When Are You Entitled to a Disability Pension from the National Insurance Institute? Everything You Need to Know

If you have suffered a physical or mental injury due to illness, an accident, or a chronic medical condition, and are unable to participate fully in the workforce or maintain a regular work routine, you may be entitled to a disability pension from the National Insurance Institute. This pension serves as a financial safety net for individuals whose medical condition limits their ability to work and earn a living. It applies to people with temporary or permanent medical impairments that directly affect their earning capacity and offers a fixed monthly payment along with additional benefits to help ease daily life.

What Is a Disability Pension and Who Is Eligible?

A general disability pension is a monthly allowance granted by the National Insurance Institute to a person whose earning capacity has been significantly reduced due to illness, accident, or another medical condition.

The main eligibility criteria are:

1.  Age: between 18 and retirement age.

2. Medical disability: at least 60% medical disability, or 40% if one of the impairments is rated at 25% or higher.

3. Functional disability (loss of earning capacity): at least a 50% reduction in earning capacity.

4. Income test: no fixed maximum — according to current regulations.

What Does the Process Involve?

The process begins with submitting a claim form for a general disability pension, along with updated medical documents, expert summaries, and a record of medical history. Once the claim is received, the National Insurance Institute summons the claimant to a medical committee that determines the severity of the impairments.

If sufficient medical disability is established, the case proceeds to the next stage — assessment of earning capacity by a rehabilitation officer. Once all stages of evaluation have been completed, a formal decision is issued, specifying the determined disability percentage and the pension amount.

Disability Percentages - How They Affect Eligibility

The percentage of disability determined directly affects both eligibility and the pension amount. The higher the disability percentage, the greater the chance of receiving a higher pension. The standard eligibility levels are 60%, 65%, 74%, and 100%, with only those rated above 74% qualifying for a full pension.

It is important to understand that there are two separate stages: medical disability and functional disability. A person may be recognized as medically disabled but still be deemed capable of working,  and therefore not receive a pension.

The Medical Committee - How to Prepare Properly

The National Insurance medical committee is a professional body that decides the type and degree of disability. It includes physicians from the relevant fields of specialization for your case. Preparation is crucial and can have a major impact on the outcome of your claim.

Key recommendations:

• Bring all relevant medical documents.

• Present a full picture of your condition: functional, psychological, and physical.

• Be focused and clear. The hearing is brief, so use your time wisely.

• Do not downplay your difficulties - explain how your condition affects your daily life.

What If Your Claim Is Rejected?

If you receive a negative response or a disability percentage that does not reflect your true condition, you have the right to appeal. A medical appeal may be filed within 60 days to a higher-level committee, or an appeal regarding earning capacity may be filed with the Labor Court.

In an appeal, it is important to present updated medical opinions, letters from employers or specialists, and a clear explanation of why the National Insurance decision is incorrect. A well-prepared and reasoned appeal can sometimes completely change the result.

Practical Tips for Improving Your Chances of Approval

1. Do not go through the process alone - legal advice or professional representation significantly increases your chances of success.

2. Collect detailed medical documentation from multiple sources.

3. Be consistent - both in medical examinations and in reports.

4. Obtain letters from psychologists, occupational physicians, or social workers.

5. Keep the National Insurance Institute informed of any changes in your condition.

A general disability pension from the National Insurance Institute is an essential right for those with functional limitations. The process of obtaining it can be complex and challenging, but with proper preparation, professional guidance, and a solid understanding of the procedures, you can fully exercise your rights.Don’t give up on what you are entitled to.