Correctness control of certifying temporary incapacity for work

The Act of 25 June 1999 on cash social insurance benefits in respect of sickness and maternity introduced provisions aimed at strengthening the correctness control of certifying the incapacity for work and the control of the correct use of medical certificates on incapacity for work. Inspections were also aimed at rationalising expenditure on these benefits. To achieve this, the following solutions were introduced:

  • the employee had to provide the employer or the Social Insurance Institution with the printout of ZUS ZLA in paper form within 7 days from receiving it,
  • the right to allowance in respect of incapacity for work after cessation of sickness insurance has been limited,
  • the assessment basis of the allowance assessment after the cessation of sickness insurance has been limited to 100% of the average remuneration from the previous quarter,
  • the qualifying period has been introduced:
    • 30 days for people insured compulsorily,
    • 90 days for people insured voluntarily.

ZUS controls the correctness of certifying temporary incapacity for work and the correctness of use of medical certificates on incapacity for work. The use of sick leaves may be also monitored by allowance payers.

In 2018, ZUS carried out 496.3 thousand inspections. As a result, it suspended payment of sickness allowances to 32.6 thousand people. The amount of the withheld allowances was PLN 31.2 million.

The Social Insurance Institution must also reduce the assessment basis for the assessment of sickness allowance and the rehabilitation benefit when the insurance entitlement has ceased. The total amount of benefits reduced in this respect in 2018 for 166.7 thousand people was PLN 160.3 million.

The insured person, who has received a medical certificate on incapacity for work in paper form before 1 December 2018, had to submit it to the contribution payer within 7 days. If this obligation was not complied with (for reasons attributable to the insured person), ZUS reduced the sickness allowance, as well as the care allowance, by 25%. The reduction was applicable from the 8th day of incapacity for work until the day when the insured person delivered the certificate. In 2018, ZUS reduced benefits in this respect for 52.7 thousand people to a total of PLN 3.5 million. The reduction does not apply to sick pay.

The total amount of cash social insurance benefits in respect of sickness reduced and withdrawn in 2018 was PLN 195.0 million.