As a result of inspections in the Legnica, Wałbrzych and Wrocław branches, PLN 731,110.20 returned to ZUS. As in the previous year, the Legnica ZUS branch recovered the most money—PLN 322,886.19; the Wrocław branch recovered PLN 188,289.45, while the Wałbrzych branch recovered PLN 58,896.70.

Anyone on sick leave may be inspected by the Social Insurance Institution (ZUS) as many as twice. ZUS checks both whether the person on leave is genuinely ill and how they use the leave.

“The amount of payments challenged following ZUS inspections is almost twice as high nationwide this year as in the same period last year,” says Iwona Kowalska, ZUS spokesperson in Lower Silesia. “However, the number of people whose benefits the Institution reduced as a result of losing their insurance entitlement has fallen considerably, which shows that we take sick leave less often after losing our jobs.”

What does ZUS verify?

Under the Act on Cash Benefits from Social Insurance in the Event of Sickness and Maternity, the Social Insurance Institution is required to systematically inspect both the correctness of decisions on temporary incapacity for work and the proper use of sick leave. In the first type of inspection, ZUS medical assessors verify whether a person using sick leave is still ill and therefore unable to work. In the second type, ZUS employees check whether the person is using the leave for its intended purpose rather than, for example, working while on leave.

How many people were inspected?

In the first half of this year, the Institution conducted 241,100 inspections nationwide of people who were on sick leave. This was nearly 25,000 fewer inspections than in the same period of the previous year. However, this year’s verification of sick leave proved considerably more effective. There were nearly 15,000 decisions suspending further benefit payments, compared with just over 10,500 in the first half of the previous year. The amount of suspended benefits increased even more—almost twofold—to PLN 12.6 million (PLN 6.9 million in the comparable period of 2017).

How does it work?

Under its powers, the Social Insurance Institution reduces the assessment basis for sickness benefits to 100% of the average monthly wage when a person on sick leave loses their entitlement to sickness insurance, for example as a result of an employment contract expiring. On this account, in the first half of this year ZUS reduced sickness and rehabilitation benefits for more than 90,000 people, by nearly PLN 83.5 million in total. In the same period of the previous year, the corresponding figures were nearly 105,000 people and PLN 89.3 million.

When does ZUS reduce a benefit?

Until electronic sick leave comes into widespread use on 1 December 2018, the Social Insurance Institution is required to reduce benefits by 25% for anyone who fails to submit their sick leave to their employer or ZUS within seven days. The benefit is reduced for each day of delay, starting from the eighth day of leave. In the first half of this year, the Institution reduced sickness benefits on this account by nearly PLN 2.1 million. In the same period of the previous year, the amount was PLN 2.19 million.

In total, during the first half of 2018, ZUS suspended or reduced sickness benefits worth PLN 98.1 million.