Patient insurance in Estonia: the first year of TOKVS

For many years, a patient injured by medical treatment in Estonia faced an uphill struggle: the claim had to be brought directly against the doctor or hospital, evidence and expert opinions had to be obtained at the patient's own expense, and litigation was often the only route. Many patients gave up; many doctors perceived every complaint as a personal accusation. On 1 November 2024, the Healthcare Provider's Compulsory Liability Insurance Act (tervishoiuteenuse osutaja kohustusliku vastutuskindlustuse seadus, TOKVS), commonly called "patient insurance", came into force.¹ In the first eight months of 2025, 335 insurance applications were filed (called complaints in the headline of the original op-ed), 42 of which had been recognised as insured events by the time of publication, and dozens of compensation payments were made; these are not final figures for the whole first year. This post, an updated English version of an op-ed published in Postimees in October 2025, explains the system for international insurers and reinsurers.

Date note: the date of this post (13 October 2025) is the date of the original publication. This English version was written for this website in 2026.

A liability insurance, not a no-fault scheme

TOKVS did not introduce a Nordic-style patient injury scheme in which compensation does not depend on the provider's liability in the classic sense. The Estonian system is compulsory liability insurance: the insured event requires that the healthcare provider is liable for the damage caused to the patient (TOKVS § 10).² Substantive liability is still governed by the Law of Obligations Act (võlaõigusseadus, VÕS); what has changed is the procedure, which is simpler, faster and cheaper for the patient, who now claims through the provider's insurer.

Key features

• Who must insure. The obligation rests on the healthcare provider (TOKVS § 4); insurance is a condition for providing services.³
• Minimum limits. EUR 100,000 per entitled person, EUR 300,000 per insured event and EUR 3,000,000 per insurance period, with separate limits of EUR 30,000 and EUR 100,000 for non-pecuniary damage (TOKVS § 11).⁴
• No deductible against the claimant. Any deductible operates only between insurer and provider (TOKVS § 12).⁵
• Exclusions. The statute lists excluded situations; of practical importance is the exclusion of losses below EUR 200 (TOKVS § 20(3)).⁶
• Procedure. The provider must notify the insurer of the claim, and the insurer must decide within the statutory period, at the latest by the 180th day (TOKVS § 21).⁷
• Conciliation committee. A liability insurance conciliation committee operates at the Health Board (Terviseamet) (TOKVS § 23).⁸
• Limitation. The Act provides a three-year limitation period with an absolute long-stop of ten years (TOKVS § 26).⁹

The Act has been amended since entry into force; the current version, in force since 1 October 2026 (RT I, 30.06.2026, 33), amended § 4(5) on the insurance obligation and § 20(9) on exclusions.¹ Policy wordings should be checked against the current text.

What the first year showed

Moderate claims volume. Critics predicted an avalanche of claims and sharply rising premiums. With 335 applications in the first eight months, that did not happen. Nordic experience suggests that volumes grow gradually over several years as awareness increases.

Payments without litigation. Dozens of patients received compensation without going to court. Under the previous regime, many of these claims would probably never have been brought.

Dentistry under the spotlight. Before the Act took effect, dentists argued that premiums were disproportionate and would raise prices by up to ten percent. Analysis of premium levels against typical clinic turnover showed that claim to be unfounded; higher premiums for a statistically higher-risk specialty are standard risk-based pricing.

The conciliation committee is central. Where insurer and patient cannot agree, the committee offers a cheaper and faster route than the courts and will shape interpretation of standard of care and causation.

Issues to watch

• Causation. Because the scheme is liability-based, the patient must still prove a causal link between a breach and the harm. In medicine, complications may be inherent risks rather than errors.
• Adequacy of limits. Non-pecuniary damage sub-limits are low for catastrophic injuries. Above the limits, the provider remains personally liable.
• Market capacity. The number of insurers writing this class in Estonia is limited. Capacity, pricing and wording quality will depend on market entry, including on a freedom-of-services basis, and on reinsurance support.
• Transparency. Publication of anonymised conciliation committee decisions would help all parties calibrate expectations.

Notes for foreign insurers

Foreign insurers writing TOKVS business on a freedom-of-services or branch basis should note that the statutory minimum terms override contrary policy terms to the extent they protect the injured party, that the claims procedure and deadlines are statutory, and that the conciliation committee procedure must be built into claims handling. Recourse against the insured provider in cases where the insurer is released internally should be addressed in the wording. The leading Estonian commentary on the Act is the 2024 annotated edition co-authored by Olavi-Jüri Luik.¹⁰

How a claim works in practice

A typical claim proceeds as follows. The patient (or a relative, in a fatal case) informs the healthcare provider that they believe treatment caused harm and asks for the claim to be forwarded to the provider's insurer. The provider notifies its insurer, and the insurer gathers the medical records and, where needed, an independent medical opinion on standard of care and causation. The insurer then issues a reasoned decision within the statutory time limit. If compensation is accepted, the insurer pays within the statutory limits; any excess over the limits remains a direct claim against the provider. If the patient disagrees, the case may go to the conciliation committee at the Health Board and, ultimately, to court.

For claims teams, the main practical challenges are obtaining complete medical records quickly, assessing causation where the injury may be an inherent risk of treatment, and quantifying non-pecuniary damage within the statutory sub-limits. Documentation of informed consent is often decisive: many disputes turn not on the treatment itself but on whether the patient was properly informed of its risks.

For providers, cooperation with the insurer is both a contractual duty and a practical necessity. A provider that responds openly to the patient, while leaving the evaluation of liability to the insurer, reduces the risk of escalation.

Conclusion

The first year of Estonian patient insurance shows a functioning system: patients are using it, procedures are simpler and cheaper, and claims volumes have not exploded. The questions for the coming years are whether conciliation practice will produce consistent standards and whether limits are adequate in severe cases.

Originally published in Estonian: Postimees, 13.10.2025, "Esimene aasta patsiendikindlustust: 335 kaebust ja kümned makstud hüvitised", https://arvamus.postimees.ee/8341906/olavi-juri-luik-esimene-aasta-patsiendikindlustust-335-kaebust-ja-kumned-makstud-huvitised. Rewritten and updated as of November 2026.

Related pages

• Estonian insurance contract law
• Direct action against liability insurers
• Publications
• Services for insurers

References