| 12 June, 2022

Before taking the sickness leave - all you need to know about the sickness leave

Pursuant to the ‘Benefit Act’ it is nothing else but the pecuniary benefit from the sickness insurance paid to the insured person in the event of sickness. All the persons employed under employment contract are obligatorily subject to social insurance (including the sickness insurance). The persons may opt-in for the insurance scheme, e.g., persons employed under order contract [umowa zlecenia]. The insured person is entitled to sickness benefit (allowance) in the event of sickness after the lapse of 30 or 90 days of insurance respectively.


Agent [Zlecenioiorco]! You may join the voluntary sickness insurance if you are compulsorily subject to old-age/disability pension, i.e., when you do not simultaneously have another insurance title, or if another seller/principal every month pays for you old-age/disability pension contributions calculated on the basis lower than the minimum wage for work.

Both the students and the pupils under 26 may not join the voluntary sickness insurance on account of order contract (they are neither subject to social insurance nor to the health insurance on account of order contract).


Example 1

Mrs. Katarzyna has worked under employment contract in company X since 1st January 2020. Her monthly salary in 2022 is higher than PLN 3,010 gross. On 1st April 2022 she starts employment under order contract with company Y. All the ZUS contributions in company X are obligatory. In company Y, she may not join the voluntary sickness insurance scheme on account of the order contract as there is no obligation to pay old-age/disability pension contributions. 


Example 2

Mister Tomasz is simultaneously employed in two companies under order contract. The monthly basis of assessment/calculation of old-age/disability pension in company X in 2022 is PLN 5,000. In company Y, the monthly basis of assessment/calculation of old-age/disability pension in 2022 is PLN 1,000. A duty to pay old-age/disability pension contributions will result from employment in company X and on that account Mr Tomasz may join the voluntary sickness insurance. In company Y there is no possibility of joining the sickness insurance.

 

Example 3

Tymon is a student and has not attained the age of 26. On 1st April 2022 he signed employment contract with company X; irrespective of the salary received, he will compulsorily be subject to social insurance (including the sickness insurance). If Tymon was employed under order contract, he would neither be subject to social insurance nor to health insurance.

 

Remember! Employment contract gives you a guarantee of being covered by obligatory sickness insrance. 



Source: Own work on the basis of the Social Insurance Act of 13Th October 1998 (Journal of Laws of 2021 item 423, as amended.)


WAITING PERIOD – WHEN ARE YOU ENTITLED TO SICKNESS PAY?


A very important issue in the case of sickness insurance are the so-called waiting periods. The right to the benefit after the expiry of 30 days of insurance applies to persons who are obligatorily subject to sickness insurance - i.e., employees. On the other hand, persons who are voluntarily insured will only acquire the right to the benefit after 90 days of insurance, e.g., contractors or sole traders (self-employed). As long as your length of service is more than 10 years and you have a permanent place of employment, you may find this thread redundant. The situation changes when you are a first-time employee or you are planning to change your job and the interval between your first and second job will be longer than 30 days. In such situations you have to remember that the sick leave you receive during the waiting period will excuse your absence from work, but you will not receive any benefit for this.

If you change jobs, there may be a break in your insurance. If the interval is not longer than 30 days, the period of the previous insurance will be included in the period of the new insurance.

Why is 10 years' seniority so important?


When you take up a new job (only if you have an employment contract), having 10 years of documented seniority entitles you to sickness benefit from the first day of insurance!

HR advice: are you changing jobs? Don't forget to provide your new employer with all the employment certificates you have received to date. Your employment history will help determine from which date you are entitled to wages/sickness benefit. A common mistake made by employees is to provide an employment certificate only from their previous workplace.

Who else can benefit from sickness pay/allowance from the first day of insurance? 

- school or university graduates if they were insured or took out voluntary sickness insurance within 90 days of leaving school or obtaining their diploma;

- persons who have become unfit for work following an accident on the way to/from work.

 

WHO PAYS WAGES/SICKNESS BENEFITS? 


Now that we know how long you are entitled to receive a benefit for incapacity for work, it is worth reviewing the rules for the payment of sick pay/allowance.

Payment of benefit in the case of employees (employment contract) 

For the first 33 days (insured person up to 50 years of age) or 14 days (insured person over 50 years of age) of paid incapacity for work in a calendar year, the benefit in the form of sick pay is financed and paid from the employer's funds.

From the 34th day (insured person up to 50 years of age) or the 15th day (insured person over 50 years of age) of paid incapacity to work in a calendar year, the benefit in the form of sickness benefit is financed by ZUS. Sickness benefit will be paid by the Social Insurance Institution if your employer as of 30th November of the previous year had reported up to 20 persons for sickness insurance. If the employer reported more than 20 persons for sickness insurance on 30th November of the previous year - he becomes the payer of benefits, i.e., he will be responsible for calculating and paying the benefits (he will be able to deduct the paid benefits in the monthly settlement declaration).

