Letter to the State Administrator regarding doctors who refuse to write a medical certificate

Løvemammaene have sent the following letter to the State Administrator in which we conclude by requesting the State Administrator to prepare a guidance letter to the country's BUPs and habilitation services regarding a medical certificate in connection with applications for care benefits.

Below you can read the letter in its entirety.

Major challenges related to care allowance for children with mental disorders and cognitive diagnoses.

The organization Løvemammaene and the Løvemammaene help service have over time seen a recurring problem related to parents/caregivers who need childcare benefits not receiving the necessary medical certificate where children have/have had follow-up in BUP (child and adolescent psychiatry) or HABU (child and adolescent habilitation). The result is that families lose part of, or in the worst case, their entire income.

According to Section 9-16 of the National Insurance Act, when applying for care benefits, a medical certificate from a specialist health service must be submitted. BUP and HABU are part of the specialist health service. A general practitioner cannot write a medical certificate for an application for care benefits. Both somatic and mental illness give the right to care benefits.

It is very serious that families are deprived of their income opportunities because doctors in BUP and HABU refuse to write medical reports, often due to what we perceive to be a very lack of knowledge about this legislation, or because the child no longer has follow-up in the specialist health service. But the fact that children do not have follow-up in the specialist health service does not mean that children are healthy, or do not have challenges that could trigger the right to care allowance for the parents.

Both the central board and the support service in Løvemammaene receive daily inquiries regarding care allowance. The need for care money can have various reasons. However, we see that a striking number of inquiries are linked to a lack of documentation from BUP, either because the children are fully examined and discharged, or because the doctor refuses to write a medical certificate. A number of inquiries are linked to HABU, but there the greatest challenge is that children who have been assessed are discharged and thus lack a point of contact in the specialist health service further on.

We have the impression that BUP in many cases lacks understanding of the regulations related to care benefits and/or that they do not see it as their task to write such a declaration. 

As examples we can mention: 

• BUP will not print a doctor's report because the child has been discharged / fully examined
• BUP says that care allowance is only a transitional arrangement
• BUP tells parents that they are not entitled to childcare allowance
• BUP says that care allowance is only for families with children who are serious
• somatically ill

The rules on care allowances mean in practice that children who, due to their illness/condition, require continuous supervision and care for all or part of the day are not left to fend for themselves because their parents/caregivers have to go to work. We believe that current practice in BUP, and partly in HABU, means that children may risk that from one day to the next they will no longer have a caregiver present because their parents/caregivers are forced to go to work, which would entail a major safety risk, e.g. for children who self-harm, suicidal children, children with severe anxiety, psychosis, etc. In the worst case, lives could be lost. Leaving a child who needs care and supervision due to their illness/condition to fend for themselves because BUP and HABU refuse to write a medical certificate when the conditions for care allowance are met, thus constitutes a serious violation of the human rights of children regarding their right to protection, a violation of the best interests principle, and the general legal certainty for the children concerned.

Children with other less acute serious illnesses/conditions that require care and supervision are also at risk of their illness/condition worsening if they are left to fend for themselves when their caregivers have to go to work. This can have far-reaching consequences for the child themselves, the child's family, and the surrounding community.

In the Children's Act 30 it is stated, among other things, that "the child must not be subjected to violence or otherwise handled in such a way that the physical or mental health is exposed to harm or danger". The child's need for protection and care appears from several provisions in the UN Convention on the Rights of the Child. The right to care is most clearly stated in Article 3 No. 2. In addition, Section 104 of the Constitution states that in all decisions concerning children, the child's best interests must be a fundamental consideration.

Refusing to write a medical certificate so that caregivers are not even given the opportunity to apply for care allowance from NAV, could in practice mean that BUP/HABU denies children with great care and supervision needs to have a caregiver with them, and thereby leaves these children to fend for themselves. However, we know from experience that parents do not leave their sick children to themselves and rather opt out of work/income, and therefore the current practice is more of a poverty trap for these already vulnerable families.

For those children who no longer have follow-up in the specialist health service, it is also a big challenge for the parents to obtain a doctor's certificate. Because the GP cannot write a medical certificate, these must be referred to the specialist health service, which must assess the referral, set up a telephone consultation or appointment, and then write this medical certificate. This is time-consuming for both parties, cumbersome and a huge waste of resources in an already hard-pressed specialist health service.

Caregivers who apply to NAV for care allowance without attaching a medical certificate are automatically rejected. This means that NAV does not make a real assessment of whether the conditions for care allowance are met, and that caregivers in such cases also do not have a real opportunity to appeal.

We hereby request the State Administrator to prepare a guidance letter to the country's BUPs and habilitation services stating what their tasks are when it comes to writing a medical certificate. We request that it be pointed out that caregivers are entitled to a medical certificate if the conditions are otherwise met. We also request that the State Administrator draw attention to the fact that it is a serious violation of legal certainty to refuse to write a medical certificate, as this is the only way caregivers can have a real opportunity to apply to NAV for care benefits based on current regulations.

With best regards
Løvemammaene