The sickness and maternity benefits are supposed to substitute your income from employment, if you have fallen ill, given birth to a baby, or if you bring up a handicapped child and you can not make your living at the same time.
The rights and obligations in Poland citizens and the mandates of institutions with respect to cash benefits in the event of sickness or maternity are provided for by the following legal acts:
· the June 26, 1974 Act on the Labour Code (J. of L. No 21/1998 Item 94 as currently amended.
· the June 25, 1999 Act on cash benefits under social insurance in the event of sickness or maternity (J. of L. No 31/2005 Item 267),
· the October 30, 2002 Act on social insurance for accidents at work and occupational diseases (J. of L. No 199/2002 Item 1673 as currently amended.
· the December 20, 1990 Act on social insurance of farmers (J. of L. No 7/1998 Item 25 as currently amended).
In Poland workers shall have the right to:
· remuneration for the period of illness, to be paid by the employer with the employer’s own funds, regardless of how many workers the employer employs – for 33 days of illness a year altogether.
Also self-employed persons shall be entitled to receive the aforementioned benefits.
· sickness allowance under the sickness or accident insurance – available for the period of illness – for 182 days maximum (in case of tuberculosis – up to 270 days). It shall be paid by ZUS or the contribution payer (i.e. the employer)
· rehabilitation benefit under the sickness or accident insurance – available for 12 months, if you have received the sickness allowance, you are still ill, but owing to rehabilitation you may recover your capability for work. It shall be paid by ZUS or the employer compensatory allowance under the sickness or accident insurance, available for 24 month maximum during rehabilitation. It shall be paid by ZUS or the employer.
· maternity allowance, available if you have given birth to, adopted, or taken care of a child. It shall be paid by ZUS or the employer.
· care allowance, available if you are covered by the mandatory sickness insurance, and therefore you are employed – if you care for an ill child or an ill family member. It shall be paid by ZUS or the employer.
A T T E N T I O N !
An employer shall pay, if the employer employs more than 20 workers and only throughout the period of insurance of the worker, who is entitled to the benefit.
Framers shall be entitled to the following:
· sickness allowance,
· maternity allowance,
These benefits shall be paid by KRUS.
In Poland neither students, nor the members of the family of a person employed or self-employed, shall have the right to sickness benefits, unless they are insured.
A T T E N T I O N !
The coordination principle does not mean, however, that there the same regulations in force in every State. Once you have started working in another State – you shall be subject to the State’s national regulations. The same way a foreigner, who starts working in Poland, shall be subject to the Polish regulations.
Of course this principle does not mean that you are always entitled to the benefit! You must have met some specific conditions – “have earned” the benefits – the same way as in Poland, where you shall not receive any benefit only because you have fallen ill.
You must have been insured.
In Poland your employer shall transfer your sickness or accident insurance contributions on your earnings.
To be entitled to the remuneration for the period of illness and to the sickness allowance you must have been insured for a specific duration. This is the period when you worked, and your employer, or yourself, transferred the sickness or accident insurance contributions.
The sickness insurance is mandatory for anybody employed and voluntary for anybody self-employed.
You shall acquire the right to the sickness allowance or remuneration for the period of sickness when you are subject to the mandatory sickness insurance – after 30 days from the insurance coverage effective date. You shall be entitled to the sickness allowance from the first day of your insurance coverage only if you have completed a 10 year long period of mandatory insurance before. All previous insurance periods shall be aggregated, if no time gap in between them has exceeded 30 days.
If you are voluntarily insured – the sickness allowance may be awarded to you after 180 days of your interrupted sickness insurance.
A T T E N T I O N !
If you have had an accident at work, on your way to or from work, or you have contracted an occupational disease, you shall be entitled to receive the sickness benefits even when you have not completed the required period of insurance!
A T T E N T I O N !
The Polish legislation makes the right to the sickness benefits dependant on the period of the claimant’s prior insurance, while the actual place and duration of the claimant’s residence shall be irrelevant. But ZUS and employers, while establishing the right to the sickness allowance, must take into account the duration of residence in another State if in that State the right to the benefit depends on the duration of residence in the State’s territory, and the period of insurance in Poland of the insured claimant has been too short.
Aggregation of insurance, employment, or residence periods
Let us remind you that a State’s legislation may provide for the right’s to the sickness or maternity benefits dependency on the employment (i.e. insurance) duration or the residence in the State’s territory. So it is worth checking, whether in the State, where you intend to work, the employment history or residence counts.
What shall you do, if you have worked in several Member States, but in none of these long enough to be eligible for the benefit?
