Key Benefits:
REGULATION OF THE MINISTER OF SOCIAL POLICY 1)
of 31 December 2004
on medical case law in the Social Insurance Institution
On the basis of art. 46 (1) 4 of the Act of 20 December 1990. o social insurance of farmers (Dz. U. 1998 r. No. 7, pos. 25, of late. 1. 2) ) The following shall be managed:
§ 1. The Regulation shall specify:
1. the detailed rules of the decision on the total incapacity for work in the agricultural holding and the decision on the advisability of professional retraining;
(2) the case-law procedure;
(3) the procedure and the time limit for appeals against the decisions of the doctors in the Agricultural Social Insurance Fund, hereinafter referred to as "the Cashier";
4) the forms of supervision over the adjudication of doctors 'appraisers of the Kasy and Doctors' Committees of the Kases;
5) additional professional qualifications required of physicians carrying out tasks in the field of medical case law.
§ 2. The following shall be taken into account when the total incapacity for work on the holding is to be declared:
(1) the nature and the course of the disease processes and their impact on the physical state of the organism and, in cases of entitlement to the agricultural pension for incapacity for work, due to the consequences of the accident at work or occupational disease, including their the relationship with that accident or the disease;
2) the psychophysical efficiency of the organism, the degree of adaptation of the organism to anatomical cavities, disability, and the effects of the disease;
(3) the age and type and extent of the work to be carried out so far by the person concerned on the farm;
4) the possibility of restoring the capacity to work on the farm by treatment and rehabilitation and the provision of orthopaedic objects, prostheses and auxiliary agents.
§ 3. In determining the total incapacity for work on an agricultural holding, circumstances shall be established concerning in particular:
(1) the date or period of establishment of the total incapacity for work on the holding;
2. the durability or foreseeable duration of the total incapacity for work on the holding;
3) indications for rehabilitation of the medical treatment carried out by Kasa;
(4) causation of the total incapacity for work in the agricultural holding with an accident at agricultural or agricultural occupational disease;
5) the inability to live independently.
§ 4. 1. The date of establishment of the total incapacity for work on the holding shall be the date on which the condition of health of the person concerned has deteriorated to the extent that the incapacity for work in the holding is completely incapable of being worked.
2. If the deterioration of the health status has occurred within a certain period of time, the last day of that period shall be taken as the date of the total incapacity for work on the holding.
3. If there is no possibility of establishing neither the date nor the period of establishment of the total incapacity for work on the farm, the date of establishment of the incapacity shall be the date of application of the application for the benefit.
§ 5. 1. Awaiting the total incapacity for work on the farm, it shall be determined whether it is incapacity permanent or periodic, taking into account the prognosis as to the state of health of the person concerned and the possibility of recovering the ability of the person concerned to work in the agricultural holding.
2. Awaiting periodic total incapacity for work on the farm, taking into account the nature and seriousness of the organism's performance, shall be determined at the same time:
1) indication as to the need for rehabilitation in order to regain the ability to work on the farm;
2) the expected duration of this incapacity.
§ 6. 1. If the total incapacity for work on the holding is the result of an accident at work of agricultural or agricultural occupational disease, ruling on the total incapacity for work in the agricultural holding, it shall also rule on the causal relationship with the This is the case or disease.
2. If the detected breach of the fitness of the organism causing total incapacity for work in the agricultural holding also causes an inability to stand alone, it shall rule on the incapacity for self-existence.
3. If the incapacity for self-existence arose as a result of an accident at work of agricultural or agricultural occupational disease, the provision of the paragraph. 2 shall apply mutatis mutandis.
§ 7. 1. If the total incapacity for work on the farm is permanent, it shall be decided on the advisability of professional retraining.
2. The advisability of professional retraining shall be given if the person applying for an agricultural pension for the incapacity of work has permanently lost the capacity to work on the holding and may, after retraining, acquire the capacity to work in the holding of employment in a Member State, non-agricultural profession.
3. The provisions of paragraph 2 shall apply mutatis mutandis to the judgment of the advisability of professional retraining and shall take into account:
1) the qualifications, the profession and the possibility of continuing to do gainful employment;
2) the opinion of a psychologist and a professional adviser.
§ 8. When the doctor is adjudicated, the Kasy doctor or the Kasy medical commission is bound to:
1) by the decision of the state district health inspector, in the scope of the finding of agricultural occupational disease;
2) the findings of the starost on the possibility of professional retraining.
