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ZUS is investigating fraudulent claims for sickness benefitsTVN24
The Social Insurance Institution (ZUS) retrieved over PLN 150.5 million in the first half of 2025 due to audits of sick leaves and reductions in benefits following employment termination. ZUS reports that some insured individuals occasionally view sick leave as a chance to earn additional income or take a vacation.
The Social Insurance Institution (ZUS) announced that 227,000 audits of sick leave took place in the initial half of 2025. Consequently, 14,800 benefits, amounting to over PLN 22.2 million, were suspended. Moreover, benefits after the end of employment were reduced by PLN 128.3 million. In total, PLN 150.5 million was returned to the ZUS Fund.
In comparison, during the same timeframe in 2024, 260.8 thousand inspections were conducted, resulting in 18.6 thousand decisions and a total recovery of PLN 117.5 million, also due to benefit reductions post-employment.
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ZUS: Sick leave is not a time for vacation or extra work
ZUS (Social Insurance Institution) reminds that sick leave is not a period that the insured individual can freely utilize, unlike vacation leave. Sick leave serves as a time for restoring the ability to work, rather than for undertaking additional employment or going on vacation.
When evaluating the misuse of sick leave, ZUS considers the leave’s intended purpose, which is for the insured individual to regain full work capacity and to rejuvenate through rest and potential rehabilitation.
The Institution clarifies that an individual unable to work due to illness may only engage in ordinary daily tasks and those related to their health, such as attending a doctor’s appointment, visiting a pharmacy, or purchasing essential groceries.
If the Social Insurance Institution (ZUS) detects irregularities during an inspection, it has grounds to issue a decision denying sickness or rehabilitation benefits. This denial applies to the entire duration of the sick leave during which the irregularities were observed or for the full month of rehabilitation benefits when they were identified.
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Two types of audits
The Social Insurance Institution (ZUS) performs two types of audits. The first pertains to the accuracy of determining temporary incapacity for work and the issuance of sick leave certificates, while the second relates to the proper utilization of sick leave certificates.
The ZUS (Social Insurance Institution) medical examiner assesses the certification. They verify the medical justification for issuing the certificate, determining whether the health condition warrants the declaration of temporary incapacity for work over a specified duration, considering the type and context of the job.
The Institution points out that in reviewing a medical certificate, the ZUS medical examiner may examine the insured individual, refer them for a specialist evaluation to a ZUS consultant, request the doctor who issued the medical certificate to provide the medical records supporting its issuance, and seek explanations and information related to the matter, as well as mandate additional tests within a defined timeframe.
The decision on the method of conducting the inspection (whether it will involve analysis of medical documentation or physical examination of the individual holding the medical certificate) is made by the ZUS medical examiner on a case-by-case basis.
ZUS emphasizes that if, following a direct examination, the medical examiner finds an earlier cessation date for incapacity for work than indicated in the medical certificate being reviewed, they will issue a corrective certificate, which is treated the same as a certificate confirming no contraindications for working in a specific role, issued in accordance with Labor Code regulations.
The original medical certificate becomes invalid after the date specified in the certificate issued by the medical examiner. Subsequently, ZUS issues a ruling declaring ineligibility for the benefit (for that period).
According to the Institution’s data, in the first half of 2025, there were over 157,900 inspections of temporary incapacity decisions, with 6,700 cases resulting in a corrective certificate. This led to savings of PLN 5.6 million.
Employee checks during sick leave
The second type of check involves ascertaining whether the insured individual is using their sick leave during the declared incapacity for work as intended, meaning by not working or engaging in other activities that contradict the doctor’s recommendations and could impede recovery. Should the insured person misuse their sick leave, the Social Insurance Institution (ZUS) will withhold the benefit. If the benefit has already been disbursed, the insured individual must repay it.
This type of control is performed by ZUS employees and also by contribution payers (employers) who register more than 20 insured individuals for sick leave insurance.
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