Payment of benefit in the case of agents (zleceniobiocy) (order contract): 

From the 1st day of paid incapacity for work in a calendar year, a benefit is paid in the form of sickness benefit, which is financed by ZUS. The benefit will be paid by ZUS or by the principal. The benefit payer is determined in the same way as for the payment of the benefit to the employee.

How will ZUS find out that it should pay you sickness benefit and determine its amount? 

An employer who is not a benefit payer in a given calendar year sends a request (on form Z-3 or Z-3a) to the Social Insurance Institution (ZUS) for benefit payment together with the necessary information about the insured person (insured person's data, information about employment, paid benefits and the amount of salary for particular months). Your benefit will be determined on the basis of this application.


AMOUNT OF WAGES/SICKNESS BENEFIT 


You are entitled to a monthly salary/sickness benefit of 80% of your benefit base.


In exceptional situations, you will receive a benefit of 100% of the benefit base, i.e., if your incapacity for work:

- falls during pregnancy (code B will be shown on the leave);

- arises as a result of an accident on the way to or from work;

- resulting from the screening of donor candidates or from the procurement of cells, tissues and organs from donors.

I very often come across a misinterpretation of the legislation, as insureds expect a benefit payment of 80%/100% of their salary (written in the contract). It is important to note that sick pay is paid at a rate of 80% or 100% of the benefit base. The benefit base for one day of incapacity for work is one thirtieth of the monthly base (regardless of the length of the calendar month).

Remember! Health contributions and tax/tax will be deducted respectively from the agreed amount of your salary/sickness benefit.



THE INSURED PERSON- EMPLOYEE


The basis for calculating the benefit for employees is the average monthly remuneration (minus deducted social security contributions) paid for a period of 12 months preceding the month in which the incapacity occurred. 

The above-mentioned period excludes months in which the employee worked less than half the working time due to excusable reasons.

Remuneration for months in which the employee was absent due to excusable reasons but worked at least half the working time is supplemented (usually to the amount of the monthly remuneration stipulated in the contract).

Example 1 

Mrs. Katarzyna has been employed under employment contract with company X since 1st January2020. She was unfit for work in April 2022. The employer/ZUS will determine the basis for calculating the benefit taking into account salaries paid for the period from April 2021 to March 2022. The basic salary on the employment contract until the end of 2021 was PLN 5000 gross. Since 2022, Mrs. Katarzyna has been receiving a pay rise of PLN 1000zł gross. Mrs. Katarzyna was unfit for work due to illness in May 2021 and September 2021 and in September 2021. For this reason, in September 2021 she did not work half the applicable working hours - we exclude this month when determining the benefit base. Detailed calculations below. 


If the employee's incapacity for work arises before the expiry of 12 months of insurance and he/she is entitled to sickness benefit, the basis shall be determined from the full calendar months of insurance. 

Mr. Tomasz has been employed with company Y under employment contract since 14 October 2021. He was unfit for work in April 2022. The employer will determine the basis for calculating the benefit taking into account salaries paid for the period from November 2021 to March 2022 minus the social insurance contributions. The salary for October 2021 is not taken as the basis, as it is an incomplete month of insurance.

Example 2

What happens if the employer gets sick in the first month of employment? In this case, the employer will first verify whether the insured person is entitled to sickness insurance benefits, i.e., whether the interval between insurance periods was no more than 30 days or whether the insured person has 10 years of work experience or whether the insured person graduated from a school or university within the last 90 days. 

Example 3 

Mrs. Katarzyna changed the employer. She was employed under employment contract with company X from 1st January 2020 to 31st January 2022. She started a new job with company Y from 15th February 2022. The remuneration was set at a fixed monthly rate of PLN 5,000 gross. The employee became unfit for work during the period from 20th to 25th February 2022. In this case the interval between successive titles to obligatory sickness insurance was less than 30 days - this means that the whole period of uninterrupted insurance in company X can be included in the current period of insurance and in company Y Ms. Katarzyna is entitled to remuneration/sickness benefit from the first day of insurance. She will be paid sickness benefit for the entire period of sick leave. How will the new employer or the Social Security Institution determine the basis for calculating sick pay?

Pursuant to Article 37 of the ‘Benefit Act’ if the inability to work occurred before the end of a full month of sickness insurance, the basis is the remuneration which the insured person would have earned if he/she had worked the whole month. 

