Right to coverage of expenses for healthcare services in the event of occupational injury

Full coverage basically means you will not have to pay any user fees. On NAV's website, you can read more about the conditions for having a personal injury or illness approved as an occupational injury.

Once NAV has approved your injury or illness as an occupational injury, you will receive a decision about this from NAV. The decision will describe the injury or illness that has been approved. You can then apply to Helfo for coverage of healthcare costs relating to your occupational injury. You will find the application form further down the page.

You can apply for coverage of expenses for travel to and from treatment. Read more about the refunding of travel expenses at Pasientreiser (Patient Travel).

Helfo may cover essential expenses for the following healthcare services under Section 5-25 of the National Insurance Act (only in Norwegian):

• medical care, outpatient clinics and X-rays
• physiotherapy
• dental care
• medicines, food products for medical purposes and medical supplies
• bandages
• appropriate aids (glasses)

Helfo does not cover expenses for treatment by a chiropractor or speech therapist, or treatment by a psychologist under the regulations concerning occupational injuries. In such cases, Helfo will pay subsidies in accordance with the ordinary subsidy rules of the National Insurance scheme.

In order to have your expenses covered in full under the rules concerning occupational injuries, it is a requirement that the need for the healthcare service is primarily or largely due to the occupational injury.

When you send Helfo receipts for expenses for treatment, you must enclose a copy of the approval decision from NAV.

If you receive treatment after the end of this three-month acute period, your doctor must provide a written statement documenting a clear link between the injury you have had approved and the treatment you are receiving. 

In most cases, it is sufficient to provide documentation or an application from a GP. The doctor may consider whether you need treatment, medical equipment or supplies, for example. In case of dental injury, a general dentist can provide the statement. The first time you apply for a subsidy for glasses, an ophthalmologist must provide the statement.

You must then apply to Helfo for coverage once you have received your occupational injury decision from NAV. See "Submitting applications to Helfo digitally" further down the page.

Helfo covers user fees and supplies according to fixed rates.

If you have received a decision from NAV and require medical care, treatment at an outpatient clinic or X-rays as a result of the occupational injury, you must take the decision letter with you to the treatment center. The doctor will consider whether the treatment is necessary as a result of your occupational injury. In this case, you will not have to pay a user fee.

The treatment provider must have a GP agreement with the municipality or an operating subsidy agreement with the regional health trust (hospital).

See "Submitting applications to Helfo digitally" further down the page.

Helfo covers user fees according to fixed rates.

If you have received the decision from the NAV and need physiotherapy treatment as a result of your occupational injury, you must take the decision with you when you go to the physiotherapist/manual therapist. The treatment provider will consider whether the treatment is necessary as a result of and in accordance with the approved occupational injury from NAV. In this case, you will not have to pay a user fee.

You do not need a referral from a doctor, chiropractor or manual therapist.

In order for you to be entitled to an allowance, the physiotherapist must have an operating subsidy agreement with the municipality, and an direct settlement agreement with Helfo. 

The dentist will consider whether the treatment is necessary as a result of your occupational injury. If so, you will not have to pay a user fee. The treatment should restore the condition that existed before the accident occurred.

If you need dental treatment before you have received NAV's approval decision, the dentist must consider whether you meet the conditions for coverage according to point 13a, tooth damage related to an accident that is not an occupational injury.

If you have already paid the deductible when you receive the decision from NAV, you can take the decision to the dentist and ask the dentist to reconsider the terms, and possibly refund the deductible to you.

It is a requirement that your treatment provider has an arrangement with Helfo regarding direct settlement in order for you to receive allowance for dental treatments.

Please note that the dentist's fees may be higher than the National Insurance scheme's rates. This means that you must expect to pay the difference between what Helfo covers and what the dentist charges.

In order for you to be entitled to an allowance for dental treatment from 1. January 2021, your treatment provider must have an arrangement with Helfo regarding direct settlement.

If treatment began before 1. January 2021, you may be entitled to an allowance even if your treatment provider does not have a direct settlement arrangement. Planned treatment is not considered to be treatment which has started.

If you need any of these things for more than three months after the date of injury (acute phase), the doctor must provide a statement detailing your needs.

In the medical statement, the doctor must confirm that your needs are due to the approved occupational injury. The statement must also specify the medicines, food products and medical supplies that you need as a result of your occupational injury. 

As a general rule, GPs can apply for a subsidy for an approved occupational injury.

Your GP, another doctor at the GP’s surgery or a doctor at a multidisciplinary pain clinic can apply for an individual subsidy for you for medicines that contain opioids. If you are going to use pregabalin (Lyrica) to treat neuropathic pain or trigeminal neuralgia, the same requirements apply to who can apply, but the application can also come from a specialist in neurology. If you need a higher daily dose of opioids than 100 mg oral morphine equivalents, your GP will not be able to prescribe for you. Then the application must come from a doctor at an interdisciplinary pain clinic.

To receive a refund for an addictive medicine, the doctor must state the dose. Helfo can cover up to the dose specified by the doctor in the statement. However, there is an upper limit to how much Helfo covers for opioids and pregabalin.

When your doctor sends the application to Helfo, you can forward a copy of the occupational injury decision.

See "Submitting applications to Helfo digitally" further down the page.

If you receive a decision concerning a subsidy to cover your expenses, you can collect medicines, food products or medical supplies from your local pharmacy or medical supplies store. You must then take the decision from Helfo with you, but you will not need the occupational injury decision from NAV. When you present the decision from Helfo, you do not have to pay user fees.

If you need any of these things for more than three months after the date of injury, the doctor must provide a statement detailing your needs.

In the medical statement, the doctor must certify that your needs are due to the approved occupational injury. The statement must specify the medical supplies that you need as a result of your occupational injury. It must also state the approximate total quantities of creams, ointments and oils that you will need per year.

You must send this statement, along with a copy of the decision from NAV approving your occupational injury, to Helfo. See "Submitting applications to Helfo digitally" further down the page.

You must pay for the purchases yourself and send itemised receipts to Helfo for a refund. Bandages and medical supplies must be purchased at a pharmacy or medical supplies store. This does not apply to creams, ointments and oils.

If you are receiving wound care from a community nurse, it is the municipality that is responsible for covering the expenses involved.

Helfo will cover the cost of frames up to NOK 1,500 and essential lenses (of the least expensive option). If, for medical reasons, you cannot wear glasses because of your occupational injury, you may be able to have the cost of contact lenses covered.

The cost of an eyesight test by an optician will not be covered.

An ophthalmologist must confirm that the visual impairment is due to your occupational injury.

You must send this statement, along with a copy of the decision from NAV approving your occupational injury and an itemised receipt, to Helfo. See "Submitting applications to Helfo digitally" further down the page.

If you need new glasses due to wear and tear and there is no change to your prescription, the optician can write a statement.

If you need other aids as a result of your occupational injury, NAV will consider whether you are entitled to coverage of your expenses.

In order to be entitled to a refund, NAV must have approved your occupational injury.

You will need to attach the following:

•            itemized receipts (stating the product name, price, date of purchase and name of the retailer)

•            the approval decision from NAV

You will also need to check the sections above to see whether you need to attach a medical statement to your application.