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
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
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
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
- 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
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
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.