In order to avoid such unpleasant situations the aggregation rule has been adopted throughout the Community. The rule enables benefit award, even if the claimant’s history of employment and/or residence in the territory of a State is too short. If there was no such rule, you would simply loose your right to the benefits.
A T T E N T I O N !
Because in Poland no insurance history is required for maternity benefits, no insurance periods shall have to be aggregated there.
How it shall be aggregated if you claim the Polish sickness benefit?
Let’s assume that you had worked shortly in Poland and then you left for abroad. You had worked for several moths abroad and then you returned home, where you recovered your employment. The period of your insurance either in Poland or abroad has been too short for your eligibility for the benefits. Therefore all periods of your employment in both countries shall be aggregated, provided that no gap in between them has exceeded 30 days.
How should you claim your benefits?
If you claim a Polish benefit – the periods of your insurance in other countries shall be taken into account for calculation of the insurance period required to acquire the right to the sickness allowance or remuneration, unless the gap in you insurance has exceeded 30 days. If the gap in you insurance has exceeded the limit, they shall be aggregated only when the gap resulted from a child-care leave, leave without pay or military service.
Otherwise no prior insurance periods completed before a time gap in excess of 30 days shall be considered at establishing the right to the sickness allowance or remuneration.
· If you have been employed abroad or you have pursued self-employed activity, you must have a certificate to verify the periods of insurance, employment, or residence in the territory of another State. The residence certificate only in the territory of a State, where residence history makes the claimant eligible for the sickness benefits.
· If you have been a seasonal worker and you want this employment period considered – you must produce your contract of employment certified by the employment office of the Member State, where you have been working, and a certificate on the E104 form to verify your employment periods.
With respect to seasonal workers the periods of employment shall be aggregated, even if a gap in the insurance period has exceeded the limit allowable by the Polish legislation (30 days) and by regulations of other countries – provided however that the gap did not exceed 4 months. But they shall be aggregated only if the person concerned has been a seasonal worker in another Member State and in Poland alike.
How your right to other benefits under the sickness and accident insurance shall be established?
This concerns also foreigners, who work in Poland.
· Rehabilitation benefit – you must submit a report issued by the evaluating doctor at your local ZUS branch office. The evaluating doctor shall issue such report on the ZUS Np-7 form and at your request. The form may be forwarded to the State of your actual stay.
The evaluating doctor shall issue such report based on your medical record.
· Compensatory allowance – you must submit a report issued by the regional occupational medicine centre or a ZUS evaluating doctor to the effect of recommendation to carry occupational rehabilitation.
· Maternity allowance – you must submit the child’s birth certificate issued by the foreign institution and the childbirth report issued by the hospital.
· Care allowance – available only to the persons covered by the mandatory sickness insurance, i.e. those employed under contract of employed, members of agricultural cooperatives, and conscripts dispatched for the substitute military service. A doctor’s certificate of the care provided must be submitted.
· Benefits do not cumulate
According to the Community provision of non-cumulating benefits, you may not receive more than one the same benefits for the same period of the mandatory sickness insurance.
If you work, for instance, in two countries at the same time – you can be awarded the benefit in either of them only. This follows from the Community principle of one law.
If you are entitled to receive the maternity benefits from two or more countries – you shall receive the certificate from the state, where you have given birth to your child.
If you have given birth to a child e.g. in Poland, but prior to the delivery you had worked e.g. in Germany and France, you shall be eligible for the benefit pursuant to the legislation of the State, where you have worked recently, i.e. the French legislation.
In each Member State the sickness and maternity benefits are paid over a different period. It may happen, however, that a Member State shall award a sickness benefit for a duration provided for in another Member State.
How is it in Poland?
In Poland this rule shall concern the sickness allowance only.
An employer or a ZUS branch office, at setting the maximum duration of your allowance payment, may take into consideration the fact, that you have received an allowance for the same sickness in another Member State, where:
· you have been ill continuously,
· the time gap in between the previous and current periods of incapacity for work because of the same illness has not exceeded 60 days.
If you are a farmer – the period of the allowance availability covers 180 days, but if you are still incapable of working thereafter and further treatment and rehabilitation shall prognosticate the recovery of your capacity for work, it may be extended but no longer however than by another 360 days. As is the case with respect to persons employed and self-employed, the interrupted periods of sickness allowance receipt under other insurance shall be taken into consideration.
In Poland the amount of the sickness and maternity benefits due to a person employed or self-employed shall be assessed based on the base remuneration or income amount, on which the sickness or accident insurance contributions had been paid over the last 12 months prior to losing capacity for work.
The sickness allowance amount due to an individual farmer shall be assessed at 1/30 of the agricultural pension base amount for each day of the incapacity for work, whereas the maternity allowance amount – at 3,5 multiples of the agricultural pension base amount.
