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.
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.
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The amount depends on three important factors. These are:
In practice, this means that you must have worked a sufficient number of years, which is determined by age:
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.
Let’s use a case study to see how Ms. Hana estimated her disability pension using an online calculator
When you reach retirement age, you will start receiving an old-age pension to replace the invalidity pension (if it is higher than your existing pension). You must apply to the relevant district social security office. The degree of invalidity is then assessed by the Social Security Office’s assessor. Pensions granted before 1 January 2024 are increased as of 1 January 2024, so that the basic rate of the pension is increased by CZK 360 per month. The amount of the basic pension assessment for 2024 is CZK 4 400.
In the case of Mrs Hanna, 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.
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 can 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.
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. 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 have not been awarded a disability pension, or if you disagree with the decision on the level of disability, do not despair. You have several options for defending yourself, from filing an objection with the Social Security Administration to filing an administrative appeal with the Regional Court to retaining the services of an attorney. It is important to make sure that you meet the legal deadlines and file correctly completed documentation. If you are unsuccessful in the objection procedure, you can also take legal action, without paying court fees. Proper documentation of medical conditions can be the key to success.
Tip: See also our article on how to defend yourself against a decision in an administrative procedure.
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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.
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