approvED
International Process Guidelines Accidents at Work and Occupational Diseases AW_BUC_01b - Certification right benefits in Kind - Competent Member State sends the Certification
Date: 12/09/2018 Version of guidelines document: v4.1.0 Based on: AW_BUC_07c version v4.1.0 Common Data Model version: 4.1.0
TABLE OF CONTENTS
AW_BUC_01b - Certification right benefits in Kind - Competent Member State sends the Certification ................................................................................................................................................................. 4 How to start this BUC? ............................................................................................................................ 5 What is my role in the social security exchange of information I have to complete?............. 5 CO.1 Who do I need to exchange information with? .............................................................. 5 CO.2 How do I identify the correct institution to exchange information with? ...................... 5 CO.3 How do I send the ‘Certification of the right to benefits in kind’ SED DA002? ............... 6 CO.4 What should I do if it turns out that I must cancel the former decision made in `Certification of the Right to Benefits in Kind´ SED DA002? .................................................... 6 CP.1 What should I do if I received a ‘Certification of the right to benefits in kind’ SED DA002? ..................................................................................................................................... 6 CP. 2 What should I do if I am responsible for the business process? .................................... 7 CP.3 What should I do if I am not responsible for the business process? ............................... 7 CP.4 What should I do if I received `Cancellation of Certification of the Right to Benefits in Kind´ SED DA003? .................................................................................................................... 7 BPMN diagram for AW_BUC_01b ........................................................................................................... 8 Structured Electronic Documents (SEDs) used in the process ................................................................ 8 Horizontal sub-processes ........................................................................................................................ 8 Administrative sub-processes ................................................................................................................. 8
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 2
Document history:
Revision Date Created by Short Description of Changes v0.1 07/04/2017 Secretariat First draft of the document submitted for review to the AWOD Ad Hoc group v0.2 09/05/2017 Secretariat Implement changes and updates following the AHG comments. Version submitted for AC review. v0.99 14/06/2017 Secretariat Implement changes and updates following the AC comments. Version submitted for AC approval. v1.0 12/07/2017 Secretariat AC approved version With minor formatting and clarification corrections v4.1.0 12/09/2018 Secretariat Performed patch changes to reference the new CDM version 4.1.0
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 3
AW_BUC_01b - Certification right benefits in Kind - Competent Member State sends the Certification
Description: The role of AW_BUC_01b is to allow institutions to exchange information about the Claimant (person who is claiming the benefits) such as the insurance situation and other details that the Institution in the Member State of stay or residence needs in order to decide about a claim for benefits in kind in respect of an accident at work or an occupational disease. This case deals with the situation when an insured person, staying or residing outside the Competent Member State, claims the rights to benefits in kind in case of an accident at work or an occupational disease. The institution in the Competent Member State sends the certification of the right to benefits in kind in case of an accident at work or an occupational disease. In case of cancellation related to the person's right to benefits in kind in case of an accident at work or an occupational disease, the Competent Member State sends to the Member State of stay or residence a document cancelling the previously confirmed right to benefits in kind. When the Business Use Case is successfully completed, the Institution of the Member State of stay or residence is informed whether the rights are granted and benefits will be reimbursed by the competent institution or not. Legal base: The legal basis of AW_BUC_01b lies in in the basic Regulation No 883/2004 and in the implementing Regulation No 987/2009. The following table specifies the SEDs used in this BUC and documents the articles that provide the legal basis for each SED: SED Basic Reg (883/04) Implementing Reg (987/09) 17 19 20 36 36 36 24 24 25 26 33 33 (2) (1) (1) (1) (2) (2a) (1) (2) (1) (1) (1) DA002 Certification of the Right to Benefits in Kind DA002 Certification of the Right to Benefits in Kind Glossary of relevant terms used in AW_BUC_01b: Term used Description
Case Owner The Case Owner is the institution of the Competent Member State that confirms or denies the person’s right to benefits in kind in case of an accident at work or an occupational disease. The Case Owner is allowed to send a cancellation document to the Counterparty if the person's right to benefit in kind in case of an accident at work or an occupational disease has been cancelled.
Counterparty The Counterparty is the institution of the Member State of residence/stay. Claimant The claimant is the insured person who stays or resides outside the competent Member State and claims for the benefits in kind in case of an accident at work or an occupational disease.
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 4
How to start this BUC?
In order to help you understand the AW_BUC_01b we have created a set of questions that will guide you through the main scenario of the process as well as possible sub-scenarios or options available at each step along the way. Ask yourself each question and click on one of the hyperlinks that will guide you to the answer. You will notice that in some of the steps where it is allowed to use the additional horizontal and administrative sub-processes they will be listed under the step description. What is my role in the social security exchange of information I have to complete?
If you are the Competent Institution of a Member State that wants to transmit information about the proper right to benefits in kind in case of an accident at work or an occupational disease to the Institution in the Member State of stay or residence, your role will be defined as the Case Owner I am the Case Owner. (step CO.1)
If you are the Institution of the Member State of stay or residence that receives a certification of the right to benefits in kind from another country, your role will be defined as the Counterparty. I am the Counterparty. (step CP.1)
CO.1 Who do I need to exchange information with?
As the Case Owner, your first step will be to identify the Counterparty by identifying the responsible Member State of stay or residence. Then you have to identify the relevant Institution in the Member State that is responsible for the information you wish to exchange. The institution can be chosen only among the institutions responsible for the accident at work and occupational disease sector. It is not possible to choose more than one institution. This activity will define the Counterparty you will be working with in the exchange of information. I need to identify the Counterparty. (step CO.2) I have identified the Counterparty I need to contact. (step CO.3)
CO.2 How do I identify the correct institution to exchange information with?
