Nearly PLN 1,300,000 returned to ZUS after an inspection of sick leaves in Lower Silesia during the first half of this year. The institution inspected 27,000 sick leaves. The result? 638 people were deprived of their benefits (as a result of improper use of sick leave), while ZUS medical examiners shortened the leaves of 1,159 people, having deemed them fit for work.

ZUS:

The Social Insurance Institution is becoming increasingly effective at detecting irregularities in the issuing and use of sick leaves. In the first half of 2019, ZUS questioned sickness benefits amounting to nearly twice as much as in 2017.

Across the country, in the first quarter of 2019, the Social Insurance Institution conducted 324,000 inspections of sick leaves. As a consequence, 21,100 decisions were issued suspending further payment of sickness benefits or questioning how the sick leave was used. The amount of benefits suspended for this reason in the first half of 2019 reached PLN 19,173,600.

“Month by month, we inspect more sick leaves because, after the introduction of the electronic e-ZLA system, even leaves lasting only a few days are immediately visible in our system. This allows us to inspect more quickly those that raise our doubts,” says Iwona Kowalska-Matis, regional press spokesperson for ZUS in Lower Silesia. “Therefore, it should not be surprising if, two days after going on sick leave, we are invited to an inspection by a medical examiner. The system also makes it possible to track the number of sick leaves issued to one person by, for example, different doctors,” she explains.

Who is subject to inspection?

Inspections primarily cover people who frequently take successive short-term sick leaves from different doctors or long-term sick leaves, as well as people who previously had to repay a benefit because they used sick leave improperly.

Inspections are also conducted among patients of doctors who issue large numbers of sick leaves. There are standards for the duration of illnesses, and the length of a sick leave is verified based on them. ZUS selects some sick leaves for inspection at random, so any leave may be checked.

The Social Insurance Institution is required to inspect both the correctness of decisions on incapacity for work and the proper use of sick leaves. In the first case, ZUS medical examiners verify whether a person on sick leave is still ill and whether continuing the leave is necessary, or whether it should be shortened.

An inspection of the proper use of sick leave involves checking whether the person taking the leave and receiving sickness benefits is working or performing other activities that are inconsistent with the doctor’s recommendations and may hinder recovery. If a person uses sick leave contrary to its purpose, the institution suspends payment of the benefit, and if it has already been paid, orders its repayment.

“ZUS is not the only body entitled to inspect how an employee uses sick leave. This may also be done by any employer who employs more than 20 people. Authorized company employees may visit the employee’s home to check whether they are actually recovering during the leave,” explains Iwona Kowalska-Matis.

An employer may also ask ZUS to conduct an inspection. In that case, an official will carry out the inspection and inform the employer of its results. If, during the inspection, it is found that an employee is using sick leave contrary to its purpose, they will lose the right to the benefit for the entire period for which the e-ZLA was issued.

A medical examiner may also inspect the issued sick leave documentation and, in case of doubt, invite the sick person to ZUS for a follow-up examination.