What to do in case of incapacity for work

Insured persons who have been declared as temporarily unfit for work due to illness, injury or a quarantine measure by a competent general practitioner (GP) will receive sickness benefits under the conditions laid down in the Social Security Act. During the period of temporary incapacity for work, they are obliged to observe the treatment prescribed. At the same time, both the employer and the Social Security Insurance Agency may check on them.

What to do in case of incapacity for work

An insured person who is recognised as temporarily unfit for work must comply with the treatment prescribed by the GP. The treating doctor shall inform insured persons who are temporarily unfit for work to what extent – taking into account their current state of health – they may carry out normal daily activities. The treatment prescribed depends on the nature of the disease. This means that insured persons may not engage in the employment they have been recognised as temporarily unfit for, they must observe the time allowed for walks outside, during certain illnesses they must lie down, they must not smoke or consume alcohol, they must not go to pubs or restaurants and must go for a check-up with the GP on the specified date.

Sanctions for failure to comply with the treatment prescribed

If it is suspected that the treatment prescribed is not being followed, the Social Security Agency will investigate the circumstances, with the cooperation of the insured person, from whom it will request a response to the facts ascertained. At the same time, the Social Security Agency will ask the GP for a written opinion regarding the suspicion of non-compliance with the treatment. The Social Security Agency will decide whether or not there has been non-compliance with the treatment prescribed on the basis of the results of the investigation. If the Social Security Agency assesses that its suspicion is indeed a non-compliance with the treatment prescribed, the insured person will lose the right to sick pay between the date of the non-compliance and the end of the temporary incapacity for work, but for no longer than 30 days from the date on which the treatment prescribed by the doctor was violated. The Social Security Agency may also impose a fine on insured persons if they do not respect other obligations which they are required to comply with under the Social Security Act, such as not notifying the relevant branch that they have changed address or not removing an obstacle to the inspection visit (e.g. dog, broken doorbell or other obstacle, difficult access to the flat, etc.) despite being warned. The fine is usually up to EUR 100, and for repeated non-
compliance with obligations during each temporary incapacity to work up to EUR 170.

Who performs the home checks?

As a rule, non-compliance with the treatment prescribed is usually discovered through inspections to check that treatment is being followed. This may be performed on the initiative of the medical officer, the GP, the employer or another natural person or legal entity. The check shall be carried out whenever requested by a presiding judge or chief prosecutor. Compliance with the medical treatment for a temporarily unfit insured person is checked by a designated employee of the Social Security Agency. The inspection is carried out at the home of the insured person temporarily unfit for work with his consent, or at the place where he is staying according to the certificate of temporary incapacity for work. The check of compliance with the treatment may be carried out 7 days a week, including during weekends and public holidays.

What if the patient cannot be reached at home?

If the insured person temporarily unfit for work is not at home, the inspector will leave a Notice of the Inspection in the letterbox. On the basis of that notice, the patient must contact the medical assessment services of the relevant Social Security Agency branch to substantiate the reason for his absence.

Who determines the conditions for walks during incapacity for work?
The determination of conditions for walks is part of the treatment prescribed for an insured person temporarily unfit for work. Where the nature of the illness allows, the relevant GP may permit walks, usually at the first check-up. In practice, it is usually specified that walks can be taken during four hours of the day, e.g. from 10 am to 12 pm and from 2 pm to 4 pm, but it is the responsibility of the GP to specify the conditions. The times for walks, if permitted, is recorded by the GP on the ‘Confirmation of temporary incapacity for work’ form and in the medical file of the person temporarily unfit for work.

Who determines the conditions for walks during incapacity for work?

The determination of conditions for walks is part of the treatment prescribed for an insured person temporarily unfit for work. Where the nature of the illness allows, the relevant GP may permit walks, usually at the first check-up. In practice, it is usually specified that walks can be taken during four hours of the day, e.g. from 10 am to 12 pm and from 2 pm to 4 pm, but it is the responsibility of the GP to specify the conditions. The times for walks, if permitted, is recorded by the GP on the ‘Confirmation of temporary incapacity for work’ form and in the medical file of the person temporarily unfit for work.

What happens for people living alone who need to leave their home?
Patients who do not have a time specified for walks and who live alone, with no close relative to ask for help with basic subsistence needs, may leave their home to purchase essential foods or medicines. However, we recommend having a receipt, which can be presented as a document to justify one’s absence when a check is carried out; the time of the inspection visit of the treatment should coincide with the time indicated on the receipt.

Do I have to stay at my home address during incapacity for work?
Insured persons/patients do not have to stay at their permanent place of residence for the duration of the incapacity for work. They may be at an address which they specify. However, this must be agreed with the GP, who indicates this address on the ‘Confirmation of temporary incapacity for work’ form. The change of address (if permitted by the GP) must be notified in writing (by informal letter) to the competent branch of the Social Security Agency within 8 days.

Do I have to stay at my home address during incapacity for work?

Insured persons/patients do not have to stay at their permanent place of residence for the duration of the incapacity for work. They may be at an address which they specify. However, this must be agreed with the GP, who indicates this address on the ‘Confirmation of temporary incapacity for work’ form. The change of address (if permitted by the GP) must be notified in writing (by informal letter) to the competent branch of the Social Security Agency within 8 days.