News

15 November 2022

Ombudsman Diana Kovacheva sent an opinion to the chairmen of the parliamentary committees on labour, social and demographic policy, Georgi Gyokov, and on health care, Assoc. Prof. Dr. Anton Tonev, as well as to the line caretaker ministers Lazar Lazarov and Dr. Asen Medzhidiev, in which she presented again the unresolved problems of medical expertise for years.

 “The Ombudsman’s opinion, which was asserted more than once, is that the lack of adequate and timely reform action leads to violation of the rights of thousands of people with disabilities and their families. In view of the current debate on the subject and the need for urgent and appropriate measures to overcome the existing deficits of the system, I would like to emphasize the problems identified by the institution in handling individual  complaints”, wrote the Ombudsman.

The public defender emphasizes that in most cases the prescribed deadlines for scheduling dates by the Territorial Expert Medical Commissions (TEMCs) and the National Expert Medical Commission (NEMC) are not observed. Moreover, the delays in a significant number of cases are drastic, amounting to up to a year from the submission of the documents. 

“The statutory three-month period for the TEMCs and the NEMC to issue a decision from the date of receipt of the medical documents, in the absence of adequate financial support during this period for disabled persons, is also too long and is a precondition for infringing the rights of citizens who, until the expert's decision is issued, are deprived of the opportunity to exercise their rights as disabled persons", emphasises Diana Kovacheva.

She points out that the medical examination authorities are not looking for options to inform the citizens who have to appear for a re-examination before the expiration of their current medical expert decision in an appropriate timeframe so as to prevent interruption.

“It is clear from the complaints and reports received that citizens are only notified after the expiry of their permanently reduced working capacity/type and extent of disability and many still submit documents for re-certification. Thus, they should wait at least 3 months, and in most cases even longer, for a date to be set”, the Ombudsman states.

Prof. Kovacheva points to the fact that currently there is a serious problem with the expired expert medical decisions after 30 June 2022, which have not been officially extended. Thus people with disabilities are practically left without funds for the period until a new expert medical decision is issued.

The Ombudsman recalls her recommendation a month ago, in which she stressed that despite the adopted amendments to the regulations on medical expertise, the problem of staff shortage in TEMCs has not been addressed.

“The lack of pediatric specialists to participate in the examination is one of the main reasons for delayed certification and re-certification by TEMCs for children up to 16 years of age”, states Diana Kovacheva.

She adds that the issuance of a decision by TEMCs and NEMC long after the submission of the documents is a very serious reason for biased decisions due to the dynamics of the health status of the relevant citizen.

“The proposed amendments to the Medical Examination Ordinance published by the Ministry of Health for public discussion on 11 November 2022 did not address these issues. In this respect, I think it is useful to discuss the possibility of sending letters of appearance for re-certification considerably earlier, while the time limits of the Regional Health Inspectorates should take into account the delays in the field”, emphasises Kovacheva.

She draws attention to the fact that the delay in the certification or re-certification of citizens with disabilities has an adverse impact on the opportunities to exercise their rights during the period in which they do not have valid expert medical decisions, as well as that disabled people who have to appear for first certification by TEMC are seriously affected.

She says that due to the lack of expert medical decisions these people are deprived of pensions, monthly financial support, parking passes, travel and more benefits, and are forced to tackle the challenges themselves. She adds that people with disabilities who need to be re-certified are also seriously affected, as the TEMCs schedule dates for re-certification with great delay.

Kovacheva also points out that for the period until the TEMC decision is made and the new expert decision is issued, citizens are prevented from exercising other rights, such as the use of personal assistance under the Personal Assistance Act, tax benefits and preferential public transport and parking passes in the relevant municipalities, use of concessions for issuing identity documents, exemption from paying for a vignette sticker, etc.

          Serious attention is drawn to the fact that people with disabilities can only exercise some of their rights during the appeal of the expert medical decision before the NEMC, but only if in the disputed act of the TEMC they are assigned 50 and more than 50 per cent impairment/degree of permanently reduced working capacity.

