Facts
The patient lodged a complaint with the president of the National wellness Fund, in which she reported irregularities concerning the basic wellness care benefits granted to her. She alleged a misdiagnosis by the treating physician, defective treatment, withdrawal from the treatment of the applicant by the doctor and the full subject, incorrect classification of visits/teleparades.
She then brought an action before the Provincial Administrative Court against the inaction of the president of the NFZ.
In its answer to the complaint, the president of the NFZ indicated that:
- The Fund has the competence to control or interfere with the activities of medical entities only within the scope of the Act provided for and these are not all areas of activity of those entities,
- The NFZ shall consider, in a complaint procedure, client reports on the activities of the Fund and public wellness care providers in relation to the performance of the benefits financed by the public payer, the NFZ,
- the correct implementation of benefits is not assessed by the Fund, but may be raised before the Ombudsman for the Professional work of the Medical Chamber and besides by the Ombudsman for Patient Rights – the complaint revealed that the applicant had besides applied to these institutions,
- The applicant received an immediate, detailed and comprehensive answer to each of its letters.
Resolution of the WSA
When examining the complaint, the WSA stated that:
- to bring an action for inaction of the authority or to the degree that a decision, order or another act or act in the field of public administration may be brought before the administrative court,
- Inaction of the Authority shall take place where no action has been taken in the case or has been delayed by the Authority within the set time limit and, despite the statutory obligation, it has not been completed by the applicable act or by the appropriate act.
The patient brought a complaint to the president of the NFZ in which she accused of violating patients' rights, deficiency of systemic solutions and negligence.
However, specified a complaint is not handled by decision. Rules on complaints and requests (Article 221 of the KPA and subsequent).
Complaint-application mode is:
- one-off simplified procedure,
- completed notification of the manner in which the complaint was handled,
- not subject to administrative and judicial review.
Further, the WSA explained that in accordance with Article 227 of the KPA, the subject substance of the complaint may be in particular:
- failure or inadequate performance of tasks by the competent authorities or their staff,
- violation of the regulation of law or the interests of the applicants,
- chronic or bureaucratic handling.
The complaint should be handled without undue delay, no later than 1 month. The complainant shall be informed of the method of handling the complaint. The notification shall not take the form of a controlled administrative court referred to in Article 3(1) of the Law of 30.8.2002. – Law on proceedings before administrative courts (i.e. diary of Laws of 2024 item 935).
This means that the case does not fall within the jurisdiction and area of examination of the administrative court. The way in which the case is handled would be to make a complaint against the inaction of the authority in this case. If the authority does not make a decision or a decision, but simply informs about the way in which the complaint is handled, the WSA is not competent to examine whether there has been chronicity.
Consequently, the CSA rejected the complaint as inadmissible.
Order of the Provincial Administrative Court in Warsaw of 16.12.2025, I SAB/Wa 237/25, Legalis
