Inspections of pregnant women at ZUS. The office withholds the money. There were strong arguments about “circumventing the law”

Paying sickness benefits before confirming eligibility would be illegal, ZUS said in response to the Ombudsman's letter. This concerns suspending the payment of benefits to pregnant women due to ongoing proceedings regarding the determination of the right to benefits.

The Social Insurance Institution responded to the letter of the Ombudsman in which he addressed the Social Insurance Institution (ZUS) regarding the problem of the Institution suspending the payment of sickness insurance benefits to pregnant women during an inspection of their social insurance coverage.

ZUS talks about attempts to circumvent the law

In response, ZUS pointed out that verifying whether a person registered for social insurance actually has the right to it is the ZUS's right resulting from the scope of its activities. He added that a person's coverage of social insurance as an employee is conditional on his or her actual employment relationship and the Institute has the right to investigate this fact.

“An agreement concluded for the sake of appearance or to circumvent the law does not produce legal effects, including in the field of social insurance. This is confirmed by court decisions,” ZUS emphasized.

He stressed that in each case of justified doubts regarding an important circumstance necessary to establish the right to the benefit, which is also the fact of having the right to sickness insurance, he will be entitled and even obliged to take action to clarify them.

“At the same time, the payment of benefit benefits de facto before confirming the entitlement to the said benefits would be inconsistent with the provisions of the law, including the Benefit Act, which states that cash benefits under the conditions and in the amounts specified in the Benefit Act are due to persons covered by social insurance in the event of sickness and maternity, and their payment may only take place after the Institute confirms the entitlement to these benefits,” he emphasized.

He noted that the Institution pays benefits on an ongoing basis after confirming eligibility, and the payment of benefits takes place no later than 30 days from the date of clarification of the last circumstances necessary to establish the right to benefits.

“An expression of concern for the correct spending of funds”

He also emphasized that a thorough examination of social insurance coverage, including sickness insurance, is the responsibility of the Institute and an expression of care for the correct spending of funds from the Social Insurance Fund.

In his application to ZUS, the Ombudsman emphasized that the constitution guarantees special assistance to families in a difficult financial and social situation.

Citing court case law, he emphasized that the mere desire to obtain social security benefits as a motivation to take up employment does not indicate the intention to circumvent the law, just like other goals set by persons concluding employment contracts, such as the desire to obtain means of subsistence.

“Concluding an employment contract during pregnancy, even if the main motive was to obtain maternity benefits, is also not reprehensible or even contrary to the law,” he said.

He also emphasized, citing the judgment of the European Court of Human Rights, that different treatment of a pregnant employee based on an attempt to circumvent the law or obtain undue social benefits must be assessed as a manifestation of discrimination, because it may only apply to women.

Moreover, according to the Commissioner for Human Rights, women before and after childbirth do not have the strength or resources to actively participate in evidentiary proceedings and use appeal measures. (PAP)

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