Correctness control of certifying temporary incapacity for work

The Act on cash social insurance benefits in respect of sickness and maternity introduced provisions aimed at strengthening the control of correctness of certifying the incapacity for work and control of taking advantage of medical certificates in this regard. Their aim was also to rationalise expenditure on these benefits. To achieve this, the following solutions have been introduced:

• the right to allowance due to incapacity for work after cessation of sickness insurance was restricted,
• the basis for allowance assessment after cessation of sickness insurance was limited to 100% of the average wage/salary from the previous quarter,
• a waiting period has been introduced:
  • 30 days for persons insured compulsorily,
  • 90 days for persons insured voluntarily.

The Social Insurance Institution controls the correctness of certifying temporary incapacity for work and the correctness of the use of sick leaves. The use of sick leaves may be also monitored by allowance payers.

In 2023, ZUS carried out 461.2 thousand such inspections, including 372.2 thousand inspections of the correctness of certifying temporary incapacity for work. Due to improper use of sick leave, payment of sickness allowances to 28.9 thousand people was withheld for an amount of PLN 29.3 million, while the total amount of sickness allowances withdrawn due to irregularities in certification amounted to PLN 12.8 million.

ZUS must also reduce the assessment basis for sickness allowance and rehabilitation benefit when the insurance entitlement has ceased. The total amount of benefits reduced in this respect in 2023 for 96.5 thousand people was PLN 147.7 million.

The total amount of sickness insurance benefits reduced and withdrawn in 2023 was PLN 177.0 million.