In Poland, strict procedures are in place. You must adhere to them, otherwise you may problems with awarding the benefit.
If you have fallen ill, within three days after the accident or falling ill you should submit to the competent insurance institution a notice of your incapacity for work or sick leave, if the doctor, who takes care of you, is entitled to issue it.
You should find out, whether the doctor, whose care you use, is entitled to issue such sick leave certificate.
If not, then the insurance institution shall verify that you are indeed incapable of working by instituting its own medical examination and consequently issue the certificate of incapacity for work or deny the incapacity.
If you have failed to subordinate to the procedure, e.g. you have not submitted to the examination by a doctor appointed by the institution, it may refuse to award and pay the benefit.
A T T E N T I O N !
If you fail to submit such medical certificate within three days, you shall be exposed to no sanctions in the other EU Member States, because the European Court has so decided.
But remember: in our country you must submit such medical certificate to your employer or ZUS within 7 days after its issue. If you fail to do it, your benefit shall be reduced by 25% starting from the eight day of the certified incapacity for work until the day of the medical certificate’s submittal.
No sanctions shall apply however, if the failure to submit the certificate has resulted from reasons beyond your control.
A T T E N T I O N !
No Member State’s institution shall discard a document, e.g. a medical certificate, thereto submitted, on the grounds that the document is drawn up in Polish. They shall not require you to have the document translated.
According to the rule of retention of acquired rights, the cash benefits in the event of sickness or maternity shall be paid by the Polish employers, ZUS, or KRUS also when the entitled person stays or resides in another Member State.
The benefit shall be transferred to a bank account, the number of which you shall advise in your application for the benefit transfer.
The right to the sickness, compensatory, maternity or care allowance and to the rehabilitation benefit shall be limited on expiration of six months after the last day of the period, for which the allowance has been awarded.
If, however, one could not claim the allowance payment for any reason beyond one’s control, the period of limitation shall be counted starting from the day, on which the claim disabling obstacle was removed.
Additionally, when an allowance has been partly or wholly unpaid because of an error of the contribution payer or of ZUS, the right to the allowance shall be limited on expiration on the three year period.
In order to facilitate allowance awarding and assessing, there must be an efficient system in place for exchange between individual Member States of information on the insured. That’s why the Member State institutions inform each other of:
· insurance periods you have concluded in their respective territories,
· your incapacity for work,
· results of medical control and examination,
· awarding or denying benefits.
The institution use for the purpose special Community forms. All Member State use the same forms, but each in its own language.
· concerning the aggregation of periods of insurance or periods of residence Sickness – maternity – death/allowance? – tuberculosis”:
· particulars (street, number, postal code, town, and state) of the institution of another Member State, the legislation of which the insured person has been recently subject to,
· particulars of the insured person, who has claimed the cash benefit, therefore the periods of the person’s insurance, employment, or residence concluded in another Member State should be aggregated,
· reference number of the insurance contracted with the institution of another Member State, to which the form shall be forwarded,
· whether the insured person has been employed or self-employed,
· name of the last employer or the name of the recently pursued self-employed activity.
· names of the last employers or undertakings, or previously pursued self-employed activity.
· E 105 – „Certificate concerning the members of the family of an employed person or delf-employed person to be taken into consideration for calculation of cash benefits in the case of incapacity for work”
· E 115 – „Claim for cash benefits for incapacity for work”,
This shall include in particular:
· particulars of the person employed, self-employed, or unemployed, who has claimed the benefit payment.
· reasons for the incapacity for work,
With respect to “maternity” the expected delivery date shall be given.
· informs about examination carried out by a doctor appointed by the institution of the State of residence (stay) and the doctor report's conclusion. If the incapacity for work is verified by a ZUS-appointed evaluating doctor, the evaluating doctor shall issue the E116 form.
· E 116 – „Medical report relating to incapacity for work (sickness, maternity, accident at work, occupational disease)”,
· E 117 – „Granting of cash benefits in case of maternity and incapacity for work”,
· E 118 – „Notification of non-recognition or of end of incapacity for work”.
An integral part of the E118 form constitutes the Annex that contains details of the measures available in each Member State of appeal from the decision documented by the E118 form and notice of the measures of appeal provided for in the Polish legislation.
As a matter of fact the E 118 form is a decision to the effect of non-recognition or of end of incapacity for work, in connection with the examination carried out by a doctor appointed by the institution, or with the claimant’s failure to submit to the formalities provided for in the legislation of the State of residence (stay). It also contains decisions concerning the right to the cash benefits.