§ 9. On the basis of a decision on a permanent and long-term health injury in relation to the determination of the right to a one-off compensation for an accident at work of agricultural or agricultural occupational disease, as well as the relationship of death of the insured person of the provisions on social insurance in respect of accidents at work and occupational diseases are applied accordingly.
§ 10. 1. Doctors of the Kasa shall pronouncize in matters belonging to the local jurisdiction of one or more of the field premises of the Kasy.
2. The medical committees of the Kasy shall rule on matters belonging to the local jurisdiction of one of the branches of the Regional Forests.
§ 11. 1. The case-law proceedings shall be taken at the request of the competent organisational unit of the Kasy, which shall contain:
1. the name, date of birth and place of residence of the person applying for the social insurance benefit of the farmers, hereinafter referred to as "the person";
2) determining the purpose of issuing the decision and an indication of the circumstances which the doctor's spokesperson or the medical commission of the Kasses are required to establish.
2. The application shall be accompanied by an examination or documentation relating to an accident at work of agricultural or agricultural occupational disease or a health attestation issued by a medical practitioner and an interview.
3. The proper organizational unit of the Kasa shall direct the person for medical examination carried out by the doctor's spokesperson Kasa or the medical commission of the Kasa, indicating the date of the examination.
4. The case-law procedure should be carried out and completed immediately.
§ 12. 1. A doctor's spokesperson or doctor's medical committee shall issue a decision on the basis of a direct examination of the person and the analysis of the documentation possessed with the previous treatment.
2. A doctor's spokesperson or the medical commission of the Kasy may consider the case and issue a judgment without examination of the person, if the possession of the documentation is sufficient to give the ruling, and the state of health of the person prevents her from being personally present on the Test.
3. If the state of health of the person, established by the appropriate medical certificate, prevents the examination, and the completed documentation does not give grounds for consideration of the case in accordance with the mouth. 2, the examination should be carried out by a doctor's spokesperson in the place of residence or other place of permanent or periodic residence of the person.
4. Paragraph Recipe 3 shall apply mutatis mutandis to the examination carried out by one of the members of the Kasy medical commission for its needs. The findings made as a result of this examination shall form the basis for the full formulation of the decision by the medical committee of the Kases.
§ 13. 1. In case of impossibility to issue a decision by a doctor's expert or a doctor's medical commission on the basis of a direct examination of the person and on the basis of the medical records held, the doctor's spokesperson or the medical commission of the Kasy directs a person for additional studies, a specialist consultation, a psychologist's examination or a hospital observation.
2. In the case referred to in paragraph. 1. A doctor who is a spokesperson for the Kasa or the medical commission of the Kasa shall postpone the decision, while establishing:
1) what additional or specialist research should be done;
2) the purpose of carrying out hospital observation.
3. The consultant and the psychologist provide opinions on the basis of a direct examination of the person and the analysis of the medical documentation.
§ 14. 1. In the event of a failure without a reasonable cause of the person for examination by the doctor's spokesperson, or the medical committee of the Kasa, the re-summons for the test shall be provided with a repayable acknowledgement of receipt, at the same time as the person with the effects of the effects failure to report to the test.
2. Failure to re-enter the examination within the prescribed period without a reasonable cause shall result in the cancellation of the case-law proceedings and the reimbursement of the documentation to the appropriate organisational unit of the Kases.
3. The provisions of the paragraph. 1 and 2 shall apply mutatis mutandis to persons headed for additional studies, specialist consultations, a psychologist's examination or hospital observation.
§ 15. 1. From the decision of the doctor, the apprentices to the person shall have the right to appeal to the medical committee of the Kasses within 14 days from the date of service of the discharge from the content of the decision.
2. The appeal of a person shall be provided by the Organisational Unit of the Kasy mentioned in the wording of the decision.
§ 16. 1. The medical committee shall adjudicate in a three-person composition.
2. The Chairman of the Kasy medical commission is appointed by the President of the Kasa.
3. The remaining members of the Kasy medical committee appoints the director of the Regional Branch of the Kasa from among the Doctors ' Experts.
4. The doctor of the appraisal of the Kasa, during the period of the function of the member of the medical commission of the Kases, may not issue decisions in l of the instance.
§ 17. 1. The judgment of the Kasy medical commission is decided by a simple majority of votes.
2. A member of the medical commission of the Kasa, in the case of a different position in the case, may declare in writing his or her own sentence, with the reasons for the statement.
3. A separate Chair of the medical commission of the Kasa shall be annotated on the basis of a statement by a separate chairman.
§ 18. 1. The supervision of the President of the Money for the adjudication of the appraisers of the Kasa and the medical committees of the Kasy shall include direct supervision and supervision of the authority.
