No. 07-00-00384/2017-02  Date: 12 January 2018

OPINION

The present opinion was issued following a complaint procedure lodged upon a complaint filed by S.R. from I. against the Republic of Serbia Health Insurance Fund, Republic of Serbia Health Insurance Fund Sremska Mitrovica Branch Office, Inđija Local Office, on account of discrimination on the grounds of health status. The complainant stated in her complaint that report of her medical specialist and documents discharging her from the hospital state that she suffers from multiple illnesses, namely: Sclerosis Multiplex, Vaskulitis, Mononeuritis Multiplex and Polyncuropathiac Aliac, but that despite the findings of and recommendations by specialist doctors in different health care institutions, first level medical review panel of the Republic of Serbia Health Insurance Fund, Sremska Mitrovica Branch Office, Inđija Local Office, had taken a decision stating that the complainant had not met the requirements necessary for granting extended rehabilitation program paid for by mandatory health insurance, stating that diagnosis G58.7 – Mononeuritis multiplex did not imply renewal of rehabilitation. In their declarations responding to allegations made by the complainant in her complaint, the Republic of Serbia Health Insurance Fund Head Office and Republic of Serbia Health Insurance Fund Sremska Mitrovica Branch Office, stated, inter alia, that the complainant had not been granted rehabilitation extention, as the Rulebook on Medical Rehabilitation in Stationary Healthcare Institutions specializing in rehabilitation, in its List of Indications as an integral part of this Rulebook, did not foresee renewal of rehabilitation for patients with diagnosis of  mononeuritis multiplex (G58.7), while the second reason for denying her the extention of rehabilitation program was the fact that she had failed to provide hospital discharge papers which were issued in the last 30 days. In addition, in its declaration the Republic of Serbia Health Insurance Fund Head Office stated that if medical documentation, based on which entitlement to extended rehabilitation is achieved, lists several diagnoses, the only diagnosis which would be taken into account is the one which entitles a patient to a certain right, while the first level medical review panel had not reviewed the complainant’s diagnosis, G35 – sclerosis multiplex, as this diagnosis had not been confirmed. In the course of the complaint procedure it has been ascertained that the complainant was treated in 2013 at the Hospital for Rehabilitation in Banja Kanjiža, and that her hospital discharge papers confirm that she had been diagnosed with mononeuritis multiplex (G58.7) illness. However, on 31 July 2017 the complainant was examined by a neurologist who stated in her report that S.R. has been ill for 27 years and that she had been diagnosed with polyradiculopathia and mononeuritis multiplex of autoimmune genesis. Part of the neurologist’s report which refers to the patient’s diagnosis, states that the doctor has ascertained two diagnoses: G35- sclerosis multiplex as the referral diagnosis and G62- polyncuropathiac aliac as the main diagnosis. In addition, S.R. had been examined by a medical specialist – physiatrist, who had diagonosed the complainant with sclerosis multiplex (G35), clearly indicating this diagnosis in his report. Both doctors have stated in their reports that there was a need to send S.R. to a rehabilitation center  for an intensive physical treatment.  Likewise, in the course of the complaint procedure it has been ascertained that on 2 August 2017, S.R. was referred by her family doctor for a stationary treatment in “Vrdnik” rehabilitation center, indicating diagnosis sclerosis multiplex (G35). However, first level medical review panel of the Republic of Serbia Health Insurance Fund, Sremska Mitrovica Branch Office, Inđija Local Office, had issued its opinion No. 4164 on 31 August 2017 rejecting complainant’s application for extended rehabilitation stating that “the diagnosis G58.7 mononeuritis multiplex did not warrant renewal of rehabilitation.” The analysis of the complaint, declarations and submitted evidence showed that the complete medical documentation submitted by the complainant to the first level medical review panel indicates that her health status was such that in the course of her years long medical treatment in different healthcare institutions three different diagnoses had been made, namely sclerosis multiplex, polyncuropathiac aliac and mononeuritis multiplex. However, when deciding on the complainant’s application for rehabilitation renewal, the first level medical review panel had failed to take into consideration the overall health condition of the complainant, rather it had based its decision on one diagnosis only which cannot serve as the basis for granting rehabilitation renewal, which it could not have done if the complainant had been diagnosed with only one illness which would entitle her rehabilitation extention, which was contrary to the rule cited by the Republic of Serbia Health Insurance Fund in their declaration responding to allegations made by the complainant, namely that when deciding on the right to extended rehabilitation program overall medical documentation of the insuree must be taken into consideration, but that the decision is to be made on the basis of a diagnosis which entitles the insuree to this right. Thus, the complainant had been put in an unequal position with respect to other insurees on the grounds of her personal characteristic – health status. Hence, the Commissioner for the Protection of Equality has issued its opinion stating that the Republic of Serbia Health Insurance Fund, Sremska Mitrovica Branch Office, Inđija Local Office whose first level medical review panel had issued an opinion stating that S.R. from I. was not entitled to extended rehabilitation program, had violated provisions of Article 6 related to Article 27 of the Law on the Prohibition of Discrimination. For this reason a recommendation was issued to the Republic of Serbia Health Insurance Fund, Sremska Mitrovica Branch Office, Inđija Local Office to take all necessary measures aimed at eliminating the consequences of discriminatory treatment S.R. had been subjected to, namely to enable her to exercise her right to extended rehabilitation program, to send a written apology to the complainant on account of discriminatory treatment within a period of 15 days from the date of receiving the present opinion and to refrain in the future from violating anti-discrimination regulations in the course of its regular work and activities.