Estonia's disability criteria leaving those affected scratching their heads
Last year, the number of people with disabilities fell by nearly 8,000. However, for many, it remains unclear what criteria the Social Insurance Board used to make such decisions, and later to change them.
Liis, the mother of a two-year-old and a five-year-old, had until this year received a positive decision when applying for disability status for her daughter, who is blind in one eye, and for her son, who has only one kidney. This summer, however, the Social Insurance Board decided that neither child has a disability, reasoning that the daughter can see with one eye and that the son, despite having only one kidney, can live a normal life.
"They wrote in my daughter's case that because she can see 1.0 with her right eye, she doesn't meet the criteria. To qualify for a moderate disability, vision would have to be at least 0.3. That left me very confused about why the disability was granted in the first place. I challenged the decision and suddenly my daughter was granted a moderate disability again — but my son was not. It's really unclear why one person decides not to grant it and another says 'yes,'" Liis said.
According to the Estonian Chamber of People with Disabilities, the official number of people with disabilities dropped by more than 8,000 last year and many cases remain puzzling even to them. In more serious situations, they have repeatedly had to turn to the courts to defend people's rights, often successfully.
"People come to the Chamber mainly with cases involving reassessments. A person was previously found to have a disability and now it's time for a reassessment — the law hasn't changed, the methodology hasn't changed — but the result for the person is different. It appears that the scope for interpretation by the case handler or medical expert is quite wide. They could decide either way based on the same facts, which raises questions. This suggests we need clearer guidelines and clearer criteria," said the Chamber's lawyer, Kristi Rekand.
The Social Insurance Board (SKA) acknowledged that doctors do have room for interpretation in making decisions. However, the guidelines were updated this year, and since spring, they have implemented random checks where one expert doctor reviews another's opinion. To make decisions clearer to the public, the agency also plans to make the full expert opinion available to applicants starting this fall.
"There's definitely room for interpretation. Our main problem is simply a lack of resources — our qualified doctors are extremely overworked. Perhaps we really do need to find additional resources to bring in more doctors so they can do their work more thoroughly. That is an issue. Secondly, the same feedback programs where one doctor's opinion is reviewed by another would also need new expert doctors," said Kalev Härk, head of the board's expert evaluation department.
SKA also noted concerns that the doctors whose assessments they rely on do not always fill out patient data thoroughly enough. This leads to decisions that later need to be revised.
"The quality of health data is a serious problem. It has improved over time, but unfortunately, there are still certain hospitals and doctors who are not very accurate when providing health data," Härk added.
The Ministry of Social Affairs plans by early 2026 to use an analysis to determine what changes the system needs to make it clearer and fairer.
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Editor: Marcus Turovski
