Decree of the Ministry of Health, the State Social Security Office and the Central Council of Unions No. 8 / 1962 Coll.
Ordinance of the Ministry of Health, the State Social Security Office and the Central Council of Trade Unions on the joint application of claims for reimbursement of medical care, sickness and pension benefits and decisions on them (Regression Refund Order)
Valid
Effective from 01.02.1962
8
DECLARATION
Ministry of Health, State Social Security and Central Council of Trade Unions
of 9 January 1962
providing for the joint application and decision-making of claims for medical care, sickness and pension benefits (Regression Refund Order)
The Ministry of Health, the State Social Security Office and the Central Council of Trade Unions, in agreement with the Ministry of Finance, Transport and Communications, other participating central authorities and the Central Union of Production Cooperatives, provide, pursuant to Article 23 (1) of Act No. 150 / 1961 Coll., on compensation for accidents and occupational diseases (hereinafter referred to as "the Act ') and the principles approved by the Government Resolution of 24 November 1961:
General provisions
In order to improve care for safety and health at work, safety in transport and to respect the rules of socialist coexistence and to combat accidents and occupational diseases in a consistent, consistent and effective manner, the application of reimbursement of medical care costs, sickness insurance benefits and pension benefits arising from accidents or occupational diseases, as well as decisions on such compensation, shall be harmonised.
The joint application of claims for reimbursement of medical care costs and sickness and pension benefits pursuant to § 17 to 19 of the Act ("regression entitlements') is entrusted to national health institutions (Section 2).
The regression claims are decided by the district national committees (section 3).
Reporting, detection and application of regression entitlements
(1) The basis for the detection and application of regression claims shall be the reports submitted in accordance with the provisions of other paragraphs on damage to health or death resulting from accidents at work and non-occupational or occupational diseases (hereinafter referred to as "accidents').
(2) Health care institutions report accidents to citizens who have been admitted to treatment due to an accident and report the cause of the injury (as a rule, according to the findings of the treated citizen).
(3) The racing (local) committees of the basic organisations of the Revolutionary Trade Union Movement, and, where appropriate, their authorised Commission for Safety and Health at Work, as well as the racing confidants, report on all accidents which were the reason for providing a certain sickness insurance benefit on the holding. In the report, the trade unions shall indicate the causes and circumstances in which the injury occurred and who they consider responsible for the injury; if there is an accident at work or an occupational disease, they shall indicate in particular whether they have occurred by failing to comply with the obligations arising from the rules on safety and health at work or by mandatory instructions of the undertaking concerned by the national professional supervision or health and safety authorities at work. The trade union authorities shall also state in the report whether they recommend the application of the regression entitlement.
(4) The report on accidents which were the reason for the provision of certain sickness insurance benefits in the production cooperative is submitted by the Board of Directors of the Production Co-operative and, where appropriate, by its Board of Workers. The provisions of the preceding paragraph shall apply mutatis mutandis to them.
(5) The higher trade unions and labour security inspectors shall report on accidents at work and occupational diseases in which they are involved in the investigation and shall also analyse the causes of the injury identified. This also applies to other authorities involved in the investigation of accidents and the identification of their causes (for district mining authorities, for the Institute of Technical Supervision and its Inspectorate, for district and local national committees as regards accidents in single agricultural cooperatives, etc.).
(6) The public security authorities report the accidents investigated. indicate in particular a brief description of the accident and the most important circumstances necessary for the exercise of the regression entitlement.
(7) The reports referred to in the preceding paragraphs shall be made by the authorities by means of a compulsory declaration without undue delay to the district national health institute in which the accident occurred or to another national health institution responsible for applying the regression claim (§ 6).
(1) Health care establishments shall report to the National Health Institute responsible for applying regression entitlements, in addition to the data referred to in Section 4, the data needed to calculate the costs of treatment immediately after the end of treatment. The sickness insurance authorities and, where applicable, sickness insurance (Revolutionary Trade Union Movement, Cooperative Production and National Committees) report the amount of sickness insurance benefits paid as such immediately after the payment and social security authorities have completed the amount of pension benefits granted immediately after the legal authority has given the decision to grant them.
