The proposal would move all rulings to a single-doctor model in both first and second instance, replacing three-doctor panels now used on appeal.
The Ministry of Family, Labor and Social Policy says the bill would standardize procedures across all types of cases handled by ZUS, from disability pensions to nursing supplements and social pensions.
The ministry stresses that the legal definitions of incapacity for work and inability to live independently would not change, so eligibility criteria for benefits would remain as they are.
The draft clarifies when an insured person loses the right to a sick leave benefit.
“Gainful work” would be defined as any paid activity, regardless of the legal basis for the work, with an exception for incidental actions required by important circumstances.
Routine daily activities would not count as misuse of sick leave, but actions that hinder or prolong treatment or recovery would.
The draft would also allow a person to receive a sick leave benefit from one source of employment while earning wages from a different source, reflecting cases in which someone may be unfit for one job but able to perform another.
The bill would broaden who can issue certain rulings.
Physiotherapists could decide on medical rehabilitation cases within ZUS’s disability-prevention program for musculoskeletal conditions, while nurses could issue rulings in cases that assess inability to live independently.
The chief certifying physician at ZUS, or a deputy, would decide which cases may be assigned to these specialists and would supervise their work.
Staffing rules at ZUS would change. Certifying physicians could work under an employment contract or a civil-law (freelance) contract, which is a common arrangement in Poland’s health sector.
Senior posts, including the Chief Medical Officer of ZUS and oversight inspectors, would be employment-contract roles only.
Base pay for certifying physicians would be set on principles similar to minimum base pay for certain employees of medical providers.
Qualifications would also be adjusted so that, in addition to medical specialists, non-specialists could be hired if they are in specialty training and have completed the basic module for that training, or if they have practiced as a physician for at least five years.
Organizationally, ZUS would consolidate adjudication tasks and direct supervision in new adjudication centers located within its regional branches.
ZUS would also gain clearer authority to verify whether sick leave is being used for its intended purpose, including the right to request medical documentation from the doctor or clinic that issued the certificate.
Large employers that pay sickness benefits directly, those with more than 20 insured employees, could run such checks themselves or ask ZUS to do so.
The draft states that inspections must respect privacy and use measures that are adequate and proportionate to the goal.
If adopted, most provisions would take effect on January 1, 2026.
(rt/gs)
Source: IAR, PAP