New regulations on controlling the use of L4 will come into force on Monday. The situations in which the insured person may lose the right to sickness benefit will also be clarified – the Social Insurance Institution told PAP. The changes will also cover medical certification in ZUS.
The amendment to the Act on the social security system and certain other acts, some of the provisions of which will enter into force on April 13, is based on two pillars – reform of medical certification in ZUS and reform of sick leave. The new regulations come into force in stages. The first ones, concerning the control of the correctness of adjudicating temporary incapacity for work and issuing medical certificates, came into force in January. The last part of the reform will enter into force at the beginning of 2027.
ZUS announced in a press release that the regulations coming into force on Monday specify that: an insured person may lose the right to sickness benefit for the entire period of leave from work if, during the period in which he or she was declared incapable of work, he or she performs paid work or undertakes activities that are inconsistent with the purpose of the leave. The plant emphasized that the principle that the period of leave from work should be used to regain health and convalescence remains unchanged. This means that the insured person cannot perform any activities that would disrupt this process during this time.
For this purpose, the concepts of paid work and activity incompatible with the purpose of leave from work have been clarified.
Paid work is any activity that is of a gainful nature, regardless of the legal relationship that is the basis for its performance. It is not the so-called incidental activities, i.e. activities that require significant circumstances to be undertaken during the period of leave from work (this cannot be an order from the employer).
Activity that is inconsistent with the purpose of leave from work is any activity that hinders or prolongs the treatment or convalescence process. These do not include ordinary everyday activities or incidental activities that require significant circumstances to be undertaken during the period of leave from work.
ZUS emphasized that checking the correct use of sick leave involves checking whether the insured person does not use it contrary to its purpose. He explained that the changes in the regulations concern the rules and procedures for carrying out such inspections. These changes, he added, include issues such as:
- rights and obligations of persons carrying out the inspection (e.g. to provide identification of the inspected person in order to establish his or her identity),
- obligations of inspected persons,
- rules for conducting an inspection, preparing an inspection report or submitting objections to the findings contained in the report.
Pursuant to the regulations, the Social Insurance Institution is currently authorized to carry out inspections of insured persons and persons after termination of sickness insurance regarding the correct use of sick leave.
The new regulations assume that the inspection will consist in determining whether the person is taking actions that exclude him or her from the right to temporary leave from work, and in the case of care allowance, also in determining whether, apart from the insured person, there are no other family members living in the same household who can provide care. Inspectors will be able to identify the person being inspected in order to establish their identity. They will also be entitled to enter the place where the inspection is carried out and to receive information from the inspected person, his/her contribution payer and the treating doctor.
New regulations on medical certification in ZUS will also come into force from Monday.
The Institute explained that the scope of ZUS's activities includes, among others, issuing decisions: for the purposes of determining entitlement to social security benefits and other benefits falling within the jurisdiction of ZUS, for the purposes of implementing tasks delegated to ZUS under other acts, for the purposes of benefits subject to community and bilateral (bilateral) coordination, and also as part of the control of judgments on temporary incapacity for work.
Currently, as he emphasized, these tasks are performed only by specialist doctors employed under employment contracts. After changes in the law, the forms of cooperation with medical staff will be flexible, and medical examiners, physiotherapy and nursing specialists will be able to perform work on the basis of an employment contract or a contract for the provision of services.
Moreover, in addition to medical examiners, judgments in specific cases will be able to be issued by persons holding the title of specialist in the field of physiotherapy (in matters of medical rehabilitation as part of ZUS pension prevention) or nursing (in matters of inability to live independently).
In addition to specialist doctors, doctors undergoing specialization training in a specific field of medicine and doctors with 5 years of professional experience who do not hold a specialist title and do not undergo specialization training will also be able to work as adjudicators.
The Institute announced that other changes, in particular regarding the organization of judicial proceedings and the new procedure for issuing judgments, will enter into force on January 1, 2027. (PAP)
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