A spokesperson for the Social Insurance Institution, Paweł Żebrowski, summarized the results of medical dismissal checks carried out between January and September 2023. He pointed out that the amount of benefits reduced and withdrawn after these checks amounted to almost PLN 130 million.
According to his rights, the Social Insurance Institution applies 2 different types of medical exemptions checks. The first focuses on monitoring the usage of medical exemptions, checking that the persons covered are not abused. The second audit focuses on assessing the correctness of the judgement on temporary incapacity for work, in order to guarantee that medical leave is granted in accordance with the actual condition of the patient.
Medical discharge check. What does ZUS check?
When examining the correctness of the usage of medical exemptions, representatives of the Social Insurance Institution (ZUS) carefully check whether the persons covered by the exemption are taking up work or engaging in another activities that may possibly hold their recovery, specified as, for example, renovation work at the place of residence. The ZUS spokesperson notes that specified control may besides be carried out by employers with more than 20 employees.
In the case of an assessment of the correctness of the judgement on temporary incapacity for work, the doctors of the ZUS shall carefully check whether the individual utilizing the e-ZLA is inactive sick and whether it is essential to keep the dismissal or whether it is possible to shorten it. The Ombudsman adds that this check may besides be based on an analysis of the medical records on the basis of which the doctor issued the discharge.
In the same year, from January to September, ZUS carried out almost 337 000 medical sick leave checks throughout the country. As a result, 20,6 1000 decisions were taken to suspend further payment of sickness benefits, which translates into the amount of suspended benefits of PLN 19,4 million.
Withdrawal of sickness benefit results in correction of contributions
This information suggests that from January to September 2023 in Poland there was a crucial decrease and withdrawal of sickness benefits worth PLN 129 million 377 thousand. The Social Insurance Institution (ZUS) emphasizes that persons who incorrectly benefit from a medical exemption may lose their right to receive sickness benefits for the full period covered by the controlled exemption.
If an irregularity is found in the usage of a medical certificate, ZUS takes steps to halt payment of sickness benefits. If the benefit has already been paid, ZUS may order its reimbursement. This is simply a countermeasure to defend the strategy from abuse.
It is besides worth noting that in the case of checking the correctness of the judgement on temporary incapacity for work, if the doctor of the Social safety Office finds that the individual being examined is already healthy, the period of medical leave may be reduced. In specified a situation, the patient retains the right to receive sickness benefit only until the date of the examination, which aims to effectively adapt the benefits to the actual needs.
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