Treatment expenses for illness and accidents

Treatment expenses for illness and accidents

The most convenient way to file a claim for compensation is through our Web Service. Log in to the Web Service using your banking codes, provided that you have medical expenses or accident insurance granted by Mandatum Life or Kaleva. You can file a claim for compensation even if you are not the owner of the policy under which you are insured. In this case, you will not be able to see the details of the contract in the Web Service, but you can still apply for compensation.

We will begin to process your claim after you have submitted all the necessary documents. The claim for compensation must be filed within one year of when the expenses arose. File a claim for compensation as a private customer even if the policyholder or beneficiary is the company you represent.


Claiming compensation

Always pay the treatment expenses yourself first, and then apply for compensation from Kela, unless the medical facility or pharmacy has already deducted Kela’s share of the compensation for treatment or medication expenses.

Be sure to have on hand all of the receipts and documentation related to the claim, as you will need these when you fill in the claim form. See the required attachments below.

Log in to the Web Service and select Claims matters from the menu at the top. Fill in a new claim form by clicking on New claim under the Earlier claims table. If you wish to apply for a claim extension concerning a prior illness, select the correct claim from the table and then select Claim extension from the summary that opens up below.

Fill in all of the fields and click Continue to save the information on the page. Fill in each of the claim’s pages within 15 minutes to ensure that you do not lose your information. If it takes you longer than that, the information you have entered in the claim form will be cleared for data security reasons.

Send the claim form from the summary page. After you have sent the claim application, you will be informed about whether you need to send any attachments. We recommend that you scan or photograph the attachments and send them to us electronically along with your claim form. Please note that we do not always ask for attachments to be sent. If sending attachments electronically is not possible, you can send them to the postal address stated on the claim form confirmation page.

You will receive a decision on your claim after we have processed your application. The claim decision will appear in the Web Service archive on the next weekday after the application has been processed.

Attachments to the claim form

Treatment expenses for illness and accidents

In accordance with the insurance terms and conditions, medical expenses insurance covers medical expenses that are not compensated by law and which the insured him-/herself must pay in order to receive treatment. First apply for compensation from Kela based on the Finnish Health Insurance Act.

If compensation from Kela has not been applied for within six months from when the expenses were incurred, our company shall have the right to deduct the share of Kela’s compensation that was not applied for from the amount of compensation.

Several private medical service providers apply for compensation from Kela on their customers’ behalf. In this case, Kela’s share of the compensation is deducted directly from your invoice, and you can file an insurance claim with us immediately.

The claim for compensation must be filed within one year of when the expenses arose. Our company is not obligated to compensate expenses that date back more than one year.

Please note that the insurance does not cover physiotherapy and other forms of rehabilitation. Dental care is also not covered, except in the case of a dental injury caused by an accident.

Application for a preliminary decision or a commitment to pay

If you are to undergo a costly examination or procedure, we recommend that you make sure in advance that it is covered by the insurance.

We issue preliminary decisions, i.e., a commitment to compensate, on costly examinations. You can enquire about whether an examination or specific treatment that has been recommended for you is covered by the insurance by calling our claims service, tel. +358 200 31100. In many cases, the claims handler can issue a preliminary decision on whether the expenses will be compensated over the phone. When you receive a preliminary decision, first pay the expenses yourself and then apply for compensation from Kela. Thereafter, you can file a claim for compensation based on your insurance.

You can enquire with our claims service by phone about a commitment to pay for an MRI after you have received a referral from a specialist physician.

We also issue a commitment to pay in the case of costly surgical procedures. The physician’s statement that is drawn up for the commitment to pay must state the reason and need for the procedure, as well as a cost estimate. Once you receive the commitment to pay, the medical facility can directly invoice the insurance company for the costs of the procedure.

Physician’s reports and statements related to requests for a preliminary decision and commitment to pay can be sent to Mandatum directly from the medical facility. You can also send the physician’s account of your treatment, stating the reason and need for the examination or procedure, attached to a message in our Web Service.