In the first half of 2024 the Social Insurance Institution (ZUS) carried out intensive checks on the usage of medical exemptions. Pomorskie ZUS branches found many irregularities affecting the amount of the contested benefits. The article looks at the details of these checks, their effects and future expectations.
Summary of L4 Control
From January to June 2024, the Pomeranian ZUS troops carried out medical exemptions checks on 4.8 1000 people. As a result, a number of irregularities have been revealed:
Key Facts:
- The contested allowances: In 495 cases the entitlement to the benefit was revoked, which in full exceeded PLN 971,000.
- Irregularities: Irregularities were found in over 1.1 1000 cases, and the amount of the contested allowances amounted to over PLN 1.5 million.
- Undrawn allowances: Sickness benefits have been withdrawn for a full amount of PLN 545 thousand, which is the consequence of a simplification of the exemptions by 4863 days.
Types of ZUS Control
ZUS performs 2 types of medical exemptions checks:
- Control of appropriate usage of Exemption: It shall be checked that the medical release is utilized as intended. This includes, inter alia, verification of whether the individual on dismissal does not engage in gainful activities or another activities that may undermine the validity of the exemption.
- Control of Medical Courts: Doctors of the Social safety Office measure whether the individual on release is actually unfit to work. This control may consequence in a simplification or withdrawal of the exemption.
Effects of Control
Krzysztof Cieszynski, regional spokesperson of ZUS in Pomeranian Voivodeship, stressed that the checks are carried out in accordance with statutory obligations. The funds paid for sickness benefits come from insured contributions and are so essential to monitor them. ZUS controls whether the exemptions are utilized according to their intent and the persons on release follow the recommendations of doctors.
Key Conclusions:
- Compliance: Individuals on release should limit their activity to the essential regular activities and wellness improvements, specified as doctor visits or grocery shopping.
- Abuse: The usage of a medical exemption in a manner incompatible with its intent may consequence in the failure of entitlement to the allowance for the full period of exemption.
Analysis and Prediction
According to the data, in 2023 ZUS in Słupsk and Gdańsk besides found many irregularities, which may propose an expanding trend in the detection of fraud. ZUS continues its controls, focusing on cases which rise doubts, specified as inadequate periods of incapacity for work, abuses of exemptions from various doctors or deficiency of vulnerability to research.
Intensification of medical sick leave checks by the Social Insurance Institution in the first half of 2024 revealed crucial irregularities that affected the amount of the contested benefits. Checks are a key component in ensuring the correct usage of sickness benefits and their effectiveness will be monitored in the coming months. The insured should be aware of strict rules for the usage of exemptions in order to avoid the financial consequences of the abuse of that right.
Continued here:
ZUS Controls L4: Effects and Conclusions of the First Half of 2024
