Amendment The Act on the Social Insurance System, which enters into force on April 13 this year, specifies situations leading to the loss of the right to benefits. sick leave.
ZUS may deprive the insured person of benefits for the entire period of leave from work, if during L4 you will be in paid work or doing things that make your recovery more difficult. As ZUS emphasizes, The rule requiring the use of the leave period for recovery and convalescence remains unchanged.
The new regulations define paid work as any activity of a gainful nature, regardless of the legal relationship that is the basis for its performance. It does not include incidental activities, i.e. those that must be performed for important reasons. However, this cannot be an order from the employer.
Activity inconsistent with the purpose of sick leave
Activity inconsistent with the purpose of leave from work includes any activity that hinders or prolongs the treatment or convalescence process. It does not cover ordinary everyday activities or incidental activities that require significant circumstances to be undertaken during leave – informs ZUS.
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The reform also introduces detailed rules for monitoring the use of sick leave. The changes include the rights and obligations of persons carrying out the inspection, which include, among others, verifying the identity of the inspected person in order to establish his or her identity. The regulations also specify the obligations of the insured persons subject to inspection and the manner of preparing an inspection report and submitting objections to the findings contained therein.
Powers of ZUS controllers
The inspection is to determine whether the person does not take actions that exclude him from the right to temporary leave from work. In the case of care allowance, the inspectors will also check whether, apart from the insured person, there are no other family members living in the same household who can provide care.
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Inspectors will be entitled to identify the inspected person, enter the place of inspection and receive information from the insured person, his/her contribution payer and the treating doctor.
Changes in ZUS medical certification
The new regulations also change the rules of medical certification at the Social Insurance Institution. ZUS issues decisions for the purposes of determining entitlement to social security benefits, for the purposes of carrying out assigned tasks and as part of the control of decisions on temporary incapacity for work.
Currently, these tasks are performed only by specialist doctors employed under employment contracts. After the changes, ZUS will be able to employ doctors on various terms – 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.. In addition to certifying physicians, judgments in specific cases will be issued by persons holding specialist titles in the field of physiotherapy or nursing.
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Doctors undergoing specialization training in a specific field of medicine and doctors with five 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.
