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What if you disagree with the disability pension decision?

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?

žena o francouzských holích, které nepřiznali invalidní důchod
7 minutes of reading

Chapters of the article

It all starts with applying for a pension

Hana suffers from a neurological condition that causes dizziness, tingling in her hands, back pain, motor impairment and impaired walking ability. As her condition has not and will not improve and, in her opinion, has made it difficult for her to work for a long time, she has applied for a disability pension. She herself estimates that her workload has increased by about 50 per cent and believes that she is entitled to a Grade II disability pension.

There are three types of invalidity pensions in the Czech Republic: first, second and third degree. The assessment is based on the percentage reduction in the person’s ability to work.

  1. A first-degree invalidity pension means a decrease in working capacity of at least 35 % but no more than 49 %,
  2. a second-degree invalidity pension means a reduction in working capacity of at least 50 % but not more than 69 %,
  3. a third-degree invalidity pension means a decrease in working capacity of 70% or more.

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Amount of invalidity pension

The amount depends on three important factors. These are:

  • earnings during (working) life,
  • the length of time earned (for disability pensions, the length of insurance is added),
  • the degree of disability awarded.

In practice, this means that you must have worked a sufficient number of years, which is determined by age:

  • up to age 20 – less than 1 year of pension participation,
  • 20-22 years – 1 year of pension participation,
  • 22-24 years – 2 years of pension participation,
  • 24-26 years – 3 years of pension participation,
  • 26-28 years – 4 years of pension participation,
  • 28 and over – 5 years of pension participation.

If you are over 28, it will also be relevant whether you have completed the required period of insurance (5 years) in the last 10 years before the disability. However, if you are over age 38 and do not meet the required years of service, you may still meet the alternative requirement of 10 years of coverage in the last 20 years before the disability.
The disability pension for self-employed is determined in the same way as for an employee, counting the years you have been participating in social security.

Example of the calculation of the disability pension in 2022

Let’s use a case study to see how Ms. Hana estimated her disability pension using an online calculator

  • Current gross monthly salary in CZK 34,000
  • Year of pension commencement 1992
  • Year of birth 1970
  • Degree of disability II.
  • Calculation of disability pension is CZK 10837

From June 2022, there will be an extraordinary increase in pensions in view of the high inflation rate. At the same time, a pension contribution of CZK 500 per month for each child raised has been agreed, effective January 2023. When you reach retirement age, you will start receiving an old-age pension to replace the disability pension (if it is higher than your current pension).

You must apply to the relevant district social security office. The degree of invalidity is then assessed by the Social Security Administration’s assessor.

In Hanna’s case, the application for an invalidity pension was rejected at the first stage.

Tip: Another reason for refusing an application (apart from the reviewing doctor’s report) may be that the applicant has not obtained sufficient insurance.

Examination of the degree of invalidity by the assessing doctor

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 invalidity 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.

What if you disagree with the verdict of the assessing doctor?

If, when you first applied or when your condition was reviewed, the assessing doctor assessed your health condition with a verdict you disagree with (i.e. did not grant you a pension, decided to reduce its level or did not decide to increase it), you can appeal or object to the decision of the CSSA on the invalidity pension.

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 the appeal, you must state which decision it relates to (whether it was a decision not to grant, reduce or withdraw an invalidity pension), who issued it and what its reference number is. It is important to state why you disagree with it, and to document all the relevant facts, including, for example, medical reports and reports from other doctors. Based on the objections received, the medical 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 application has been refused on the grounds that you have not completed the required period of insurance, an appeal is virtually pointless. If your health allows it, you can complete the period of insurance you need to complete by working in a job 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.

Action in the administrative courts in the event of unsuccessful objections

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.

Mrs Hana objected to the decision not to grant an invalidity pension, but again unsuccessfully. Eventually, with our help, she filed an administrative claim in which she again described her medical condition, stated how it limited her in her occupation (shop manager), and documented the medical reports of her neurologist and orthopedist. Eventually, she was awarded a first degree disability pension. It is possible to continue working when this is granted. 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.

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Author of the article

JUDr. Ondřej Preuss, Ph.D.

Ondřej is the attorney who came up with the idea of providing legal services online. He's been earning his living through legal services for more than 10 years. He especially likes to help clients who may have given up hope in solving their legal issues at work, for example with real estate transfers or copyright licenses.

Education
  • Law, Ph.D, Pf UK in Prague
  • Law, L’université Nancy-II, Nancy
  • Law, Master’s degree (Mgr.), Pf UK in Prague
  • International Territorial Studies (Bc.), FSV UK in Prague

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