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 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. File a claim for compensation as a private customer even if the policyholder or beneficiary is the company you represent.

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. More information on claiming a life insurance benefit is available here.

Claiming compensation

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 fields of the claim form. If you are submitting a follow-up claim to a previous claim, check the contact information and bank details and update them if necessary. 

Send the claim form from the summary page. After you have sent the claim application, you will be informed about whether any attachments are needed. 

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


Required attachments

When you claim expenses for the treatment of an illness or accident, attach the related medical expense receipts (e.g. doctors’ fee receipts, payment receipts related to examination expenses and receipts from health clinics or outpatient clinics).

For any medications, be sure to attach the receipt from the pharmacy and a copy of the prescription. 

When claiming compensation for an accident, accounts of the treatment and possible physician’s statements concerning the injuries are usually also required.

We recommend that you always send the required attachments electronically. If you cannot send them electronically, mail the attachments to the address:

Mandatum Life

Internetkorvaukset

Info 9

Tunnus 5012429

00003 VASTAUSLÄHETYS

Kaleva

Internetkorvaukset

Info 9

Tunnus 5018083

00003 VASTAUSLÄHETYS


Treatment expenses for illness and accidents

Medical expenses insurance covers, to the extent stated in the insurance terms and conditions, the medical expenses that are not compensated under another act and which the insured must pay themself 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, e.g. physiotherapy and other forms of rehabilitation. Dental care is also not covered, except in the case of a dental injury caused by an accident.

Making a claim for a commitment to pay or a preliminary decision

We also grant commitments to pay for more costly examinations and procedures. Usually, the healthcare facility will send the physician’s request for a commitment to pay related to the examination or procedure directly to Mandatum. You can also send us the physician’s account of the treatment yourself as an attachment to a message in the Web Service. 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 healthcare facility will directly invoice the insurance company for the costs of the examination or procedure. 

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 or procedures. 

You can enquire about whether an examination or specific treatment that has been recommended for you is covered by the insurance from our claims service at the number 0200 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.