Case: Establishing disability status after a road traffic accident — a victory over the system

In this article, we examine a case from the fields of medical law and state bureaucracy. It is a story about how legal protection works when the medical system attempts to minimise a patient’s problem. In medical law, the absence of a single examination or one missing figure in test results can often determine a person’s fate.

This material is an in-depth expert analysis for those who value the highest standard of service. We will demonstrate how strategy, digitalisation and strict process control can deliver a result that initially appeared impossible.

In June of this year, a tragedy occurred. Our client was involved in a serious road traffic accident (RTA), as a result of which he sustained multiple injuries. The most severe consequence was the loss of an organ — due to vital medical indications, doctors performed a nephrectomy (removal of one kidney).

After his condition stabilised and he was discharged from hospital, the client encountered a new bureaucratic reality. Doctors at the outpatient clinic categorically refused to issue a referral for an expert team assessment. Their argument sounded like a sentence reinforced by medical terminology: “You were not continuously on sick leave for more than 120 days. Since the second kidney has assumed a compensatory function, the limitations in daily functioning are mild. There are no grounds for establishing disability status.”

For a person who had just lost an organ, this sounded absurd. It was with this sense of hopelessness that the client approached our medical law practice at Prikhodko & Partners.

Legal support in our company does not begin with drafting complaints. It begins with deep, almost clinical analysis.

After receiving the case materials, our team transferred them into a digital environment. Medical documents and data are anonymised, and a specialised medical professional is involved who has experience participating in expert team assessments and understands the nuances of the procedure and Ministry of Health requirements.

We manage all ongoing cases in a secure environment, which allows us to involve relevant experts and control every stage without losing a single detail. The legal services agreement was signed remotely through the Vchasno service — we value our clients’ time and eliminate the need for unnecessary office visits.

What did our professional analysis of the medical documents reveal?

Our medical lawyer, together with an engaged nephrologist, reviewed the hospital discharge summary (Form 027/o), ultrasound results and biochemical blood and urine tests. The doctors’ main mistake was their formalistic approach. They relied on the general rule of 120 days of temporary incapacity for work while ignoring the irreversible anatomical defect and the patient’s actual functional condition.

The key marker in this case was GFR — glomerular filtration rate. This indicator demonstrates how effectively the kidneys, or the single remaining kidney, filter the blood. The doctors failed to notice that our client’s GFR had started to decline rapidly, indicating the development of chronic kidney disease (CKD).

We developed a clear protection algorithm for the client:

1. Professional analysis of medical documents

We do not simply read discharge summaries — we look for legal leverage within them. The documents were thoroughly analysed by a medical lawyer and a specialised medical professional with many years of experience supporting cases involving the establishment of disability status, including after road traffic accidents. We identified discrepancies between the patient’s objective condition and the doctors’ conclusions.

2. Assessment of the prospects of obtaining disability status

There is no place for false hope in this area of legal services. We provided the client with a clear and substantiated conclusion. Given the loss of an organ and the decline in GFR to a level corresponding to Stage 3 CKD, the likelihood of obtaining disability status was high. We demonstrated that the limitations in daily functioning were not “mild”, as the doctors claimed, but moderate, which constituted direct grounds for referral to the expert team and obtaining a disability group.

3. Recommendations for additional examinations (Strengthening the position)

You do not attend an expert team assessment empty-handed. Based on our analysis, we prepared a comprehensive list of required additional examinations. We referred the client for specific laboratory panels (creatinine monitoring over time, 24-hour proteinuria) to document that the single remaining kidney was operating at the limit of its capacity and required continuous medical and dietary management.

4. A clear algorithm for obtaining disability status

We developed a step-by-step roadmap for the client, which included:

• a comprehensive list of medical and legal documents;
• the procedure for their preparation and requirements for medical discharge summaries and conclusions (signatures, seals, stamps, dates, a detailed description of the condition and the indicators on which the diagnosis was based);
• a strategy for behaviour and communication with doctors at each stage of the medical assessment process.

Phase 2: Meticulous work with documents

With the results of new examinations in hand, which conclusively documented moderate impairment of the excretory system, we moved to the active phase — interaction with primary healthcare.

We contacted the family doctor. This time, it was not simply a conversation between a frightened patient and an indifferent professional. It was a legally structured dialogue supported by a package of perfectly prepared documents. We made the system operate according to the rules.

We paid particular attention to the referral for the expert team assessment — the assessment of temporary incapacity for work and persistent impairment of bodily functions). This is the document on which 90% of the expert team’s decision depends. If it is completed carelessly, a refusal is likely.

What we monitored when the referral was completed:

1. “Medical history” section: We insisted that the referral clearly describe the causal link between the road traffic accident in June, the emergency nephrectomy and the client’s current condition. No vague wording.
2. “Clinical diagnosis” section: The principal diagnosis had to be formulated exclusively in accordance with ICD-10, specifying the stage and degree of functional impairment. We ensured that the doctor entered not merely “Condition after nephrectomy”, but “Stage III chronic kidney disease, moderate impairment of the excretory function of the single remaining kidney”.
3. “Results of additional examination methods” section: We ensured that the GFR calculation results and specific test indicators that we had initiated during the additional examination stage were entered here. These figures became our main protective evidence.
4. “Daily functioning status” section: We ensured that the appropriate degree of limitation in self-care and ability to work was specifically documented.

Expert support during the expert team assessment (Personal attendance of a medical lawyer at the assessment)

The biggest mistake patients make is attending the assessment alone. Imagine performing a complex injection protocol without an assistant or adequate lighting. The risk of a critical error increases dramatically.

As the head of the medical law practice, I always emphasise that a medical lawyer should be beside the client at the moment the decision is made. We immediately involved our medical lawyer in the process, who officially accompanied the client during the expert team assessment.

Why did this become a decisive factor?

Psychological barrier. The presence of a lawyer immediately changes the tone of communication among the members of the expert team. Arrogance and formalism are replaced by respect for the law.

Protection of the client’s position. When one of the expert team members attempted to return to the argument about the “compensatory function of the second kidney”, our lawyer immediately referred to Resolution No. 1338, the Ministry of Health Unified Protocols, the GFR indicators and the current Ministry of Health instructions regarding the establishment of disability groups in cases involving anatomical defects.

Control of the record. We ensured that all of the client’s complaints were entered into the meeting record, preventing any subsequent manipulation of the documents.

Result: a victory confirmed by law

Thanks to an impeccably prepared evidence base, the proper completion of the referral and legal protection directly during the assessment, the decision was made in our client’s favour. He was granted Group III disability status for one year. In one year, we will raise the issue of extending the disability status, and if his condition worsens, changing it to Group II disability status.

The client received not only social protection and state pension benefits, but also a strong evidence base for a subsequent civil claim against the person responsible for the road traffic accident for compensation of material damage and compensation for moral damage.

A medical lawyer in Kyiv or any other region is not a luxury; it is a necessary tool for navigating complex bureaucratic systems. A positive result requires in-depth knowledge and depends on expertise, the right strategy and uncompromising protection.

If you or your loved ones need to appeal an expert team decision, or if you are being unjustifiably denied the exercise of your rights to healthcare and social protection, do not try to overcome the system on your own. Entrust this complex work to professionals who understand the anatomy of the law in depth.

After a road traffic accident, are you being refused a referral for an expert team assessment or the establishment of a disability group? Contact the medical lawyers at Prikhodko & Partners for document analysis, assessment of prospects and legal support.