Inspection of the validity of rulings of temporary incapacity for work

The Act of 25 June 1999 on social insurance benefi ts under social insurance in the case of sickness and maternity introduced provisions aimed at strengthening the regulation of the inspection of the validity of rulings of temporary incapacity for work and the control of medical certificates in this regard, as well as the rationalisation of expenditure on benefits in respect of sickness and maternity. They are the following:

  • an obligation to submit (to the employer or a ZUS branch) a certificate of incapacity for work within 7 days from the day of its receipt,
  • the limitation of an opportunity to receive the allowance in respect of an incapacity for work that occurred after the end of sickness insurance and limitation of the calculation basis of this allowance to 100% of the average remuneration calculated on the basis of the average monthly remuneration from the previous quarter,
  • the introduction of the qualifying period of 30 days for persons compulsorily insured and a qualifying period of 90 days for persons covered by sickness insurance on a voluntary basis.

ZUS evaluating doctor monitors the correctness in the certification of temporary incapacity for work and controls the issuing / use of medical certificates.

In 2016, 569,500 such controls were carried out as a result of which 22,200 individuals were judged to have abused the terms of temporary incapacity for work and had their sickness allowance payments stopped. The sum of suspended allowances resulting from the controls was PLN 16.3 million.

Pursuant to statutory regulations, the Social Insurance Instituti on is obliged to reduce the calculation basis of the sickness allowance and of the rehabilitation benefit if the insurance entitlement has ceased. In such a case the benefit amount is limited to 100% of the national average monthly remuneration. The amount of benefits limited in this respect in 2016 was PLN 183.4 million. 209.9 thousand people found themselves in such a situation.

The insured person is obliged to submit a medical certificate to the contribution payer within 7 days from the date of certificate obtainment. If this obligation is not complied with for reasons attributable to the insured person, the amount of sickness and care allowance is reduced by 25% starting from the eighth day of the certified incapacity for work to the date when the certificate was delivered. The mentioned reduction does not apply to sick pay. In 2016 allowance payments were reduced in this respect by a total amount of PLN 4.2 million.

The total amount of cash benefits in the case of sickness and maternity which were reduced and withdrawn in 2016 was PLN 203.8 million.

(Note: 1 EUR = ca 4.26 PLN)