ZUS inspectors went out into the field 660 thousand times. What were their charges against the sick?

In the first half of the year, ZUS conducted 260.8 thousand inspections regarding the correct use of sick leave. In 18.6 thousand cases, it found irregularities and issued a decision suspending further payment of sickness benefits. In this way, the institution saved PLN 23.9 million, almost PLN 117.5 million (this is the total amount of reduced and withdrawn cash benefits from social insurance). This was established by the daily “Fakt” after reviewing the inspection report.

Sick leave checks

The scale of abuse is not huge – the lion’s share of the inspected employees used their sick leave correctly: they stayed at their place of residence (or another place they informed ZUS about in the appropriate procedure), they did not work, they recuperated.

Inspectors can visit any patient, but in certain situations the risk of their appearance is greater. The first to be inspected are certificates that raise doubts due to, among other things, a period of incapacity for work that is inadequate for the illness or cases in which the insured person receives successive certificates from different doctors for different illnesses. Attention is also drawn to those who did not appear for an examination by a medical expert on the designated date or who had previously committed abuse.

The decisions of officials can be appealed to court

“Fakt” gave examples of patients who were proven to be performing activities that, according to ZUS, they should not have been performing during their sick leave. “A carpenter on sick leave due to a broken arm was caught planing pickets. As he said, he was doing it as part of his rehabilitation, a woman who was on sick leave due to depression performed in pubs, singing. As she explained, she was doing it as part of her therapy,” describes “Fakt”.

Insured persons whose benefit payment has been withdrawn may appeal to the court, which will assess whether they have committed any violations. An interesting example would be determining whether giving performances could have served the purpose of therapy. There is a popular belief that sick leave issued in connection with depression is subject to different rules than sick leave caused by, for example, pneumonia. There are different ways of overcoming mental illness or alleviating its symptoms, and being around people can help many patients, but will travel, volunteering and such activities not be questioned by ZUS?

What is allowed during sick leave from a psychiatrist?

TVN24 asked Paweł Żebrowski, the ZUS spokesman, to resolve the doubts. He explained that for ZUS it does not matter whether the sick leave is issued by a psychiatrist or another specialist.

– Sick leave certificates issued, for example, by an orthopedist for a damaged knee, or by a psychiatrist for a spine-related condition, or by a psychiatrist for depression are checked in the same way – says the ZUS spokesman. He explains that what is important is primarily whether the person on sick leave does not perform activities that prolong the time of their recovery.

You must inform ZUS about any change of place of residence.

He adds that sick leave was invented to help people recover. Also from a psychiatrist. – Sick leave has a very simple structure. There are two options: the patient either has to lie down or can walk. The doctor’s recommendations must be followed. Therefore, we cannot treat sick leave as a vacation or as a holiday. Also in the case of a certificate from a psychiatrist – the ZUS spokesman reminds.

The sick person can change their place of residence and, for example, move in with family so that they are not alone at home during the illness. However, they must inform ZUS about this. They can do this by phone or email.

More and more sick leave certificates issued by psychiatrists

The number of sick leave certificates issued due to mental and behavioral disorders has increased. In 2023, ZUS received 8.7 percent more such certificates than in 2022.

This group of diseases includes, among others, depression, schizophrenia, neurosis, neurotic disorders, personality disorders and reactions to severe stress.

Last year, doctors issued over 1.4 million medical certificates for disorders that fall into this group. Insured persons spent 26 million days of sick leave on such sick leave. In turn, in 2022, 1.3 million such certificates were issued for 23.8 million days of sick leave.

The diseases that were the main reason for issuing medical certificates for mental and behavioural disorders included:

• reaction to severe stress and adaptation disorders – 477.6 thousand medical certificates for 8.86 million days of sickness absence

• depressive episode – 251.6 thousand certificates for 5.14 million days,

• other anxiety disorders – 246 thousand certificates 4.77 million days.