This document summarizes two case studies regarding sickness benefits and the application of EU coordination rules: 1) For Ms. X who has lived in Estonia since 2008, Estonia is the competent state to provide benefits since she has been insured there as an unemployed person, even though she receives an invalidity pension from Germany. 2) For Ms. X who worked in Estonia while living in Latvia and developed a chronic disease upon retirement, she is entitled to continue receiving medical treatment for this disease in Estonia as a former frontier worker, with the costs borne by the Estonian institution. The answer is the same even if the need for treatment was due to a

1. organising training and setting up networks on the
European Coordination of Social Security Schemes
in the 27 Member States
Estonian case studies: Sickness benefits
Linda Sassian
Chief specialist of international relations
department
Estonian Health Insurance Fund

2. trESS
Case 1
Ms X has lived in Estonia since 2008 and has been insured as unemployed
person since. She does not receive any benefits from the Unemployment
Insurance Fund. The Unemployment Insurance Fund only pays social tax
for persons insured as unemployed and not having the right for insurance
on any other basis.
In 2010 Ms X has been awarded invalidity pension from Germany.
Which is the competent state? Is it the person’s choice according to art 16
p.2?

3. Case 2
During her active life, Ms. X worked as a frontier worker in Estonia while
living in Latvia. A month before her retirement, she contracted a chronic
disease.
•Question: Under which conditions is Ms. X entitled to receive medical
treatment for this disease in Estonia?

4. Under Art.28 p 1 of reg. 883/2004: A frontier worker who retires is entitled
in case of sickness to continue to receive benefits in kind in the Member
State where he last pursued his activity as an employed or self-employed
person, insofar as this is a continuation of treatment which began in that
Member State. The term "continuation of treatment" means the continued
investigation, diagnosis and treatment of an illness.
Art 28.p 5 states that the cost of the benefits in kind referred to in
paragraphs 1 shall be borne by the competent institution responsible for
the cost of benefits in kind provided to the pensioner or to his survivors in
their respective Member States of residence.

5. Art 29 of reg. 987/2009 states that if the Member State where the former
frontier worker last pursued his activity is no longer the competent
Member State, and the former frontier worker or a member of his family
travels there with the purpose of receiving benefits in kind pursuant to
Article 28 of the basic Regulation, he shall submit to the institution of the
place of stay a document issued by the competent institution (S3).
Alternative question 1: Is the answer to this question different if the need
for medical treatment stems from an (non-occupational) injury sustained
one month before her retirement?
Answer: No

6. Thank you!