In order to determine the relevant Competent Institution from another Member State you will need to consult the Institution Repository (IR). The IR provides an electronic record of all current and previous Competent Institutions and Liaison Bodies that have been responsible for the cross border coordination of social security information for each of the relevant Member States. Please note that the Liaison Body should be chosen only if it is impossible to identify the correct Competent Institution in the respective Member State or if the case is handled by the Liaison Body. To access the IR please use the following link. I have now identified the Competent Institution from the Member State I need to contact. (step CO.3)
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 5
CO.3 How do I send the ‘Certification of the right to benefits in kind’ SED DA002?
Fill out the ‘Certification of the right to benefits in kind’ SED DA002 by entering all the required information. Afterwards, you send SED DA002 to the Counterparty. As the form is individualized the case can concern only one person. Sending SED DA002 starts the international exchange of information. SED DA002 is a message from your institution confirming or denying the right of a person to benefits in kind in case of an accident at work or an occupational disease. SED DA002 is always sent from the Competent Institution in the competent Member State to the Institution of the Member State of stay or residence of the insured person. Unless you later need to revise a positive decision on the right to benefits in kind, the Business Use Case ends here. If you have granted the person’s right to benefits in kind with the `Certification of the Right to Benefits in Kind´ SED DA002, but later the person insurance situation has changed and you have to revoke the right to benefits in kind, so you are sending a cancellation. I have granted the right to benefits in kind and I need to cancel this earlier decision. (step CO.4)
CO.4 What should I do if it turns out that I must cancel the former decision made in `Certification of the Right to Benefits in Kind´ SED DA002?
If you have granted the person’s right to benefits in kind with the `Certification of the Right to Benefits in Kind´ SED DA002, but later realize the person insurance situation has changed and you have to revoke this right, you need to send a cancellation. The `Cancellation of Certification of the Right to Benefits in Kind´ SED DA003 cancels the former decision made in SED DA002 confirming the person’s right to benefits in kind in case of an accident at work or an occupational disease. Only you can send a cancellation with regard to your own previous SED DA002. Fill out SED DA003 and send it to the Counterparty. In general, you do not receive a specific reply from the Counterparty. The Business Use Case ends here.
CP.1 What should I do if I received a ‘Certification of the right to benefits in kind’ SED DA002?
The process is initiated by receiving the ‘Certification of the right to benefits in kind’ SED DA002 from the Case Owner. SED DA002 is a certification from the Competent Institution of the competent Member State confirming or denying the right of a person to benefits in kind in case of an accident at work or an occupational disease. After receiving SED DA002, you first have to check according to your national procedures if you are responsible for the business process. I am responsible for the business process. (step CP.2) I am not responsible for the business process (step CP.3)
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 6
CP. 2 What should I do if I am responsible for the business process?
You received the ‘Certification of the right to benefits in kind’ SED DA002 from the Case Owner and you are responsible for the business process. You can use the information contained in SED DA002 in any national decision necessary with regard to the claimant. You are enabled to grant benefits in kind on behalf of the competent institution. If you do not need any further information from the Case Owner and you do not receive any further messages from it, the Business Use Case ends here. After receiving a DA002 confirming a right, I have received a `Cancellation of Certification of the Right to Benefits in Kind´ SED DA003 from the Case Owner.(step CP.4)
Sub-process steps available to the Counterparty at this stage: I want to exchange additional information not foreseen in SED DA002 (H_BUC_01).
CP.3 What should I do if I am not responsible for the business process?
You have to forward the case to the competent Institution in your Member State using 'Forward Case' Administrative sub-process AD_BUC_05.
CP.4 What should I do if I received `Cancellation of Certification of the Right to Benefits in Kind´ SED DA003?
The `Cancellation of Certification of the Right to Benefits in Kind´ SED DA003 cancels the former decision made in SED DA002 confirming the person’s right to benefits in kind in case of an accident at work or an occupational disease. Only the Case Owner that sent the SED DA002 can send a cancellation with regard to this right. The effective date of cancellation is the date I received SED DA003. You can use the information contained in SED DA003 in any national decision necessary with regard to the claimant. You are informed that benefits in case of an accident at work or an occupational disease cannot be granted any longer on behalf of the competent institution. If you do not need any further information from the Case Owner, the Business Use Case ends here. The Business Use Case ends here.
Sub-process steps available to the Counterparty at this stage: I want to exchange additional information not foreseen in SED DA002 or DA003 (H_BUC_01).
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 7
BPMN diagram for AW_BUC_01b
Click here to open the BPMN diagram(s) for AW_BUC_01b.
Structured Electronic Documents (SEDs) used in the process
The following SEDs are used in AW_BUC_01b: • SED DA002 – Certification of the right to benefits in kind • SED DA003 – Cancellation of the right to benefits in kind
Horizontal sub-processes
The following horizontal sub-processes are used in AW_BUC_01b: • H_BUC_01-Sub Ad hoc exchange of information
Administrative sub-processes
The following administrative sub-processes are used in AW_BUC_01b: • AD_BUC_05_Subprocess – Forward Case • AD_BUC_07_Subprocess – Reminder The following sub-processes are used for the handling of exceptional business scenarios that arise due to the exchange of social security information in an electronic environment and can be used at any point in the process: • AD_BUC_11_Subprocess – Business Exception • AD_BUC_12_Subprocess – Change of Participant
Guidelines for EESSI Business Use Case AW_BUC_01b – Certification right benefits in Kind - Competent Member Date: September 2018 Document version: 4.1.0 8