Monthly benefit base = PLN 5,000 -13.71% (of the social insurance contribution) = PLN 4,314.50

80% of the benefit base = 4,314.50 x 80%= PLN 3,451.60

Basis of benefit for one day = 3,451.60/30 days = PLN 115.05

Number of days of incapacity for work from 20th to 25th Feb. 2022 = 6 days

Remuneration/sickness benefit = 6 x 115.05 =PLN 690.30

The benefit base shall not be reestablished if the interval between incapacities is shorter than one calendar month. 

Example 4. 

Mrs. Katarzyna from Example 1. got sick again in May 2022. As there has not been a full calendar month's break between sick leaves, the previous month's benefit base is used to determine the amount of salary/sickness benefit. 

Let’s assume that Mrs. Katarzyna will once again be unfit for work in July 2022. In this case, do we have to determine the benefit base anew? 

Yes, because there has been a calendar month break since the last incapacity (in May 2022) - June 2022. The payer of salary/sickness benefit will determine the benefit base from the months July 2021 to June 2022. 

After a change of full-time employment (e.g. from full-time to half-time), the basis is determined by the number of months of insurance after the change. 

Example 5. 

Mr. Tomasz was employed under employment contract with company from 14th October 2021. He was unfit for work in April 2022. As of 1 January 2022. Mr. Tomasz, by agreement with his employer, has been working part-time. His remuneration has also been reduced from PLN 5,000 gross to PLN 2,500 gross. The employer will determine the benefit base by taking into account the salary paid for the full insurance months from the change in working hours: January 2022 to March 2022. The change in the rate of pay affects the amount of the benefit, but it is irrelevant in determining which months we take to calculate the base.

Remember! To calculate the benefit base, in addition to the basic remuneration, other remuneration components are taken into account, e.g., remuneration for overtime, bonuses, awards paid for the months for which the benefit base is established. The rules for including these components in the base are laid down in Articles 41 and 42 of the ‘Benefit Act’.


THE INSURED PERSON – THE AGENT


The benefit assessment basis for agents is the average income less 13.71% of the basis, for a period of 12 months preceding the month in which the incapacity occurred.

To a large extent, the amount of the benefit is determined in the same way as for insured employees. However, if the incapacity falls before a full month of insurance and the contract does not specify a monthly income amount, in this situation the average income of insured persons who are employed under the same or similar contracts with this Principal shall be taken.


BENEFIT PERIOD, I.E., HOW LONG YOU CAN RECEIVE SICKNESS BENEFIT


You may receive sickness pay for 182 days, and in exceptional cases, i.e., if your incapacity is due to pregnancy or tuberculosis, for 270 days. Incapacity to work arising during the waiting period is not included in the benefit period.

All incapacities (irrespective of the cause) with an interval of 60 days or less count towards a single benefit period.

If the interval lasted longer, i.e., 61 days or more, the benefit period is determined anew.

Where the interval is shorter than 61 days but the incapacity occurred during pregnancy, the benefit period is also determined anew.

Remember! The benefit period is not linked to the calendar year. 


SICKNESS BENEFIT AFTER TERMINATION OF INSURANCE 

Pursuant to Article 7 of the ‘Benefit Act’:

‘Sickness benefit is also due to a person who became unable to work after the termination of the sickness insurance title if the inability to work lasted continuously for at least 30 days and arose: 1) no later than within 14 days from the termination of the sickness insurance; 2) not later than within 3 months after termination of sickness insurance in the case of a contagious disease with an incubation period of more than 14 days or another disease whose symptoms manifest themselves after more than 14 days from the beginning of the illness’

The sickness benefit after termination of the insurance title is paid by the Social Insurance Institution on the basis of information submitted by the last employer/principal. The benefit mat be taken for a maximum of 91 days. There are exceptional situations, such as, if the incapacity occurred during pregnancy, is due to tuberculosis or is due to the examination/treatment of a cell, tissue or organ donor.





















The author

Magdalena Dźwilewska-Czajka

HR & Payroll Specialist in Tias Accounting and Legal Office network. Graduate of Economics in Wroclaw. Her interest in HR and Payroll areas of specialization began as early as during her studies, when she received her first pay slip. In her professional space Magdalena appreciates working with people and at the same time she has a passion for developing her analytical skills. The above factors influence her further desire to expand her competences towards the HR industry.

Apart from work, Magdalena is focused on her family, friends and sport. Since childhood, she has been active on basketball courts, which influenced her decision to join the 1st league team in Kąty Wrocławskie.

Magdalena is also passionate about handicrafts - she creates decorations with her own hands according to the art of macramé, an ancient craft of tying strings without the use of needles, wires or a crochet hook.