The Ombudsman was contacted by a self-employed woman who was receiving a partial ZPIZ benefit for half of her working time and sick leave for half of her working time. On 28 April 2023, her personal physician submitted a proposal for the complainant's disability retirement. An expert opinion on this was issued on 30 November 2023, and the ZPIZ did not issue a decision on disability retirement until 11 January 2024, namely that the complainant has the right to a disability pension from 1 December 2023 onwards. The aforementioned decision remained final on 30 January 2024, but the complainant received a certificate of finality only on 15 February 2024. At that time, the appointed doctor issued a new decision stating that the complainant was unable to do any work due to illness until 31 March 2024. At the time of the decision on the disability pension, the complainant contacted the ZPIZ, the ZZZS and Ajpes several times and tried to arrange matters, but without success. The complainant was materially harmed due to such a decision-making time frame, as from 31 January 2024 until 19 February 2024 (deletion of the business entity from the PRS), she lost all social security rights.

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A complainant wrote to the Human Rights Ombudsman of the Republic of Slovenia (Ombudsman) citing problems related to the enforcement of the right to a disability pension, which was granted to her by the decision of the Institute for Pensions and Disability Insurance (ZPIZ) dated 11/01/2024, namely from 1/12/2023 onwards. According to this decision, the pension should be paid on the first day following the termination of the insurance. In her complaint, the complainant stated that immediately after receiving this decision, she contacted ZPIZ and asked the employee if she had to do anything based on the decision she had received. She was allegedly told to wait for the decision to become final, so that she would then receive all the instructions. On 15 February 2024, the complainant should have received a certificate from the ZPIZ about the finality of the decision of 30 January 2024. The certificate also states that the ZPIZ registers the insured person (complainant) in compulsory health insurance as a beneficiary of a disability pension with effect from the following day, i.e., 31 January 2024. Immediately after that (16 February), the complainant went to AJPES to close her S.P. At the same time, the employee there allegedly also arbitrarily deregistered her from the health insurance from 30 January 2024, even though the complainant allegedly begged her not to do this, as she was on sick leave. Thus, the complainant's S.P. was closed on 19 February. The complainant was later allegedly promised by an employee of the Institute for Health Insurance (ZZZS) that she would also close her mandatory health insurance on the same date, and said that she did not know why the AJPES employee had deregistered her from the mandatory health insurance, as she was on sick leave until 30 March 2024, and only then could she close the S.P. Although both employees, both from AJPES and ZZZS, assured the complainant that they would correct the date of termination of the compulsory insurance to 19 February 2024, this did not happen, but instead the date of 30 January 2024 came into effect. Then the complainant was supposed to arrange the deregistration from the compulsory health insurance with another regional unit of the ZZZS, she was allegedly told that the date of termination of the insurance would be manually entered date 19 February 2024. However, when the complainant tried on 01 March 2024 to make the last calculation of contributions for the period from 01 February 2024 to 19 February 2024 via eDavki, it was found that the system had blocked her, and the tax administration allegedly told the complainant that the ZZZS had deregistered her from health insurance on 30 January 2024. 2024. In connection with this, in March of this year, the complainant should contact several regional units of ZPIZ and ZZZS and AJPES. However, she did not receive any answers. Based on the above, she asked the Ombudsman for help.

The Ombudsman repeatedly contacted the ZPIZ, ZZZS, and Ajpes with inquiries for answers.

After examining the matter, the Ombudsman gave his opinion to the responsible bodies of the ZPIZ and Ajpes and to the complainant, as follows.

Regarding the decision of the ZPIZ: The Ombudsman did not receive sufficient explanations as to why the decision on the termination of the right to partial compensation was issued only on 18 March 2024, even though the decision of the ZPIZ on the complainant's disability retirement from 11 January 2024 became final on 30 January 2024. This decision (on the termination of the partial compensation) was also served on the complainant later than the payment of partial compensation was stopped according to the aforementioned decision. In the explanation, there is no stated legal basis for the termination of the payment of partial compensation from 18 March 2024, even with regard to the statement in the sentence that ZPIZ would issue a special decision on the determination of a possible overpayment and the obligation to reimburse the overpayment. According to the Ombudsman, this record is problematic and in fact inadmissible, because in the specific case, if there is or would have been an overpayment, it is the result of the timing of the decision on the complainant's status. The expert opinion was given by the disability commission on 30 November 2023 and from that date onwards, the complainant is given category I disability due to the consequences of the disease. The ZPIZ only issued a decision on this on 11 January 2024, and then on 18 March 2024 a decision on the termination of disability benefits. At the same time, the Ombudsman reminded the ZPIZ of the statutory deadlines for issuing a decision (this is 4 months from the date of initiation of the procedure; in the specific case, the procedure began with the proposal of the personal physician on 28 April 2023) and of the necessary timing of the issuance of all administrative acts that decide on the so-called disability status of the individual. If, in the case of the complainant, both decisions had been issued at the appropriate time, there would have been no complications and no deprivation of the complainant.

