Medical Committee Guide for National Insurance

What is a Medical Committee for National Insurance?

A medical committee for national insurance is a judicial-medical body authorized to decide the degree of disability of an insured person injured in a traffic accident, work accident, or as a result of an occupational disease. The committee determines disability percentages, which directly affect entitlement to monthly disability benefits, nursing care allowances, vocational rehabilitation, and additional payments from national insurance.

In principle, any insured person who has sustained bodily injury as a result of a covered accident or registered occupational disease may be entitled to benefits from national insurance, but determining the level of entitlement requires an in-depth medical evaluation by the committee.

Who Needs a Medical Committee?

• Traffic accident victims — those sustaining permanent or temporary bodily injuries affecting their ability to work and function
• Work accident victims — workers injured in an accident at work or on the way to work
• Patients with occupational diseases — individuals who contracted a disease resulting from working conditions
• Temporary disability benefit recipients — those requiring reassessment or final evaluation

Why is Preparation for a Medical Committee Important?

A medical committee does not merely read existing medical reports — it hears the injured party, examines their medical condition in real life, and considers the impact of the disability on work capacity and life skills. Proper preparation significantly affects the final outcome: higher disability percentages, entitlement to higher benefits, and avoidance of errors that could harm the claim.

Attorneys with experience representing claimants in accidents and national insurance matters know how to present the case effectively, which medical documents to collect in advance, and how to prepare the injured party for the hearing itself so that medical claims are supported by live testimony.

The Process: Stages of the Medical Committee from Start to Finish

Stage 1: Submitting a Request for a Medical Committee

The process begins when an insured person or their attorney submits a formal request to national insurance for a medical committee hearing. The request must contain a detailed description of the disability, a list of relevant medical documents (tests, physician reports, CT or MRI images, and the like), and legal arguments regarding the connection between the accident and the disability. At this stage, it is important to invest time in preparing a quality request, as it sets the tone and expectations for the entire process.

Stage 2: Collection of Medical Documents and Expert Opinions

Following submission of the request, all relevant medical documents must be collected: imaging, laboratory tests, physical examination reports, opinions of specialists (physicians expert in the field of injury), and any other document supporting claims regarding disability percentages. An opinion from an external expert physician (not only the treating physician) can significantly influence the committee's decision, especially if it contradicts the opinion of the national insurance physician.

Stage 3: Preliminary Examination by a National Insurance Physician

Before the hearing, a physician representing national insurance conducts an initial examination and reports his or her opinion regarding the degree of disability. This report is not final, but it is significant in shaping the national insurance position at the committee. Often, errors or low assessments in this report can be challenged or refuted at the hearing itself, provided there are strong documents and expert opinions to support the opposing position.

Stage 4: The Medical Committee Hearing

The hearing is the heart of the process. The hearing typically includes: the injured party (or their attorney), one or two physicians representing the committee, and any medical witness the injured party or their attorney brings (for example, an external specialist physician). At the hearing, the injured party describes his or her symptoms, the impact on daily life and work capacity, and answers questions from the physicians. The committee may also conduct an additional physical examination. At this stage, things not visible in written reports — such as apparent pain, fatigue, difficulty in movement — can influence the observers and the committee's decision.

Stage 5: Determination of Disability Percentages and Decision

Following the hearing, the committee convenes and decides on disability percentages in accordance with the national insurance disability table. The table specifies standard percentages for various injuries (for example, loss of a finger = 5%, spinal cord injury = 20–60%, chronic pain syndrome = 10–30%), but the committee may adjust the percentages according to the specific circumstances of the case. The decision is typically delivered in writing within two to three months after the hearing.

Stage 6: Appeal of the Decision (if necessary)

If the injured party or national insurance disagrees with the percentages determined, an appeal may be filed with an appeals medical committee (a higher appellate body). Such an appeal requires presentation of new evidence or legal arguments not presented at the first hearing. An attorney with experience in the field can identify when an appeal has reasonable prospects and how to build it effectively.

