Head of Medical Law Practice
Specializes in medical, corporate, and migration law. Has extensive experience working with medical and pharmaceutical businesses, particularly in licensing, circulation of medicines, and comprehensive legal support of healthcare institutions, including corporate, tax, and employment matters, as well as market entry projects of foreign companies into Ukraine.
Case: Helped a Patient Undergo Expert Team Assessment After Doctors Refused to Issue an Electronic Referral and Obtain a Disability Group
Establishing disability status through Expert Team Assessment when doctors refuse to issue a referral: a real case handled by medical lawyers.
The procedure for assessing a person’s daily functioning requires strict compliance with the algorithms approved by Ministry of Health Order No. 1448. The legislation provides for five mandatory stages of the assessment process, the first of which is the creation of an electronic referral by the attending physician in the healthcare system. In practice, however, digitalisation often runs into the human factor: patients face outright obstruction and bureaucratic excuses at the primary healthcare level.
The problem: a bureaucratic barrier at the referral stage
A client with serious health problems approached the medical law practice of Prikhodko & Partners and required comprehensive assistance with establishing disability status. The main obstacle was the categorical refusal of both the family doctor and the attending physician to issue a referral for Expert Team Assessment.
The doctors’ explanations sounded almost mocking: one doctor stated that they did not have access to the electronic referral system, while another referred to a lack of time to scan all of the client’s medical documentation. Without an electronic referral, which must contain an extract from the medical record (Form No. 027/o), a set of specialist conclusions and medical examination results, the patient is completely prevented from having the case considered by the Expert Team.
Expert solution and our team’s course of action
To resolve the bureaucratic deadlock and secure the result, our medical lawyers applied a comprehensive approach based on the current methodological recommendations of the Ministry of Health.
Professional analysis of medical documents
All available discharge summaries and examination results were reviewed in detail by a medical lawyer and a specialised medical professional from our company. It was important for us to ensure that the medical information made it possible to identify the person, confirm the state of health and objectively assess the existing functional impairments and limitations in daily activities.
Assessment of the prospects of obtaining disability status
We provided the client with a substantiated opinion on the likelihood of disability status being established. The assessment was based on how the illness affected the performance of everyday tasks, including the ability to move, perform self-care, work and orient themselves.
Recommendations for additional examinations
In accordance with Resolution No. 1338, the Ministry of Health Guidance and unified Ministry of Health protocols applicable to the identified conditions, additional examinations are prescribed only where they are necessary, proportionate and properly justified. We prepared a comprehensive list of tests and instrumental examinations aimed specifically at confirming impaired daily functioning, while avoiding unnecessary general clinical tests. This significantly strengthened the client’s position.
A clear algorithm and overcoming the doctors’ refusal
The client received a step-by-step plan for preparing and submitting the documents. Since issuing an electronic referral falls exclusively within the competence of the attending physician, we overcame the lack of competence of the client’s doctors by involving a specialist who had access to the electronic system and was competent to issue the referral. The doctor promptly scanned the entire medical file and, with the support of the medical lawyer, created the electronic referral in the system, fully resolving the issue of document submission.
Legal support during Expert Team Assessment
The legislation clearly provides that, during the assessment, a person may be accompanied by an authorised representative if the relevant application has been submitted. Our lawyer ensured personal attendance during the Expert Team assessment. This ensured compliance with the procedure during the interview and clinical examination of the person, as well as the accurate recording of the responses in the case review protocol by all members of the Expert Team.
Outcome of the case
Thanks to strict control of the process, a properly prepared evidentiary basis and direct representation of the client’s interests during the meeting, the client successfully underwent the assessment and obtained the legally established disability group. Our team was also prepared to promptly appeal the Expert Team decision, but the thorough preparation made this unnecessary.
Independent attempts to obtain a referral for Expert Team Assessment often result in wasted time because of local bureaucracy. If your doctors refuse to prepare the documents or disregard your legal rights, legal support for Expert Team Assessment from Prikhodko & Partners can help avoid common mistakes, properly assess the prospects of the case and significantly improve the chances of obtaining the required status promptly.
Have you been refused a referral for Expert Team Assessment or are the documents being delayed? The medical lawyers at Prikhodko & Partners will audit your medical documentation, prepare a course of action and provide legal support throughout the assessment process.
Юридичні послуги для медичного бізнесу та лікарів
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