Bulgaria disability assessment: TELK, NELK and appeals

The Ordinance on Medical Expertise (НМЕ) is among the most frequently applied, and most frequently appealed, secondary acts in social security practice. The expert decisions of the Territorial Expert Medical Commissions (ТЕЛК) and the National Expert Medical Commission (НЕЛК) determine the right to a disability pension, to cash benefits and to a wide range of social entitlements, and procedural errors at the assessment stage regularly lead to a court annulling the decision.

In this analysis we set out the current wording of the НМЕ: the two types of medical expertise, the hierarchy of bodies (treating doctor, ЛКК, ТЕЛК, НЕЛК), the logic of the percentage assessment and the chain of appeal up to the Supreme Administrative Court (ВАС). The text is aimed at lawyers working on social security cases, payroll and HR specialists and medical experts who work with the current rules.

Legal framework: НМЕ, the Health Act (ЗЗ) and ПУОРОМЕРКМЕ

The current Ordinance on Medical Expertise was adopted by Council of Ministers Decree No. 120 of 23 June 2017 and repeals the previous ordinance of 2010 (adopted by Decree No. 87 of 2010). The ordinance sets out the principles and criteria of medical expertise and the procedure for carrying it out, and is issued under the section on medical expertise in the Health Act (ЗЗ).

The НМЕ does not operate in isolation. It works together with the Rules on the Structure and Organisation of Work of the Bodies of Medical Expertise and the Regional Files of Medical Expertise (ПУОРОМЕРКМЕ), which govern the composition and organisation of ТЕЛК, НЕЛК and the regional files of medical expertise (РКМЕ), as well as the principle of random allocation of case files. The Rules were also amended by Decree No. 47 of 2024.

Types of medical expertise

The НМЕ distinguishes two main types of medical expertise, which differ in subject matter, competent body and the kind of act issued. Correctly identifying the type of expertise is the first step in analysing any case, because it determines which body is competent and how the decision is appealed.

Bodies of medical expertise: treating doctor, ЛКК, ТЕЛК, НЕЛК

Article 3 of the НМЕ sets out the hierarchy of bodies. Paragraph 1 lists the bodies that carry out expertise on temporary incapacity for work, and paragraph 2 provides that expertise on permanently reduced working capacity and on the type and degree of disability is carried out only by ТЕЛК and НЕЛК, with a reference to acquiring the right to a pension under Art. 68 of the Social Insurance Code (КСО).

ТЕЛК are the territorial expert medical commissions that carry out the first-instance assessment. НЕЛК is the national commission that acts as the review and second-instance body for ТЕЛК decisions. This two-tier structure is key to the appeal procedure, discussed below.

Assessing permanently reduced working capacity as a percentage

The assessment of permanently reduced working capacity and of the type and degree of disability is made as a percentage, based on reference points set out in the annexes to the ordinance. These annexes contain the methodology that medical experts use to determine the percentage for the particular illness or impairment.

Through amendments to the ordinance over the years, the range of cases in which the degree of disability is determined for life, without later re-assessment, has been widened. The specific percentage values and the cases of lifelong determination depend on the version of the annexes in force, so when analysing an individual case you need to check the current consolidated text rather than rely on memory.

Judicial review of the methodology: ВАС Decision No. 1632/2020

The secondary legislation on medical expertise is itself often the subject of judicial review. A telling example is the court’s annulment of part of the methodology for applying the reference points for assessment, which illustrates the importance of procedural requirements when normative acts are adopted.

Two clarifications matter when citing this decision. First, Decision No. 1632/2020 was given by a three-member panel and was upheld by a five-member ВАС decision of the same year, so the two acts should not be confused. Second, the annulled item III of the methodology was later restored in identical form by Council of Ministers Decree No. 241 of 2020 (State Gazette issue 79 of 2020). The effect of the annulment was temporary, and the provision should not be presented as permanently gone.

Expert decisions of ТЕЛК and НЕЛК on the disability percentage generate an extensive body of administrative case law. Arguments drawn from this case law should be presented descriptively, and only verified acts should be cited by number, because citing non-existent details undermines trust in the legal analysis.

Appealing expert decisions: НЕЛК and judicial review

The chain of appeal follows the two-tier structure of the bodies and continues in the administrative courts. A ТЕЛК decision is appealed to НЕЛК, and a НЕЛК decision is subject to judicial review before an administrative court, whose ruling can in turn be appealed before the Supreme Administrative Court under the Administrative Procedure Code (АПК).

Practical guidance for lawyers and employers

For a practising lawyer, analysing a dispute over medical expertise starts with correctly identifying the type of expertise, the competent body and the applicable version. For employers and payroll and HR specialists, the НМЕ directly affects how sick notes are accepted and the obligations that apply to an employee with permanently reduced working capacity.

For quick navigation in related material, see also our articles for the general public on the ТЕЛК pension at 50% disability and on how a sick note is calculated, which cover the practical consequences of expert decisions for citizens.

To follow how the bodies of medical expertise are organised, the official website of НЕЛК is useful, and for the link to the right to a pension, see the information from the National Social Security Institute (НОИ) on the pension under Art. 68 КСО.