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Success before the Supreme Administrative Court on the petition for special payment of the medicine OPDIVO
Article 16 of the Public Health Insurance Act enables a health insurance company to pay for treatment that is not covered by general health insurance. This article is applicable when the proposed treatment represents the only option for a patient in terms of his/her state of health.
In our case, we represented an oncological patient who went through 4 chemotherapy lines, all of which were not effective. Due to the ineffectiveness of this treatment, a request was made for payment of immunotherapy medicine OPDIVO, which contains the active substance nivolumab. The health insurance company and the Municipal Court in Prague considered the claim of “the only option for the patient” in the mentioned article. They also considered that the complainant was offered alternative treatment covered by general health insurance, i.e. chemotherapy. It was held by the Municipal Court that while chemotherapy would be less effective, it would still, in their opinion, be lege artis (according to the rules of the field).
The Supreme Administrative Court disagreed with these observations, referring to the practice of the Constitutional Court, and stated that this opinion is completely unsustainable and that such a restrictive interpretation denies the meaning of Article 16. The Supreme Administrative Court thus concluded that the conditions of Article 16 were met in this case, and the complainant is entitled to a special payment of treatment.
Our other achievements include winning disputes over the payment of KEYTRUDA medicine with the active substance pembrolizumab, and FAMPYRA with the active substance fampridine.
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Jasper Brinkman
Jasper Brinkman
"Following a devastating hotel fire in Prague, the law firm Holubová advokáti, led by attorney Klara Dvorakova, successfully represented our extended family as a group of victims. The firm navigated complex international insurance and compensation laws to defend our rights.
I would like to acknowledge the extraordinary efforts the firm had to make to bring our case to a successful compensation under extremely difficult circumstances."
Stewarts
Stewarts
"A visit to her daughter in London turned Eva's life upside down when she says she stepped into a crossing on a green light but was hit by a car. Despite her remarkable bravery, she faced a long treatment due to fractures in her pelvis, and the associated limitations and pain are likely to persist for the rest of her life. Regular headaches and impaired concentration compound her challenges.
Eva contacted us through an organization temporarily helping her manage her difficult living situation. At that time, she was destitute, relying only on subsistence payments. We were able to assist her because we specialize in personal injury and have contacts with proven colleagues abroad.
We worked with Stewarts, a UK law firm, on this case. Attorneys Klára Dvořáková and Rebecca Huxford helped Eva with the documentation in her case, explaining her options and the differences between the Czech and British systems of healthcare and social benefits reimbursement. Within a few months, thanks to the professional cooperation between the two offices, an offer of compensation from the insurance company of approximately CZK seven million was achieved. The client accepted this settlement because she did not want to deal with courts in the United Kingdom.
Subsequently, we assisted the client with related tax issues and contacted Auditone, a tax consultancy firm, which arranged for the filing of a tax return. Compensation for lost income is taxable, unlike most personal injury compensation.
'No one has done as much for me as you,' Eva said.
The fact that we were able to help Eva gives our work meaning and brings us great joy. We are very happy that, thanks to our many years of active involvement in the international professional organization PEOPIL, we can cooperate on such cases."