entered in the Estonian Population Register.
How long does the application process take?
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.
The application must be submitted to the Estonian Health Insurance Fund within a year from the occurrence of the insured event.
As an exception, an application for compensation of Covid-19 vaccine injury may be submitted retroactively from the beginning of administration thereof (27 December 2020) until 1 May 2023.
If the application is not submitted within the specified term, the Health Insurance Fund is released from the obligation to compensate the injury.
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.
|Severity of injury||Insured event until 31 December 2022||Insured event from 1 January 2023 to 31 December 2023|
|Compensation rate (in euros)|
|serious injury of moderate severity||2 000||2 390|
|serious injury of medium severity||10 000||11 940|
|serious injury||25 000||29 850|
|very serious injury||50 000||59 700|
|extremely serious injury or death||100 000||119 400|
If the consumer price index does not increase or decreases, the current sum insured and benefits remain unchanged.
The injury is compensated on the basis of the sum insured and benefits of the year when the insured event took place.
Detailed information: https://www.riigiteataja.ee/akt/128042022014
The Health Insurance Fund refuses to pay compensation for health injury caused by a vaccine if:
- the described event is not an insured event;
- the patient has intentionally caused the insured event;
- 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;
- 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;
- the entitled person has provided to Estonian Health Insurance Fund with incorrect information about the insured event;
- 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:
- after payment of compensation, it turns out that the applicant was not entitled to receive it;
- 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] tervisekassa.ee (info[at]tervisekassa[dot]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.tervisekassa.ee/en/broneerimine
Vaccine insurance premium information for vaccine distributors
From January 2023, all vaccines, incl. vaccines without marketing authorisation, are covered by vaccine insurance.
Distributors of pharmaceuticals have an insurance obligation.
Vaccines (excl. Covid-19) marketed from 1 January 2023 are covered by the vaccine insurance payment.
The insurance payment rate for 2023 is 0.15 euros. The payment rate applies to vaccines that are not Covid-19 vaccines. The difference is due to the fact that the funds to cover insurance payments for Covid-19 vaccines are derived from the state budget.
The payment rate changes every year and is published on the website of the Health Insurance Fund in December of the current year.
Reporting of vaccine insurance payment must be submitted in a digitally signed format to the Health Insurance Fund at the e-mail address vaktsiinikahju [at] tervisekassa.ee (vaktsiinikahju[at]tervisekassa[dot]ee).
Reporting: for the previous quarter by the last date of the first calendar month of the following quarter.
Report table and information on where to send it Aruande_tabel.xlsx