Practical Preparation for a Medical Committee Hearing

Preliminary and Thorough Medical Examination

Before the hearing, it is important that the injured party undergoes a thorough medical examination by a specialist physician in the relevant field (for example, a neurologist for spinal cord injury, an orthopedist for limb injury). This examination should support the claims regarding disability percentages and be documented clearly. If there is a discrepancy between different reports, it should be clarified in advance to present a consistent position to the committee.

Collection of Complete and Organized Documentation

Every medical document must be organized and sorted chronologically. This includes: initial examination reports from the emergency room, hospitalization reports, test results, physiotherapy treatment reports, and any document that records the progression of recovery (or lack thereof). Organized documentation makes the case easier to understand and conveys professionalism to the committee.

Mental and Physical Preparation of the Injured Party

The hearing can be challenging both emotionally and physically. The injured party must be prepared to describe their suffering before three to four people (physicians, attorney), and also to undergo a physical examination that may be painful. An experienced attorney can help prepare the injured party for the hearing: what to expect, how to answer questions, and how to conduct themselves in a way that strengthens the case. This preparation also includes guidance on how to describe symptoms in an objective and lawful manner, without exaggeration or minimization.

Bringing Witnesses or Expert Opinions

If appropriate, an external specialist physician who supports the injured party's claims can be brought to the hearing. Such testimony can be highly significant, particularly if it contradicts the opinion of the National Insurance physician. A written expert opinion prepared in advance (before the hearing) can also serve as written evidence if the physician cannot appear in person.

Preparation of Legal Arguments

An attorney must prepare clear and focused arguments regarding the requested disability percentages. This includes: comparison to similar cases in which the committee determined higher percentages, presentation of the connection between the disability and the inability to work, and addressing any claims by the National Insurance that may arise during the hearing. Strong legal arguments can influence the committee as much as medical documents.

Disability Percentages: Typical Ranges and Influencing Factors

National Insurance uses a standard disability table, but the disability percentages determined by the committee in practice depend on many factors. Below is a table showing typical ranges for various injuries, with the caveat that each case is examined individually:

Factors Affecting Percentage Determination

• Age of the injured person — A young injured person may suffer higher disability, as they may be out of the job market for many years
• Profession and work capacity — If the injured person cannot return to their original profession, the committee may determine higher percentages
• Severity of medical injury — An injury that shows no improvement over months or years may justify higher percentages
• Impact on daily life — Difficulties in walking, sleeping, nutrition, or other basic activities affect percentage determination
• Need for care or ongoing treatment — If the injured person requires assistance with daily activities, this increases disability percentages
• Treatment summaries and medical opinions — If doctors assess that the disability is permanent and significant improvement is not expected, the committee may determine higher percentages

It is important to note that the committee may determine percentages different from the standard disability table, provided there is medical and legal justification. An experienced attorney knows how to present arguments justifying higher percentages than the table.

Why is professional legal representation at a medical committee important?

A medical committee is a legal and technical process that benefits from legal and clinical expertise. An attorney with experience in national insurance and tort law can add considerable value:

• Professional preparation — an attorney knows which medical documents are important, how to organize them, and how to present them persuasively
• Legal arguments — an attorney can argue that the National Insurance Institute is wrong in interpreting the law, evaluating the evidence, or applying the disability table
• Preparation of the injured party — an attorney can help the injured party be mentally and physically prepared for the hearing, what to expect, and how to behave in a way that conveys credibility
• Expert opinions — an attorney can identify when an external expert medical opinion is needed and how to use it effectively
• Appeal if necessary — if the committee determines percentages that are too low, an attorney can decide whether an appeal has a reasonable chance and prepare it professionally

Mandelbrot, Gor, Vitsman-Gor and Partners has specialized in representing claimants in tort and national insurance matters since 2008. Our firm's experience with similar cases allows us to identify the strongest arguments, avoid common mistakes, and present your case in the best possible light to the committee. Additionally, we offer a first consultation meeting at no cost, so you can discuss your case and decide whether you want to work with us.