Revolution in ZUS medical boards. The government adopted the reform project

On Tuesday, the government adopted a project to reform medical certification in ZUS. The regulation assumes the improvement and standardization of the method of issuing decisions by ZUS medical examiners and the rules for controlling sick leave. The situations in which you may lose sickness benefits have also been clarified.

The deregulation project was prepared at the Ministry of Family, Labor and Social Policy. As the Chancellery of the Prime Minister said in a statement after the Government meeting, “thanks to the new regulations, the waiting time for judgments will be shortened and their quality will be improved,” and the adopted solutions will guarantee better working conditions for certifying doctors, which is intended to make up for staff shortages.

These judgments authorize, among others:

• to a disability pension,
• to the care supplement,
• to a social pension.

In addition, ZUS certifying doctors check the correctness of certifying temporary incapacity for work and issuing medical certificates.

According to the Chancellery of the Prime Minister, changes are being introduced regarding the rules for employing ZUS certifying doctors. Medical examiners will be able to choose whether they want to work under an employment contract or a service provision contract.

Clear rules regarding doctors' remuneration are also being introduced, based on multipliers of the average national salary (salaries will increase by approximately 25%), the release said.

The project also provides for the introduction of changes in the qualifications required of medical examiners, i.e. the possibility of employing – apart from specialist doctors – also doctors without the title of specialist, provided that they undergo specialization training in a specific field of medicine and complete the basic module appropriate for a given training or practice the medical profession for at least five years.

The regulation provides for the possibility of issuing judgments in specific types of cases by specialists practicing independent medical professions. In cases of therapeutic rehabilitation, as part of disability prevention in the scope of the profile of the musculoskeletal system, decisions will be issued by physiotherapists, and in cases in which inability to live independently is determined – by nurses.

“The decision to refer the case to a physiotherapist or nurse will be made by the chief medical examiner,” the government information emphasized.

The project also assumes changes to the organizational structure of medical certification. It proposes consolidation of tasks related to issuing judgments and direct supervision over adjudication in judgment centers that will be established in ZUS branches. As stated in the announcement, ZUS jurisprudence will be consolidated in larger units, which will ensure easier access and better service for patients.

ZUS doctors will also receive support from medical assistants. According to the Chancellery of the Prime Minister, this solution will relieve them of administrative tasks. In addition, a maximum 30-day deadline for issuing a decision will be introduced.

The adjudication model will also change. Single-person adjudication will be introduced in all cases. Both in the first and in the second instance, as a result of filing an allegation of defectiveness or objection, decisions will be issued by a single person (the person who issued the first decision cannot adjudicate in the second instance). Currently, in the first instance, the decision is issued by a single certifying physician, and in the second instance – by a three-person medical commission.

“People who applied for therapeutic rehabilitation and were refused a referral will be able to appeal against this decision to the district court,” the statement said.

As emphasized, the project also assumes increased supervision of the President of ZUS over the quality of judgments. It will be possible to reconsider defective judgments. The application of the principles of jurisprudence in all types of cases conducted by medical examiners and independent medical professionals will be unified.

It has also been clarified when sickness benefits can be lost. It will be lost to people who perform paid work during their leave (except for minor activities, such as shopping) or activities that prolong the illness (e.g., a forced trip during convalescence).

The regulation also introduces the possibility of taking leave in one place and working in another (e.g. for people with two jobs – if the nature of the work allows it).

The project also introduces new rules for controlling sick leave. The Social Insurance Institution will be entitled to carry out inspections of insured persons and persons after the termination of sickness insurance regarding the correctness of the use of leave from work in accordance with their purpose. The institution will be able to request the entity issuing the medical certificate or the entity providing health services where the medical certificate was issued to provide medical records relating to the insured person or a sick family member.

In principle, the act is to enter into force on January 1, 2026 (PAP)

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