ZUS massively controls L4 and suspends payments. These people are checked most often

ZUS massively controls L4 and suspends payments.  These people are checked most often

When an employee is on sick leave, the Social Insurance Institution may inspect such a person. Find out who is most vulnerable to such verification by ZUS and what causes it.

The Social Insurance Institution (ZUS) massively inspects sick leave – data shows that 7 percent more such inspections were carried out in 2023 compared to the previous year. In 2023, the amount of withheld sickness benefits increased by 33 percent (in total, benefits withheld amounted to PLN 29.3 million). Additionally, last year, ZUS issued almost 29,000 certificates on the shortening of sickness benefits (an increase of 21 percent was recorded here). Who are the most suspected people of fraud in this matter?

Who should be most afraid of ZUS audits?

The Social Insurance Institution has been struggling for years with unjustified sick leave certificates (and, as a result, unfair benefits received by insured persons). However, ZUS systematically checks who is trying to cheat the system by carrying out checks on people staying on L4. If such sick leave is not used by the patient in accordance with its intended purpose or is issued without justification, sickness benefit may be withdrawn.

ZUS checks both the correctness of incapacity for work and the correct use of sick leave. People who are found to have such irregularities during an inspection by the Social Insurance Institution may lose the benefit. This happens, among others, when such a person performs other paid work, uses sick leave in a manner inconsistent with its purpose or is not entitled to such L4 at all. Employees who use sick leave improperly may lose the right to sickness benefits for the entire period of controlled leave – in such a situation, ZUS orders a refund.

Which people does ZUS check most often?

A random person may be subject to inspection by the Social Insurance Institution. However, much more specific groups of people are also exposed to such verification. This is due to the fact that the behavior of such employees is simply more suspicious for the Social Insurance Institution. We are talking about people who take short-term but frequent sick leave. The risk of such checks also increases in the case of employees who receive many sick leaves from different doctors. ZUS may also more frequently check people whose right to benefits has already been revoked. It is shocking how Poles cheat on L4 – this is why ZUS “takes a closer look” at those who may be dishonest. Interestingly, companies have found a way to massively abuse sick leave by their employees.

When does sickness benefit stop?

If, during the verification of the correctness of the determination of temporary incapacity for work, the ZUS certifying doctor proves that the checked person is already healthy, he or she retains the right to sickness benefits, but only until the date of the examination. People on sick leave who have already used up the full benefit period, i.e. 182 days a year (in the case of pregnant women and tuberculosis patients, it is 270 days), should also be afraid of withholding money paid by the Social Insurance Institution. If such a person is still unable to work, he or she may apply for rehabilitation benefits.

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