The occupational injury case from A to Z - a two-track system

If you have suffered an injury or contracted an illness in connection with your profession or occupation, this is referred to as an occupational injury or illness. Obtaining compensation for an occupational injury/illness can be a challenging process for the person concerned. In addition, occupational injury insurance companies require the injured party to exhaust all occupational injury rights under the National Insurance Act. We therefore say that occupational injury cases follow a two-track system. Below, I will explain the process of an occupational injury case from start to finish.

The first thing you should do when you are involved in an accident at work or realise that an illness has occurred as a result of, for example, exposure to gases, solvents, paint or similar in the workplace, is to report the matter to your employer's occupational injury insurance company and NAV. Normally, the employer will report the injury to the occupational injury insurance company and NAV, but if the employer neglects this duty, the injured party can report the injury themselves. It is important that the claim forms are completed as early and in as much detail as possible. In most cases, the insurance case and the NAV case will then proceed in parallel.

The reason why it is important to report the occupational injury/illness to NAV, in addition to the occupational injury insurance company, is that an approved occupational injury/illness gives extended rights under Chapter 13 of the National Insurance Act. Examples of the extended occupational injury rights are

• By presenting a decision approving an occupational injury/illness to a medical practitioner with an operating subsidy, you do not have to pay a deductible for exemption cards 1 and 2. You will also be reimbursed for medication and travel expenses due to the occupational injury.
• If the injury has resulted in a permanent disability of 15 % or more, you will be entitled to disability compensation from NAV.
• If the injury/illness leads to incapacity for work, you can apply for disability benefit for a degree of incapacity down to 30 %. By way of comparison, under the normal rules, you must have a degree of disability of at least 50 % in order to receive social security benefits.
• The National Insurance Act requires persons applying for disability benefit to have lived in Norway for the last three years before the date of disability. If you have an approved occupational injury from NAV, the part of the disability resulting from the injury/illness will still trigger the right to disability benefit, even if the residence requirement is not met. Note that membership of other countries' social security schemes before moving to Norway may still mean that the residence requirement is met.
• In addition, there are calculation rules that may result in more favourable calculation of disability benefits for people with approved occupational injuries compared to people without approved occupational injuries.

Although social security benefits in occupational injury cases are somewhat more favourable than under the normal rules, many injured parties will still experience a loss of income. The excess can be claimed from the employer's occupational injury insurance company.

Common to all compensation cases is that the occupational injury insurance company needs to map out what happened and what personal injuries the workplace accident has caused. At an early stage in the case, the insurance company will therefore ask the injured party to complete a basic authorisation form, which allows the company to obtain limited information from relevant bodies such as the police, labour inspectorate, emergency services, hospital, GP, NAV, etc.

If the injured party reports to the insurance company that the consequences of the injury persist, and this is confirmed by the information obtained, the insurance company will normally request an extended authorisation in order to map the liability in more detail. With the extended authorisation, the insurance company can obtain unedited medical records from the relevant treatment centres for the time before and after the work accident. What the occupational injury insurance company wants to clarify at this point is whether the injured party's ailments arose immediately after the accident or whether the ailments are a continuation of previous health problems.

When two years have passed since the workplace accident and the injured party is still suffering from the occupational injury, there is a high probability that the symptoms will persist and become chronic. At this point, most personal injuries have stabilised and it is time to determine the severity of the injury.

The occupational injury insurance company will therefore take the initiative to obtain a specialist's report. The specialist will conduct a personal examination and interview with the injured party, as well as review the documentation obtained in order to assess the causal relationship between the occupational accident and the injury, and determine the permanent injury-related medical disability based on the Ministry of Social Affairs and Health's disability table. The disability table specifies the physical and psychological consequences of the injury, and the medical disability is determined as a percentage on an objective basis without regard to the injured party's occupation, reduced ability to engage in gainful employment, leisure interests and the like.

The specialist's statement will largely form the basis for the handling of the rest of the personal injury case, including the calculation of the actual compensation amount.

If the specialist concludes that there is a causal link between the work accident and the injury, and that permanent injury-related medical disability amounts to at least 15 %, it is important that the injured party submits a claim for additional compensation from NAV if this has not already been done. Additional compensation is compensation for loss of enjoyment of life and must be claimed from both NAV and the responsible occupational injury insurance company.

In connection with an application for workers' compensation from NAV, NAV may decide that a separate specialist report must be obtained in the social security case. Section 21-3 of the National Insurance Act states that NAV must take the injured party's wishes into account when choosing an expert, so that the injured party can help to influence the choice of specialist. Although the specialist statement is intended for use in the NAV case, it will also be an important document in the negotiations with the occupational injury insurance company.

As NAV and insurance companies follow two different systems, NAV will make its own assessments when applying for disability compensation, determining the degree of disability and which income should form the basis for calculating social security benefits. On the other hand, we often find that insurance companies do not comply with NAV's decisions. The Supreme Court has also ruled that insurance companies are not bound by social security decisions.

The further proceedings in the insurance case consist of obtaining information to determine the size of the damage-related financial loss. The relevant compensation items that must be substantiated are as follows:

• Revenue loss incurred
• Basic compensation covering future loss of income, loss of pension and future loss of home ownership
• Recognised home acquisition loss
• Incurred and future additional expenses
• Compensation for loss of enjoyment of life (Ménerstatning)

In the event of very serious injuries, compensation may also be claimed for socio-medical measures and additional expenses for housing adaptation.

If the injured party has become fully or partially disabled as a result of the occupational injury and has been granted disability benefit by NAV, it is important to investigate whether NAV has assessed whether the disability is due to the recognised occupational injury. This is normally stated in the disability benefit decision, which specifies that a certain number of per cent of the disability is due to an approved occupational injury. This is referred to as disability benefit with an occupational injury benefit.

If a disagreement arises between the injured party and the insurance company about the settlement, it may be wise to be assisted by a lawyer who is familiar with the rules in the National Insurance Act and the Occupational Injuries Insurance Act. In this regard, it is also important to note that legal assistance is covered by the employer's occupational injury insurance company. In our experience, it is easier to reach an amicable solution with the insurance company if the injured party has received legal assistance from an early stage in the case.

It is important to realise that such compensation cases can take a long time, often several years. This is because the body has to heal, the injured party has to undergo rehabilitation and hopefully return to work. This must be clarified before a personal injury case can be finalised.