[Poland] L4 checks – ZUS increasingly withholding sickness benefits

For the first nine months of 2022 Social Insurance Institution (ZUS) conducted nearly 320 000 inspections of persons holding a certificate of temporary inability to work. More than 16 thousand of these ended in the withholding of sickness benefits.

Each year, ZUS conducts inspections of the correct use of sick leave. The latest figures show a reduction in the number of inspections, but the introduction of e-sick leave, has increased the effectiveness of monitoring irregularities and abuse.

Better ZUS inspections, less risk of abuse

Checks on the correctness of temporary inability to work are conducted by ZUS in accordance with the provisions of the Act of 25 June 1999 on monetary benefits from social insurance for sickness and maternity.

Between January and September 2022, there were 318 800 checks and 16 500 decisions to withhold sickness benefits (3 900 more decisions than in the previous year).

In total, the amount of reduced and withdrawn monetary benefits from social insurance for sickness and maternity in 2022 amounted to more than PLN 113 000, of which more than PLN 35 000 in Q3.

The above figures show an increased effectiveness of inspections, with a decrease in their numbers. For comparison, between January and September 2021 ZUS carried out 253.3 thousand checks and issued 12.6 thousand decisions withholding sickness benefits.

The growing effectiveness of checks is a consequence of the introduction of e-leave and the targeting the checks at the areas of highest risk of abuse. For example, checkers target people who are frequently on L4 or who receive leave from a number of different doctors.

When is an employer entitled to check L4?

Employers also have the power to control the correct use of sick leave, both when the sick person has received a note on the L4 that he or she “should lie down” and with the option “the sick person can walk”. The employer can conduct the inspection independently or outsource it to an external entity but keeping in mind to comply with data protection legislation.

An employing entity is entitled to control if:

• pays remuneration for the period of inability to work due to illness, the control covers the period for which the remuneration is due,
• determines the entitlement to cash benefits from social insurance for sickness and maternity and distributes such benefits to insured persons, since it notifies to sickness insurance more than 20 insured persons (the number of insured persons is determined for each calendar year according to the status as at 30 November of the preceding year, and in relation to payers who did not notify anyone to sickness insurance as at that date),

while an employer may control an employee as well as an insured person, e.g., a person working under a contract of mandate, to whom the employer pays:

• remuneration for periods of inability to work due to sickness,
• sickness benefit from sickness and accident insurance,
• care allowance,
• rehabilitation benefit from sickness and accident insurance.

The employer should conduct inspections without setting a date in advance, and the number of inspections may depend on the needs, e.g., more inspections if employees are on sick leave more often.

Moreover, the employer has the right to check the correct use of sick leave in the following places:

• at the employee’s place of residence,
• at the place of temporary residence (the address is stated on the medical certificate),
• at the place of work or at the place of non-agricultural activity (for an employee for whom the payer of contributions has information that he/she is also employed by another employer),
• at the place of performance of work under a contract of mandate for another entity,
• at another place, if the information available indicates that this is advisable.

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