“It should be noted that in such cases a pension is granted, but in a reduced amount, and it is possible to enjoy rights such as monthly financial support, pursuant to Article 112, paragraph 1, first sentence of the Health Act and as a result of the recommendations made by the Ombudsman for the correct interpretation and application of the provision. For the rest of the rights enjoyed by disabled persons on the basis of a higher percentage of disability in a previous expert medical decision, they have to wait for the decision of NEMC and subsequently of the court”, adds the public defender.

Another problem highlighted by the Ombudsman concerns cases where the expert medical decision by NEMC is cancelled and returned to TEMC for a new decision.  She points out that for the period until the new decision is issued by TEMC, citizens remain even without the existing support granted in the form of a disability pension and monthly financial support under the People with Disabilities Act.

“It is necessary to make changes in order to eradicate the practice of repeatedly returning files from NEMC to TEMC, and the cases should be decided as soon as possible”, insists Prof. Kovacheva.

She adds that after the issue of a decision by the medical examination bodies and the entry into force of the expert medical decisions, the legally due monthly financial support is paid retroactively, as are the disability pensions due, but a number of other rights that were not exercised during the period of examination of the case by TEMC/NEMC, however, remain without the possibility of being compensated. Such are the use of personal assistance or assistant support, the funds paid for a vignette or a public transport pass.

She also emphasizes that the delay affects the specific employers, as they have to comply with the requirements for quotas under the Labour Code and the Public Servants Act.

“In the proposals for amendments to the Medical Expertise Ordinance, published by the Ministry of Health for public discussion on 11 November 2022, these problems are not addressed either. In connection with the above, I think it would be appropriate to discuss the possibility of recognizing, in the event of a delay in the scheduled dates by TEMC, the validity of the latest expert decisions of TEMC for citizens, for the period until the medical commission’s decision, and any benefits and payments received by the person with disability should not be claimed from him in the event of a change in the percentage, type and degree of disability/degree of permanently reduced working capacity, because in practice such person has acted in good faith”, states Diana Kovacheva.

In her opinion she is categorical that amendments are also needed to allow disabled people to enjoy their other rights without interruption and be compensated in case of unjustified delay by competent authorities.

She also notes the problem with the medical expertise which is a serious one, involving a lower percentage type and degree of disability/degree of permanently reduced working capacity of disabled people, which the Ombudsman has repeatedly highlighted.

“The analysis of the complaints for the last four years shows that the reason for determination of a lower percentage in the majority of cases were the changes to the Medical Expertise Ordinance (MEO) adopted by Resolution No. 152 of 26 July 2018 of the Council of Ministers, when they were applied as reference points for the evaluation of permanently reduced working capacity and the type and degree of disability in percentages were changed”, the Ombudsman emphasizes.

She adds that this has led to an avalanche of complaints from citizens, mainly because of the reduction in the percentage of the degree of disability at re-certification or a certain low percentage at primary certification, due to non-consideration of accompanying disabilities.

She recalls that after the assessment of the impact of the changes and opinions and recommendations submitted by the Ombudsman, Decree No. 139 of 6 June 2019 was adopted, amending and supplementing the Medical Expertise Ordinance, whereby accompanying disabilities are also taken into account, but only for persons who have two or more disabilities, for each of whom 50% or more than 50% is indicated in the reference points for evaluation.

She also states that following the Ombudsman’s recommendation, on 12 July 2021 the Council of Ministers adopted a decree amending and supplementing the Medical Expertise Ordinance, which increased the percentages for certain diseases/injuries and specified a lifetime term of validity.

“Unfortunately, despite the submitted opinion, the methodology for applying the reference points for evaluating the permanently reduced working capacity in percentages were not changed”, emphasizes Prof. Kovacheva.

She is categorical that it is necessary to envisage a possibility, after the expiration of the previous expert medical decision and when documents are submitted for re-certification, that citizens should be able to promptly exercise their rights as people with disabilities and be provided with social assistance until the new expert decision is issued and its entry into force.