(2) The authorities referred to in paragraph 1 are also required to report without delay any change to the reported facts, in particular for pension benefits of any final increase, reduction or cessation of payment of benefits; However, social security authorities do not have this obligation if the regression entitlement for pension benefits has been settled at capital value.
(1) The regression entitlement is exercised, unless otherwise provided for in the other paragraphs, by the County Institute of National Health, in whose territory there has been an accident which is the reason for the regression entitlement.
(2) Instead of the national health district institution referred to in paragraph 1, it exercises a regression claim
(a) a district national health institution in which basic treatment has been concentrated, provided that the institution referred to in paragraph 1 has provided only first aid;
(b) a county national health institution in which most of the injured were admitted to treatment during a mass accident, for all such injuries;
(c) a national health racing institute, where it has been entrusted with the application of regression entitlements by the director of its competent national health district institution, to the extent that such authorisation is required.
(3) If there is a regression claim which the Institute of National Health should apply against itself, or if there is a regression claim against the District National Committee whose establishment is the National Health Institute, the Regional National Committee shall entrust another National Health Institute to the application of such regression claim.
(4) The Regional National Committee or, where appropriate, the Ministry of Health may exceptionally entrust the application of regression entitlements to national health institutes which would not be competent under the previous paragraphs if there are particular serious reasons.
(1) The Institute of National Health is preparing documents for decisions on regression claims. It shall ensure that the facts are established as precisely and fully as possible.
(2) In order to establish the facts, the Institute of National Health is entitled to require organisations and citizens to communicate the necessary data, to conduct investigations in organisations and elsewhere, and to request expert observations.
(1) Once the facts and other necessary supporting documents have been established, the Institute of National Health shall notify the organisation or the citizen responsible for the regression claim of the reason and the amount of the refund requested and shall invite them to pay up to a certain time limit or, where appropriate, to acknowledge the regression claim in writing, both in due cause and amount, or to comment on the request and its supporting documents within that period.
(2) If the organisation or citizen has not paid or, where appropriate, has not recognised in writing in respect of the amount of the commitment to the regression refund, fails to comply with the recognised obligation or requests a reduction or remission of compensation, the Institute of National Health shall apply the regression claim to the determining authority (§ 11).
(3) The Institute of National Health may itself, without application to the determining authority:
(a) postpone cases which, according to the reports or results of the investigation, appear not to constitute a regression claim;
(b) to authorise, at the request of a citizen who has recognised in writing, a commitment to a regression refund in both due and above, appropriate instalments, but not for more than three years; where a citizen requests authorisation for extended instalments, the national health institution shall refer the matter to the determining authority for the decision on the regression entitlement and the instalments.
(4) The Institute of National Health keeps records of regression entitlements according to the reports and management results received; it also includes the safekeeping of reports and supporting documents to allow for proper check of postulated cases.
Deciding on regression claims
(1) The Regional National Committees set up regression commissions as a closer commission in their medical committees to decide on regression claims. If the scope of decision-making on regression claims so requires, the district national committee shall set up more regression committees in the necessary number.
(2) The Regression Commission, in cooperation with the other authorities and components of the District National Committee and in cooperation with the Regional Trade Council, also monitors the development of accidents in the district and discuss the removal of deficiencies in safety and health protection identified in decisions on regression claims. On the basis of experience gained, they shall submit proposals and suggestions to the Health Commission of the District National Committee to improve the state of health and safety at work and in transport safety and report on their activities.
(1) The President of the Regression Commission shall be the Member of the District National Committee - a member of the Health Commission. Other members of the regression committee are representatives of the Revolutionary Trade Union Movement, representatives of the State Health Administration, representatives of social security and representatives of the State Financial Administration.
(2) The President and the other members of the regression committee and their alternates are elected by the Regional National Committee. He shall ensure that, if possible, a Member who is a member of the Revolutionary Trade Union Movement is elected chairman. A representative of the Revolutionary Trade Union Movement in the Commission is elected on a proposal from the District Union Council.