2. Direct supervision under the authority of the President of the Tribunal shall be exercised by a regional doctor inspector of the case-law, hereinafter referred to as "the regional doctor".
3. Superintents under the authority of the President of the Money Office shall be exercised by the Chief physician of the Kasses.
§ 19. 1. Supervision referred to in § 18 par. 2, including in particular:
1) control of the decisions of the doctors of the appraisers of the Kasy in terms of substance and formal;
2) an analysis of appeals to the court brought against the decision of the President of the Bank in matters of social security benefit of the farmers, to which the law depends on the decision of the total incapacity for work in the farm or the incapacity for a self-contained existence to determine whether or not new circumstances have been identified in this appeal concerning the total incapacity for work on the farm or the incapacity for independent existence;
3. presentation of a position on the subject of medical practice in cases where judicial review is pending;
4) the transmission of cases for reconsideration in the event of a finding of material violation of the rules of the adjudication by the Doctors Advocates;
5. conducting trainings and instruction of Doctors Advocates in the field of medical case law;
6) an assessment of the qualifications of the case-medical practitioners of the Kasa experts;
7) to give an opinion on the candidature of the doctor's doctor as a member of the Kasy medical commission.
2. Within the framework of the supervision referred to in paragraph 1. 1 point 1, the regional doctor, within 14 days from the date of the decision of the doctor's appraisal of the Kasa, may submit in writing the allegation of malfunction of this decision, while forwarding the case for consideration by the medical committee of the Kases.
3. On the notification of the plea of defect, the decision of the doctor's expert and the transfer of the case for consideration by the medical committee of the Kasy Regional Branch of the Kasy shall inform the person whom the decision is concerned within 7 days.
§ 20. 1. Supervision referred to in § 18 par. 3, including in particular:
1) control of the correctness of application of the rules of medical jurisprudence in Kasie;
2) the analysis and control of the decisions of the doctors of the appraisers of the Kasa and the Kasy medical commission in terms of substance and formal;
3. conducting training in medical case law;
4. the opinion of the candidate for the position of the regional doctor and the chairman of the Kasy medical committee;
5) an assessment of the qualifications of the case-medical examiners of regional doctors and of members of the medical commission of the Kasy.
2. Within the framework of the supervision referred to in paragraph 1. In the case of a declaration of non-compliance with the facts or principles of a medical case, the chief physician of the Kasa may order:
1) supplement the medical documentation by directing the person for examination by the consultant physicians, on auxiliary studies or on hospital observation;
2) the transfer of the case for reconsideration by the doctor's spokesperson, Kasy or the medical committee of the Kasy.
3. A general Kasy doctor may instruct a doctor or a doctor to consider a case regardless of their local jurisdiction.
§ 21. 1. A doctor's medical expert may be a doctor who fulfils the following conditions:
1) is a specialist in particular in the scope of the following specializations: internal diseases, industrial medicine, general medicine, family medicine, rheumatology, general surgery, orthopedic-trauma surgery, rehabilitation, neurology, psychiatry;
2) has the right to pursue the medical profession in the territory of the Republic of Poland
3) have at least 5 years of service in the profession of doctor;
4) has not been punished, including for professional rewinding;
5) has received training within the scope determined by the President of the Money.
2. The regional doctor and the chairman of the medical commission of the Kasa, in addition to the fulfilment of the conditions mentioned in the paragraph. 1, shall have at least 5 years of professional practice in the field of medical case law.
§ 22. The case-law procedure for determining entitlement to social security benefits of farmers is free of charge.
§ 23. The Regulation shall enter into force after 14 days from the date of the announcement.
Minister of Social Policy: w z. C. Miżejewski
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1) The Minister of Social Policy directs the government administration-social security, pursuant to § 1 paragraph. 2 of the Regulation of the Prime Minister of 15 December 2004. on the detailed scope of the action of the Vice President of the Council of Ministers, the Minister of Social Policy (Dz. U. No 265, pos. 2643).
2) Amendments to the text of the single law have been announced in the Dz. U. 1998 r. No. 106, pos. 668 i Nr 117, poz. 756, 1999 Nr 60, poz. 636, of 2000 Nr 45, poz. 531, 2001 Nr 73, pos. 764, 2002 Nr 113, pos. 984, 2003 Nr 45, poz. 391, Nr 228, pos. 2255 and No. 229, pos. 2273 and 2004 Nr 91, pos. 873, Nr 146, poz. 1546 i Nr 236, poz. 2355.
