Inspection of the validity of rulings of temporary disability allowance
3 listopada 2016
The Act of 25 June 1999 on cash social insurance benefits in respect of sickness and maternity introduced provisions aimed at strengthening the regulation of the correctness of certifying an 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 assessment 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.
On the strength of the act ZUS appointed doctors conduct the monitoring of the correctness in the adjudication of temporary work disability as well as controlling the issuing / use of medical sick notes.
In 2014 609,400 such controls were carried out as a result of which 35,700 individuals were judged to have abused the terms of temporary work disability and had their sickness benefit payments stopped. The sum of suspended benefit resulting from the said was PLN 18.6 million.
Pursuant to statutory regulations, the Social Insurance Institution is obliged to reduce the assessment 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 salary. The amount of benefits limited in this respect in 2014 was PLN 151.8 million.
The insured person is obliged to submit a medical certificate to the contribution payer within 7 days from the date of certificate receipt. 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 2014 allowance payments were reduced in this respect by a total amount of PLN 6.5 million.
The total amount of cash social insurance benefits in respect of sickness and maternity which were reduced and withdrawn in 2014 was PLN 177 million.
(Note: 1 EUR = ca 4.32 PLN)