(3) The Regression Commission is competent to act and decide if the President is present, a representative of the Revolutionary Trade Union Movement and one of the other members (s) of the Commission.
(4) Where more than one regression panel is set up, its members (alternates) may be recruited to act and decide in any regression committee in such a way as to represent all the components referred to in paragraph 1. All regression commissions in the district may also be convened for joint meetings to discuss the tasks referred to in Article 9 (2), a single procedure and other fundamental issues.
(5) Where a regression claim from an accident at work or an occupational disease is decided, the regression committee may also invite representatives of the Revolutionary Trade Union Movement, or of the production cooperative, from the manufacturing (work) sector of the organisation in which the accident occurred.
(1) The Regression Committee shall decide:
(a) on the regression claims made by the Institute of National Health or on which the Regression Committee has initiated and approved own-initiative proceedings; decide whether or not the refund to be applied is to be reduced or remitted (Sections 13 and 14) or, if necessary, allow an appropriate instalment to be paid;
(b) the reduction or remission of the regression refunds already definitively granted.
(2) The Regional National Committee may entrust the Health Department to take decisions in place of the Regression Commission if:
(a) minor regression entitlements (generally up to 500 CZK);
(b) the regression claims already recognised in writing in both reason and above;
(c) the regression claims which have already been definitively decided on in due course (§ 16).
(3) The financial department of the District National Committee for which the regression entitlement is charged shall decide on the additional authorisation of the reimbursement payments already granted in a final manner.
(4) The local competent authority of the district national committee in whose territory the national health institution is responsible for the application of the regression claim (§ 6) is responsible for the negotiation and decision-making.
The parties to the regression claim proceedings shall be the National Health Institute responsible for the application of the regression claim and the organisation or citizen against whom the regression claim is applied.
If the organisation is responsible for an accident, the full amount of the regression entitlement shall be admitted. Reimbursement may be reduced only exceptionally if special circumstances of particular concern speak for it.
(1) If a citizen is responsible for an accident which has been committed intentionally or in intoxication or is responsible for an accident under the rules on liability for the use of means of transport, a full regression claim shall be granted which is legally due.
(2) If the case is not referred to in paragraph 1, the amount of compensation which a citizen is obliged to pay from one regression case shall be determined so that it does not exceed CZK 10,000. In determining the amount of the compensation, account shall be taken of the actual cost of medical care and of sickness and pension benefits, the social importance of the case and the proportion of the citizen responsible, in particular his / her relationship with work and social property, his / her personal characteristics and economic circumstances, and any other obligations which he / she may have incurred for the same reason for other beneficiaries; ensure that the amount of compensation is proportionate to the level of responsibility of the citizen and that the educational purpose of the regression claim is maintained.
(3) A regression claim against a citizen may be reduced or waived if the citizen's obligation to be replaced, with its consequences, also affects the person affected by an accident (e.g. a regression claim against a family member who has caused an injury to his family); the regression entitlements referred to in paragraph 1 may, for other reasons, be reduced only exceptionally, provided that special circumstances of particular concern so require.
(1) The Board of Health of the District National Committee decides on appeals against decisions on regression claims. The District National Committee may entrust the Regression Commission to decide on appeals against decisions of the Health Department of the District National Committee issued pursuant to Paragraph 11 (2).
(2) If the decision on the regression entitlement requires a specific expert assessment and if the matter has not been sufficiently illuminated in this respect in the present proceedings, the appeal authority shall obtain the expert opinion of the national higher-level committee or other body (e.g. on safety and health matters at work, the opinion of the occupational safety authorities, the technical supervision bodies or the sanitary and anti-epidemic services authorities, the transport statements of the public safety authorities).
If the Regression Commission has decided on a part of the regression claim and if the decision on it is already final, that decision shall also be binding on the decision on the other parts of it resulting from the same legal ground.
(1) The organisation which has been recognised as being obliged to pay the regression claim shall also be ordered to pay the costs incurred in carrying out the evidence and the costs required to apply the regression claims effectively. If the organisation has had a partial success with its objections and if it is not only a minor success, only a proportion of these costs will be paid.