The certificate of finality of the decision on disability retirement was issued by the ZPIZ on 1 February 2024, and according to the ZPIZ, it should have been dispatched the same day; however, it is not possible to determine when the complainant actually received it, as the ZPIZ did not provide the Ombudsman with any proof of this. The fact is, however, that the complainant sent the Ombudsman a copy of this certificate with her official endorsement of receipt of the certificate on 15 February 2024. There is no reason for the Ombudsman not to believe this, as the complainant was very active in the whole case. Immediately after receiving the decision on disability retirement, she reported to the ZPIZ, and, immediately after receiving the certificate of legal validity (16 February 2024), to Ajpes, and she handled matters at another ZPIZ regional unit and at ZZZS regional units.

The Ombudsman suggested that the ZPIZ issue certificates of legal validity of administrative acts in such a way that it will be possible to establish the actual receipt and familiarisation of the parties or insured persons with the aforementioned act. The entry into force of the retirement decision had a significant impact on the complainant's position. On the day following the finality, the ZPIZ registered the complainant for compulsory health insurance on a legal basis, on the basis of which she was no longer entitled to monetary compensation for temporary absence from work due to illness. With the certificate of finality, the complainant was also informed that the ZPIZ must submit the deletion of Ajpes from the PRS (which she arranged immediately afterwards, the decision of Ajpes on deletion is dated 19 February 2024).

Regarding the decision of the ZZZS: Based on the decision of the appointed doctor dated 25 January 2024, the complainant was temporarily unable to work due to illness from 16 January 2024 to 31 March 2024. In its reply to the Ombudsman, the ZZZS explained that the appointed doctor determined the complainant's incapacity for work, defined in the sentence of the decision, namely in relation to her remaining ability to work according to the enforceable decision of the ZPIZ of 22 November 2021 and that the appointed doctor did not have the decision of the ZPIZ of 11 January 2024 at his disposal and therefore could not take it into account. This is not true, as the ZPIZ also served the cited decision on the competent Health Centre. The relations between personal doctors and appointed doctors of the ZZZS are clear, as appointed doctors make decisions based on the documentation of personal doctors. Thus, the appointed doctor decided on the complainant's temporary suspension from work for the time when the ZPIZ decision on her disability retirement was already final. However, due to the ZPIZ decision on retirement, the complainant had the right to compensation only until 30 January 2024, when this decision became final.

The Ombudsman informed the ZPIZ and ZZZS of his findings and opinion that the complainant was harmed due to the described behaviour of the ZPIZ and ZZZS in asserting the right to a disability pension. In this case, the complainant cannot be accused of a lack of conscientiousness; on the contrary, she took several steps and activities in order to assert and secure her rights, but due to the time circumstances of decision-making and the issuance of acts, the violations and irregularities caused by the aforementioned authorities and their uncoordinated and uncoordinated actions (despite the fact that both decide on social security rights), the complainant was not successful in this. Although she was granted partial compensation from 7 January 2022 by the decision of the ZPIZ (this was terminated by the provision on disability retirement of 18 March 2024) and although at the same time she was temporarily unable to work until 30 March 2024 by the provision of the appointed doctor (until that date she also rightly expected to receive monetary compensation) and thus had her regulated status, with the decision of the ZPIZ on retirement dated 11 January 2024, from 1 December 2023 onwards, as of the date this decision became final on 30 January 2024, she lost her right to monetary compensation, partial compensation, and compulsory health insurance due to the performance of economic activity. From that day until the day the business entity was deleted from the PRS, i.e. until 19 February 2024, when the complainant was finally able to assert her right to a disability pension, she herself had to cover the costs of social insurance and other costs related to the open S.P., but she did not receive the income during this time.

The Ombudsman registered the complainant as well-founded. Due to violations of several provisions of the ZUP and the principle of good management, the ZPIZ and ZZZS violated the principle of legal security, as well as the principle of economy of the procedure from Article 14 of the ZUP, which stipulates that the procedure must be conducted quickly, with as little costs as possible, and as little delay as possible for the parties and other participants in the procedure.

The Ombudsman expressed the expectation that the ZPIZ and ZZZS will resolve the resulting complication with the complainant, take the Ombudsman's opinion into account, and act accordingly in future cases with the same or similar factual situation. 9.0-8/2024