10.04.2023
HOW DISABILITY PENSIONS ARE PAID
Disability pensions and supplements for foreign aid are payments made by the National Social Insurance Institution to people with disabilities, for whom the territorial expert medical commissions - TEMC and the National Expert Medical Commission - NEMC have established the type and degree of disability/percentage of permanently reduced working capacity 50 and over 50 percent and/or are in need of foreign aid.
The Social Security Code and the Ordinance on Pensions and Insurance Longevity clearly regulate the conditions for awarding and paying the various types of disability pensions, respectively - the supplement for foreign aid, and the same are awarded for the period of disability determined by TEMC/NEMC in the examination of the permanently reduced working capacity/type and degree of disability. Only for persons with permanent disabilities who have reached the basic retirement age under Art. 68, para. 1 of the Social Security Code, the disability pension and the foreign aid supplement are granted for life, specified by the National Social Security Institute.
In cases in which the disability pension and/or the supplement for foreign aid are granted until the term of the disability defined in the expert decision, it is necessary for the disabled to be re-certified by the medical examination authorities, who issue a new expert decision.
Based on it, the National Social Security Institute continues the payment of the disability pension/foreign aid allowance until the new term of disability.
The issuance of a new expert decision by the medical examination authorities and its entry into legal force requires a certain period of time, during which persons with permanent disabilities may remain without payments from the National Social Security Institute, due to the fact that the pensions and/or supplements they receive foreign aid is suspended or terminated.
In order not to be terminated until the new expert decision is issued, when there is a delay in the medical examination, as well as for them to continue receiving their payments from the National Social Security Institute and from the other competent authorities in the country, changes were adopted to the Law on People with Disabilities and in the Health Act.
It is the first time that a period has been introduced in which the Regional Health Inspectorate is obliged to officially notify persons of the need for regular re-certification, and this period is no later than four months before the expiry of the period in their previous decision.
At the same time, people with disabilities must submit their applications-declarations for re-certification no later than three months before the expiration of the term of their expert decisions. Apart from that, the deadline for carrying out the expertise is three months from the submission of the application-declaration in the regional card file or three months from the receipt of the complaint at NEMC.
The term "delay in medical expertise" has already been introduced into the law. It is available when, within a three-month period from the submission by the person of the necessary application-declaration for re-certification, the medical examination body has not established the type and degree of disability of children up to the age of 16 and of persons who have acquired the right to a pension for social security service and age according to Art. 68 of the Social Security Code, respectively - the degree of permanently reduced working capacity of persons of working age, as well as the confirmation of an occupational disease.
In the event of such a delay, the validity of the last issued expert decision is extended until a new one is issued and the rights of the disabled are preserved. However, this extension is not unconditional, the National Social Security Institute specifies. On the one hand, there is a requirement that the person submitted an application-declaration for re-certification no later than three months before the expiry of the last one, and on the other hand, TEMC has not made a decision within three months of submitting this application-declaration.
Only for the persons for whom these two requirements are present, the obligation of the Regional Health Inspectorate to send information by the 20th of the month to the interested bodies - National Social Security Institute, the National Health Insurance Fund, the Agency for Social Assistance, the Agency for People with Disabilities has been introduced, the National Revenue Agency and the municipality at the person's current address, indicating the scheduled date for re-certification. At the request of recertified persons, it is possible to send this information to insurers or other bodies and organizations for the purpose of exercising rights by the person within the extended period of disability of the issued expert decisions. In order to protect people's rights to the maximum extent and in order to speed up the process of paying the amounts owed to the entitled persons by the interested authorities, it was decided that the necessary information in a summarized form for the country will be sent by the Ministry of Health, in whose structure they are the Regional health inspectorates, to the interested bodies, including the National Social Security Institute.
However, the exchange of data will actually start after 28.05.2023, and until that date information will be received about the persons who are included in the personal scope of § 5 of the Transitional and Final Provisions of the Law on Amendments and Supplements to the Law on People with Disabilities. The law regulates the cases found with two transitional provisions, this being the first of them. The cited special norm covers the persons for whom there is a delay in the medical examination, and it is important to note that for these persons it does not matter in what period the application-declaration for re-examination was submitted, i. e. the requirement is not met that the same was submitted no later than three months before the expiration of the term defined in their expert decision.
The scope includes persons with:
As it was already noted, in the established proceedings for re-certification, the moment of submission of the application-declaration for re-certification is irrelevant, and the same can be submitted the day before the expiry of the term of the expert decision. This provision will apply until 28/05/2023 and only then will the requirements of the main rule begin to be observed.
For the persons under item 1 and item 2, information is received monthly from the Ministry of Health, on the basis of which the validity of the last issued expert decision of the persons is ex officio extended until their scheduled date for re-certification.
The second provision regulates the found cases. It stipulates that if for disabled people with suspended pensions due to the expiration of their expert decisions, they submit an application-declaration for re-certification before the changes come into force, there is a delay in the medical expertise, the same will be included in the relevant lists sent to the concerned authorities by the regional health inspectorates and their rights are resumed, with pensions and/or foreign assistance supplements paid to them by the scheduled re-examination date.
In addition to lists of entitled persons, to whom the validity of the last expert decision issued to them is extended until a new one is issued, it is regulated that the interested authorities receive information about persons who submitted an application-declaration for re-certification, who, after their regular summons, did not appear for an examination in TEMC. These are the persons who (despite being notified) did not appear on their scheduled re-examination date.
The law provides that after their failure to appear for re-examination, their medical documentation will be returned to the Regional Medical Expertise Registers, and the extension of the term of their expert decisions shall be deemed terminated from the date of failure to appear. The information with the persons who did not appear for an examination at TEMC is sent to the interested persons and authorities (including the National Social Security Institute) within 14 days from the date of non-appearance.
Based on the data received for the persons who did not appear on the scheduled date for re-examination, the pension insurance officials in the National Social Security Institute terminate the payment of disability pensions and/or foreign aid supplements, due to the fact that the legal basis for their receipt has ceased to exist.
