Under its statutory powers, the Social Insurance Institution conducts checks both on the correctness of decisions declaring temporary incapacity for work and on the proper use of sick leave.
– In the first case, the patient is invited to an examination by a medical examiner, who verifies whether the person on sick leave is still ill – says Iwona Kowalska, ZUS’s regional press spokesperson in Lower Silesia. – If the examiner decides that the patient has recovered, the period of sick leave will be shortened and they must return to work – she warns.
In the second type of inspection, ZUS employees check whether a sick person on leave is using it in accordance with its purpose—that is, whether they are not working professionally or performing other activities that could prolong their recovery.
– This means that anyone who has a medical certificate for sick leave may be inspected by ZUS as many as twice during a single period of leave – explains Iwona Kowalska.
Throughout 2017, the Social Insurance Institution carried out nearly 500,000 inspections of people holding certificates of temporary incapacity for work. As a consequence, 25,100 decisions were issued to suspend further payment of sickness benefits. The amount of payments suspended for this reason was PLN 23.2 million.
In the fourth quarter alone, the amount of suspended benefits was PLN 10.3 million. Importantly, the Act on cash benefits from social insurance in the event of sickness and maternity also obliges the Social Insurance Institution to reduce the basis for calculating a sickness benefit or rehabilitation benefit when a person’s insurance entitlement has ended—for example, when an employment contract has been terminated or has expired. In such cases, the benefit is capped at 100% of the average monthly wage in the country.
For this reason, from January through the end of December 2017, payments to more than 195,000 people were reduced by a total of PLN 173.4 million. Another reason for limiting the amount of a sickness benefit is late delivery of the medical certificate to the employer. If an employee on sick leave does not provide it to the employer within seven days of the date it was issued, the institution reduces the benefit paid by 25% for each subsequent day until the certificate is delivered. Payments were reduced by PLN 4.1 million for this reason, affecting 66,300 people.
In total, the amount of reduced and withdrawn cash benefits from social insurance in the event of sickness and maternity in 2017 was PLN 200.7 million.