File a Claim

PFA Health Insurance

Remember that you need a doctor’s referral in order to use your health insurance.

Please contact PFA’s Health Centre at (+45) 70 24 50 01 if you have any questions regarding PFA Health Insurance or if you prefer filing your claim over the phone.

Call (+45) 70 24 50 01 

Treatment and examination:
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Psychologist and psychiatrist:
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PFA Critical Illness

Please contact PFA’s Health Centre at (+45) 70 24 50 01 if you have any questions regarding PFA Critical Illness or if you prefer filing your claim over the phone.

Call (+45) 70 24 50 01 

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PFA Occupational Capacity

Please contact PFA’s Health Centre at (+45) 70 24 50 01 if you have any questions regarding PFA Occupational Capacity or if you prefer filing your claim over the phone.

Call (+45) 70 24 50 01 

File a claim online  

PFA Occupational Capacity – the claims process

Each case is different, but a typical claims process may look as illustrated below:

PFA Occupational Capacity - the claims process

PFA Occupational Capacity – the claims process

If we have any doubts or need additional information, we will call you. We will also contact you to offer treatment or similar if we believe that treatment by, for instance, a physiotherapist will help you regain your occupational capacity faster.

If you have already been examined by a doctor at another company's request, we often ask for a copy of the examination results which we can use in our assessment in order to save time.

We receive many letters on a daily basis, and therefore we normally do not confirm the receipt of a letter. However, to the extent possible, we will keep you informed throughout the processing of the case so that you can stay updated on who we obtain information from and when we receive the requested information.

 

 

FAQ about PFA Occupational Capacity

Find answers to your questions about making a claim to PFA Occupational Capacity.

Time frame for the processing of the case

How long the processing of the case takes varies from case to case. Sometimes we have to wait for a clarification of health and occupational matters, such as medical treatment, the results of a work ability test or employment in a flex job. Often, it takes up to 5 months before a case is finally settled.

For how long will I receive payouts?

If you are entitled to receive payouts, you will receive monthly payouts as long as the reduction in your occupational capacity is documented. Once you have regained your occupational capacity, the payouts will be reduced or lapse.

What to do when I have been awarded payouts from PFA Occupational Capacity?

You are required to contact us if:
- your job situation changes, for instance if you become unemployed
- your state of health improves and you are ready to return to work, either in full or in part
- you work full-time or part-time
- you receive unemployment benefits
- you receive sickness benefits
- you start a or are approved for a flex job
- you receive unemployment benefits for flex job, rehabilitation benefits or early retirement pension.

Do I need to contact my local authority even though my case is being processed by PFA?

Yes. Your local authority will contact you 8 weeks after you reported unfit for work at the latest, and subsequently every 3 months to assess your occupational capacity on an ongoing basis. It is also your local authority that decides whether you are eligible for a flex job, whether you need any assistive devices or assistance, and whether you need any additional education or training.

Do my payouts from PFA depend on whether I am awarded early retirement pension?

No, payouts in the event of loss of occupational capacity have nothing to do with early retirement pension. Meaning that we can process your case even if your local authority is yet to make a decision.

What will happen to my policy if I lose my job because of illness or start a flex job?

That depends on what was agreed when your plan was established. You can find more information in your terms and conditions under Documents or, if you need advice, please contact us at (+45) 70 80 71 33.

Am I eligible for payouts if I have turned 60?

You are eligible for benefits until the date your insurance cover lapses. It is stated in your policy/pension certificate when your insurance lapses. Typically, your Occupational Capacity insurance will lapse when you retire.

Can I have my endowment pension paid out?

Normally, an endowment pension cannot be paid out before you reach the age of 60, however, it may be possible to have it paid out earlier if you:
- have permanently lost at least two thirds of your full occupational capacity
- suffer from one of the life-threatening diseases that the Danish Ministry of Taxation has approved as qualifying for payouts
- have been awarded public early retirement pension.

Can I complain about a decision from PFA?

Yes, of course. If you are dissatisfied, we kindly ask that you first of all contact the PFA claims handler who determined your case and explain why you disagree with the decision. Then, we will review your case again. If you are still dissatisfied after you receive our final decision, you can complain to the Danish Insurance Complaints Board. You find more information about the complaints process at www.ankeforsikring.dk.

PFA Critical Illness – the claims process

If we receive all relevant medical information (a copy of your case record) together with your claim, we can often process your case within 5 workdays.

If you do not enclose any medical information, we will see to that we obtain the necessary information. In this case, the processing of your case may take up to 1 month and maybe more if we need to obtain information from several authorities, some of which may take a while to reply. In this type of case, the claims process will typically look as illustrated below:

PFA Critical Illness - the claim process

PFA Critical Illness – the claims process

If we have any doubts or need additional information, we will contact you by phone or e-mail.

 

 

FAQ about PFA Critical Illness

Find answers to your questions about making a claim to PFA Critical Illness.

How do I find out whether I have PFA Critical Illness?

You can see all your insurance plans at My PFA.

Log on to My PFA

Is my illness/diagnosis covered?

In your terms and conditions for your pension plan, a description of diagnoses under the insurance cover is included as well as severity criteria applying to the diagnoses. You can find your terms and conditions for your pension plan at My PFA.

Log on to My PFA

How much is my payout?

At My PFA, you can see the size of your payout from your insurance cover.

Log on to My PFA

Is it possible to receive a second payout from the insurance?

Yes, in some cases, you can be eligible for payout again after a waiting period of 6 months, provided that the illnesses do not belong in the same category. In certain cases, cancer diagnoses will entitle you to 2 payouts if the second diagnosis is made at least 7 years after the treatment of the first cancer diagnosis was completed.

Can I receive a payout from my insurance cover if my children fall ill with a critical illness?

That depends on whether PFA Critical Illness – Children is included in your insurance cover. You can see if you insurance cover includes PFA Critical Illness – Children at My PFA.

Log on to My PFA

Am I to pay tax on the payout?

No, the payout is tax-free, and does not need to be reported to SKAT (the Danish tax authorities).

Can I complain about a decision from PFA?

Yes. If you are dissatisfied, we kindly ask that you first of all contact the PFA claims handler who determined your case and explain why you disagree with the decision. Then, we will review your case again. If you are still dissatisfied after you receive our final decision, you can complain to the Danish Insurance Complaints Board. See how to file a complaint at www.ankeforsikring.dk