Is the doctor going to make that mistake in e-ZLA? ZUS will definitely take your sickness allowance

The Social Insurance Institution in 2025 intensified checks on sick leave, and the mark was one, frequently underestimated detail. New, automated ZUS systems unmistakably detect irregularitieswhich may have escaped the attention of officials so far. The consequences for patients are devastating – withholding or even full failure of entitlement to sickness benefit. 1 insignificant mistake of the doctor in the electronic release (e-ZLA) is adequate for thousands of Poles to lose key financial support during the illness. The problem is serious due to the fact that the work is formally on the doctor, but the patient bears the most serious financial consequences of the mistake. Experts are alerting that the scale of the phenomenon may increase, and the key to protecting your money is to proactively check all paper issued on our behalf.

What is the fresh “hook” of ZUS? This code determines your money.

The key component that ZUS began to verify is Correct entry of the letter code of the illness in the e-ZLA form. This is not the statistical number of the illness (ICD-10), but a peculiar indication that has a direct impact on the amount and period of payment of the benefit. Doctors, frequently acting under force of time, may omit it or enter it incorrectly, which ZUS systems immediately flag as a basis for questioning the release.

In practice, this means that if your inability to work is caused by e.g. pregnancy and your doctor forgets to enter code ‘B’, you will receive a standard 80% benefit base alternatively of due 100%. The same is actual of another codes:

• Code ‘A’ – inability to work was created after a break of not more than 60 days, due to the same illness which caused inability to work before the break.
• Code ‘B’ – incapacity for work during pregnancy (allows up to 100% of the allowance).
• Code ‘C’ – inability to work due to alcohol abuse.
• Code ‘D’ – inability to work due to tuberculosis.
• Code ‘E’ – incapacity for work caused by an infectious illness whose hatching period is more than 14 days, or another illness whose illness symptoms appear after more than 14 days from the start of the disease.

The deficiency of an appropriate code, in peculiar ‘B’ or ‘D’, is simply a signal for ZUS that the benefit can be paid at a lower amount or for a shorter period. ZUS has no work to guess the reason for the dismissal – works on the basis of hard data from the system. If the data is incorrect, the decision will be unfavourable for the insured person.

Why is ZUS stepping up controls? Automation and search for savings

The tightening of the course by the Social Insurance Institution is not accidental. This is due to 2 main reasons. First of all, advanced digitisation and implementation of analytical algorithms let for instant screening of millions of e-ZLA in search of the slightest inconsistencies. What erstwhile required the work of an army of officials, present is simply a vending device that knows no mercy and does not let interpretation. The strategy is programmed to capture formal errors and they have become the simplest way to question benefits.

Secondly, it is no secret that public finances, including the budget of the illness Fund, are under tremendous pressure. In 2025, ZUS actively seeks savings, and 1 of the most effective fields to find them is the payment of benefits. Formal control is much cheaper and faster than questioning medical grounds for dismissalwhich requires the engagement of jurisprudence doctors. Therefore, officials focus on what they can challenge most easy – on errors in documentation. For ZUS it is simply a pure profit: little paid benefits with minimal administrative effort.

How to check your e-ZLA and defend yourself from losing your allowance?

In this situation, the only effective defence is to take the initiative. Each insured individual should consider checking his e-ZLA as an absolute work immediately after visiting a doctor. Fortunately, it is simply a simple process and does not require leaving the house. Just net access and profile on Electronic Services Platform (PUE) ZUS.

Here is simply a step-by-step instruction on how to verify key data:

1. Sign in to your account on the site pue.zus.pl (you can do this with a Trusted Profile, electronic banking or qualified certificate).
2. Select the tab in the main panel ‘Safety’.
3. From the left menu choice the option ‘Medical release’.
4. Your latest (and archive) e-ZLA will appear on the list. Click on them to see the details.
5. Pay peculiar attention to the field ‘Type code’. Make certain your doctor has a correct letter in there if your situation requires it (e.g. “B” in case of pregnancy).

Regular checking of this 1 field can save you from a multimonth conflict with office and failure of due money. It is only a fewer minutes that can save immense stress and financial problems.

A mistake has already happened – what to do? Appeal procedure

If you find that your e-ZLA lacks a key code or is wrong, you must act immediately. The first and simplest step is Urgent contact with a doctor or medical establishment who has issued an exemption. The doctor has the option to cancel the incorrect e-ZLA and issue a new, correct document. In most cases this is the quickest way to solve the problem.

But what if ZUS has already made a negative decision? Then the formal road remains. Here. 30 days after receipt of the decision to lodge an appeal. The letter must be submitted to the ZUS branch which issued the decision. The appeal must specify precisely what the mistake was and include evidence, e.g. a certificate from a doctor confirming the correct origin of incapacity for work (e.g. pregnancy card). If the ZUS upholds its decision, the case goes to the labour court and social security. Although the judicial process can be long-term, in case of apparent formal errors the chances of winning are high, it requires time and nerves that can be avoided by simple e-ZLA verification as shortly as it is issued.