Do you have long-term health problems, have suffered a serious injury but have not been awarded a first degree disability pension? Or have you had your disability reduced contrary to the opinion of your district doctor? How can you defend yourself and what do you have to take into account as a disability pension claimant? If you have not been awarded an invalidity pension, you need to know how to defend yourself and how to appeal the medical opinion.
Getting a disability pension is certainly not a given or a formality. Many claimants believe that if their health prevents them from working, the award of a disability pension will be automatic. However, the reality is often different. The medical assessment service of the Czech Social Security Administration evaluates not only the medical documentation but especially the degree of decline in working capacity according to strict rules. This means that even if a district doctor or specialist confirms that you have a serious medical condition, this does not necessarily mean that you meet the conditions for disability.
Equally, you may be downgraded even though your health has not, in your opinion, improved – quite the opposite. It is at these times that it is important to know what your rights are and how you can defend yourself against such a decision. It’s not just about fighting the bureaucracy, but often about existential security, as disability pensions are a key source of income for many people. Although the road to getting your disability recognised may seem complicated, you are not alone.
Or was your retirement pension benefit calculated differently than you expected? We can help you find out how the Social Security Administration assessed your situation and check whether there was an error.
If you have been awarded an invalidity pension, you should expect to have your condition reviewed at regular intervals (the length of which is very individually determined) by the assessing doctor of the local Social Security Administration. You must attend the examination. Failure to do so could result in your disability pension being stopped.
You can also have an examination on your own request if you think you are entitled to a higher level of pension because of your deteriorating health.
The Social Insurance Institution’s assessing doctor decides according to objective medical findings and also using the Disability Assessment Decree No. 359/2009, which also describes the individual diagnoses, their variants and the estimated degree of decline in working capacity in the annexes.
Tip: Read what to do if you disagree with your care allowance.
If, when you first applied or when your condition was reviewed, the assessing doctor assessed your health condition with a verdict that you disagree with (i.e. he did not grant you a pension, decided to reduce its level, or did not decide to increase it), you can appeal against the decision of the CSSA on disability pension against the medical opinion or object to it.
Tip: You should wait until you receive the Czech Social Security Administration’s decision on your pension and therefore not appeal (object) against the medical opinion on disability. This is not a decision, only the basis for it.
Make sure you have the legal deadline for filing objections, which is essential for a possible court action later. If you do not file an objection at all, or do not file it within the time limit, you are barred from taking legal action.
Objections must be submitted in writing to the Czech Social Security Administration. In your appeal against the medical report, you must state which decision it relates to (whether it was a decision not to grant, reduce or withdraw your invalidity pension), who issued it and what its reference number is. It is important to state why you disagree with it and to provide all the relevant facts, including, for example, medical reports and reports from other doctors. Based on the objections received, the health condition will then be assessed by the CSSA doctors who are responsible for the objection procedure. This is a different doctor from the one who issued the original decision.
The time limit for issuing a decision on the objection procedure is 60 days, but may be extended by 30 days to request the necessary documents from another administrative authority. There is also a time limit for the preparation of a new opinion, which is a maximum of 60 days. The total time limit for issuing a decision on objections may therefore be 120 days, or even 150 days in more complex cases.
Tip: If your claim is rejected on the grounds that you have not completed the required period of insurance, appealing against the medical report is virtually useless. If your health allows it, you can supplement the period of insurance you need to complete with employment that triggers social security. In some cases, the solution may be to participate in a voluntary pension scheme and reapply for a disability pension in the future once the conditions have been met.
If your objections to the CSSA’s decision on your disability pension are not upheld, you have the further option of bringing an administrative action in the matter before the Regional Court. The administrative action must be filed within 60 days of service of the decision against which it is brought. It is advisable to state in the action why the medical condition, etc., was not properly taken into account and to use a lawyer to draft the action.
The application should be submitted in duplicate and should be accompanied by medical reports. The court may request further medical documentation. The assessment of the medical condition is then carried out by the assessment committee of the Ministry of Labour and Social Affairs. No court fees are payable, even if the action is unsuccessful.
Our client filed an appeal against the decision not to grant her disability pension, but was repeatedly unsuccessful. Finally, with our assistance, she filed an administrative claim in which she re-described her medical condition, stated how it limited her in her occupation (store manager), and documented the medical reports of her neurologist and orthopedist. Eventually, she was awarded a first degree disability pension. If it is granted, it is possible to continue working. Mrs Hana was thus able to reduce her working hours without fear of losing her overall income and agreed with her employer to adjust her working conditions so that she could continue to do her job.
If you disagree with a disability pension decision, you have several defenses. First, you must wait to receive a decision from the Czech Social Security Administration (CSSA), because a medical report alone is not a decision. You can then file an objection in writing with the CSSA within 30 days of receiving the decision. In your objections, you must state what decision you object to, why you disagree with it, and attach new medical reports or opinions. The objections are decided by a different assessor from the one who made the original report. If the objections are not successful, you can take an administrative action against the regional court within 60 days. The court proceedings are free of court fees and the medical condition is assessed by an independent assessment committee of the Ministry of Labour and Social Affairs. Also, if you have been awarded an invalidity pension, it is regularly reviewed by a medical assessor. On the other hand, if your application has been refused because you have not completed the required period of insurance, objecting to the medical assessment is not an option – in this case, you must supplement your insurance with work or voluntary pension insurance.
Tip: See also our article on how to defend yourself against a decision in an administrative procedure.
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