Permanent injury consequences: how they are determined and how much you get for them

What are permanent consequences and when do they occur

Permanent sequelae are health limitations that persist after treatment and are long-lasting or lifelong. They are not ordinary injuries that heal completely – for example, a broken arm that functions without limitation after an adhesion is not a permanent consequence. On the other hand, the loss of a finger, limited mobility of a joint, impaired vision or hearing, chronic pain or permanent psychological problems are already in the category of permanent consequences.

Under the Civil Code, everyone has the right to compensation for personal injury, both pecuniary (loss of earnings, costs of treatment) and non-pecuniary (pain, impairment of social life). The Labour Code grants special protection to employees in the event of a work-related accident or occupational disease. In practice, this means that if the consequences limit the ability to work, the injured person has the right to compensation from the employer or his/her insurance company.

The time aspect is also important: permanent consequences are only assessed when the health condition has stabilised. This can take months or even years. A typical example is a road traffic accident – first treatment, then rehabilitation, and only after stabilisation can it be assessed whether permanent restrictions remain.

How insurance companies and courts assess permanent consequences

The assessment of permanent consequences is based on a medical opinion. Insurance companies have contracted doctors who make a diagnosis and assess whether the condition is stable. Only then can the percentage level of disability be determined. The courts rely on medical expert reports. If there is a dispute between the opinion of the insurance company and the treating physician, an independent expert makes the decision. Case law confirms that the opinion must be objective and based on the actual state of health, not on assumptions. An example of this is a judgment where the court awarded the injured party more compensation than the insurance company had determined because the restriction of movement had substantially affected his ability to carry out his previous occupation.

The process of proving this can be complex – especially when it comes to psychological consequences (post-traumatic stress disorder, depression after an accident). However, even these are recognised as personal injury under the Civil Code. It is therefore always advisable to have an expert report prepared and accepted by the court as the main evidence.

How the tables determine the permanent consequences

Lasting effects are primarily assessed in situations where they have a major impact on a person’s health, work and daily life. The most common are:

• accidents at work and occupational diseases, where the employer (through its insurance company) pays for the employee’s damages, including loss of earnings,
• liability for damages between individuals, for example when someone causes a car accident and the other is left with permanent disabilities,
• accident insurance payouts, where a distinction is made between temporary limitations (daily compensation entitlement) and permanent consequences that affect the amount of the benefit.

Conversely, there are cases where permanence is not examined – for example, in the case of pain payments (compensation for the pain itself during treatment) or reimbursement of costs associated with treatment. Here, it is irrelevant whether the injury leaves permanent effects or the patient makes a full recovery.

This is why the compensation industry has developed a tool called the permanent impairment rating table. It lists specific injuries or health limitations and gives a percentage range for each that reflects its severity. The higher the percentage, the more serious the impact on the victim’s life and the higher the compensation – either from the insurance company or in a court case.

Each insurance company may have its own methodology, but the principle is similar. A typical example is the difference between amputation of the little finger (units of percent) and paralysis of the whole limb (tens of percent). In addition, some insurers use a progressive calculation whereby the sum insured is multiplied for serious consequences. The tables thus help to ensure that the assessment is predictable, while also giving the injured person the opportunity to estimate what benefit he or she can expect.

How to calculate compensation for permanent damage

The amount of compensation is calculated according to the formula: sum insured × percentage rating according to the table. If you have a sum insured of CZK 1,000,000 and your injury is rated at 20%, you will receive CZK 200,000.

Some insurance companies use a so-called progressive benefit. This means that if the consequences exceed a certain threshold (e.g. 50%), the amount is multiplied by a factor of 1.5 to 3.

However, it is always important to pay attention to exclusions – insurance companies often do not pay if the injury was caused by alcohol, drugs or risky behaviour. The waiting period is also important, usually 1-2 years, during which time it is assessed whether the effects are permanent.

In addition to compensation for permanent consequences, the Civil Code also allows for other claims – loss of earnings, care costs or compensation for impairment of social life. In labour law, the Labour Code provides that the employer is liable for the employee’s injury in the event of an accident at work. The calculation in these cases is not bound by the insurance companies’ tables but by the amount of damages determined by the court.

Legal entitlement to compensation for permanent consequences

A claim for compensation for permanent damage can arise from various sources: from life insurance, from the at-fault party’s liability insurance or directly under the law. The Civil Code imposes an obligation to compensate for personal injury in full, not only for pain and suffering but also for permanent consequences, loss of earnings or care costs.

If the injury occurs at work, the employer and its insurance company are liable. The employee is entitled to compensation for loss of earnings, the costs of treatment and reasonable compensation for the impairment of his/her social life.

A handy tip for injured workers is to keep all documentation – medical reports, receipts for treatment and records of lost earnings. This evidence is crucial when dealing with the insurance company and in court.

The most common disputes with insurance companies

In practice, it often happens that the insurance company does not recognise permanent consequences or significantly reduces the benefit. The most common reasons:

• the insurance company claims that the medical condition is not stable,
• different assessment by the insurer’s doctor and the treating doctor,
• attempt to assess the consequences at the lower end of the percentage range of the table,
• reference to exclusions (e.g. alcohol consumption).

The Civil Code gives the injured party the right to seek compensation through the courts. The expert’s report plays the main role in the proceedings. If the insurance company refuses compensation, the court will often award a higher amount, especially if the concrete impact on the victim’s life is documented.

An example from practice is a dispute in which the insurance company refused to pay for permanent consequences after a car accident, citing “lack of evidence”. However, the court awarded the victim full compensation on the basis of an expert’s report.

The recommendation is: if you disagree with the insurance company’s decision, use a claim, a complaint to the Czech National Bank and, in the last resort, a lawsuit.

Summary

Permanent consequences are one of the most important aspects of compensation after an accident. They represent health limitations that persist in the long term and affect the life of the injured person. A permanent impairment table is used to assess them, which provides a percentage of disability. The amount of compensation is then calculated according to the sum insured and the degree of the consequences.

In addition to insurance benefits, there is also a legal claim under the Civil Code and the Labour Code. If the insurance company refuses to pay or reduces the amount, it is possible to defend oneself with an expert’s report and in court. It is always advisable to keep documentation and seek legal advice in good time.