(2) A citizen who has been recognised as being obliged to repay a regression claim shall be ordered to pay the costs referred to in paragraph 1 at an appropriate rate, where the costs are due to him or to the case referred to in Article 14 (1).
The authorities deciding on the regression entitlement may, before or during the proceedings, take the necessary measures to ensure the purpose of the proceedings, in particular to ensure that the matters which are needed to carry out the proof are ensured.
Provisions common, transitional and final
(1) The rates of reimbursement of medical costs for regression purposes are laid down:
(a) for outpatient care, the amount of 5 CZK for each day of incapacity for work (days of constitutional or spa care are deducted). In outpatient care without connection to incapacity, 20 Ccs are counted for each practice or visit. In addition, in dental care, the price of free precious metal is calculated for the prosthetic work of precious metal, unless it has been paid by a treated citizen;
(b) for institutional care (except spa care), 60 CZK for each treatment day, without account being taken of the type of medical establishment in which such care was provided;
(c) for spa care in constitutional treatment according to fixed prices of therapeutic stays, otherwise determined prices of therapeutic performances provided in spa organisations;
(d) for the transport of a sick or medical worker to a sick ambulance vehicle by an amount of 2 CZK for each kilometre travelled; for a distance of less than 6 km, a uniform amount of 13 CZK.
(2) The rates referred to in paragraph 1 shall include the replacement of all routine and special operations as well as of all medicines and routine orthopaedic devices provided either directly or on the basis of a prescription. For medical and orthopaedic devices which are not common (e.g. limb prostheses, sick carts) as well as for other services, in particular physical treatment and other outside-office operations, compensation shall be calculated according to the relevant price lists or tariffs, or at the level of the contribution actually granted. The transport costs of patients with means of transport other than sanitary vehicles shall be reimbursed at the rate of the amounts actually paid.
Regression entitlements granted by decision or approved conciliation and regression entitlements recognised in accordance with § 8 shall be charged by the financial departments of the relevant county national committees (§ 11 (4)); decisions and reconciliation shall also be exercised. If the regression claim is not only recognised, the matter of the National Health Institute shall be referred to the determining authority.
Compensation from the regression entitlements shall be paid on behalf of the relevant county national committees at the Czechoslovak State Bank; are the direct income of the district national committees and are charged to the chapter "General Treasury Administration '.
Where the procedure for regression claims in this decree is not regulated by derogation, they shall be governed by general rules on administrative proceedings before national committees.
The application of regression claims is managed and methodically managed by the Ministry of Health in cooperation with the State Social Security Office and the Central Council of Trade Unions.
The authorities still have jurisdiction in the application and enforcement of regression claims before 1 February 1962. They shall also complete the investigation into the regression claims of accidents reported to them before 1 February 1962 and invite the responsible organisation or citizen to pay the compensation; cases in which the responsible organisation or citizen fails to pay the required compensation within the prescribed time limit or does not recognise in writing what is due and above, or fails to fulfil the recognised obligation, they shall surrender to the competent national health institute for management under the third section.
This decree does not apply to regression claims under Act No. 32 / 1957 Coll., on sickness care in the armed forces, and under Act No. 33 / 1957 Coll., on social measures of members of the armed forces, applied by the authorities and institutions of the Ministry of National Defence and the Ministry of Interior.
The provisions which allow for simplified discussion and settlement of regression claims against persons insured with the State Insurance Company in the event of liability are without prejudice. *)
This decree shall take effect on 1 February 1962.
Minister for Health:
Plojhar v. r.
Chairman of the State Social Security Office:
Erban v. r.
Chairman of the Central Council of Trade Unions:
Zupka v. r.
*) Government order of 9 March 1960 No 201 / 1960.
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Regulation Information
| Citation | Decree of the Ministry of Health, the State Social Security Office and the Central Council of Trade Unions No. 8 / 1962 Coll., which regulates the joint application of claims for reimbursement of medical care costs, sickness and pension benefits (Decree on Regression Refunds) |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.01.1962 |
|---|---|
| Effective from | 01.02.1962 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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