ZUS withdrew sick pay because the sick person was not at home. The case went to court

ZUS withdrew sick pay because the sick person was not at home.  The case went to court

The insured person, using the exemption, may perform activities necessary to meet his or her basic life needs, the court emphasized. The case concerned the withdrawal of sickness benefit payments. ZUS inspectors did not find the patient at home and concluded that he did not use L4 properly.

In 2023, 461.2 thousand tests were carried out. control of certificates of temporary incapacity for work – that is, simply sick leave. This is more than a year earlier, when ZUS conducted 429.9 thousand control. This is necessary because many patients cheat and treat sick leave as additional leave. ZUS officials often issue decisions withdrawing the payment of sickness benefit – when they find that the sick leave was used incorrectly, e.g. the patient carries out renovation work even though he was supposed to rest.

What can you do on sick leave?

So what can you do on sick leave? Much depends on the recommendation of the doctor issuing the sick leave. L4 with code 1 means that the patient should lie down and stay at home. He can go to the store, pharmacy or doctor. In turn, L4 with code 2 means that the patient can walk and moving does not affect the condition of the disease.

This is of great practical importance, because in the event of an inspection by ZUS officials or a “delegation” from the company, the patient will not suffer any consequences if he is away from home or the inspectors find him doing garden work. In the case of dismissal with code 1, this portends big problems: ZUS may withdraw the previously granted sickness benefit and, if it has been paid, demand a refund. This is the beginning of unpleasantness, because if the inspectors find that the leave has been used incorrectly, they may order an inspection of the “correctness of adjudicating temporary incapacity for work”. So whether the sick leave was issued correctly and the employee is really sick.

People whose benefits have been withdrawn by ZUS appeal to the courts if they believe that the officials approached the matter too strictly. And they often find confirmation of their opinions there.

The inspectors did not find the patient at home

This was the case of an entrepreneur from the Kuyavian-Pomeranian Voivodeship, whose story was described by “Dziennik Toruński”. In February, he had an accident at work, which resulted in a shoulder injury. He went to hospital, where he underwent surgery. Afterwards, he was treated and rehabilitated.

After leaving the hospital, Mr. Kamil continued rehabilitation at home, as recommended. While on sick leave, the doctor wrote that he could walk, so he picked his daughter up from school, went for walks with her and did lighter shopping.

He was not at home when ZUS inspectors visited him. The office found that Mr. Kamil was abusing sick leave and should return the sickness benefit he had received unjustly. The man did not agree with this approach and appealed to the court.

Court on what you can do on sick leave

The court sided with the entrepreneur. In the judgment, he pointed out that the man did not even have the opportunity to justify himself to ZUS because the correspondence had not been effectively delivered to him. Most importantly, according to the court, Mr. Kamil used L4 correctly – reports “Dziennik Toruński”.

“The insured person, using the exemption, may perform activities necessary to meet his or her basic life needs and even change his or her place of residence for the duration of treatment. Importantly, he can, following medical recommendations, leave the house, e.g. for a walk. He may also go for a check-up or rehabilitation, including one carried out independently at home,” the judge wrote in the justification.

All the more so because walks and gentle exercises in an outdoor gym are conducive to rehabilitation, he added.

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