Appeal against the ZUS doctor's decision

There are situations when a person holding a certificate of incapacity for work issued by their attending physician is called to appear before the ZUS certifying physician to verify that his condition has not improved. The opinion of ZUS may differ from the opinion of the attending physician and from the expectations of the insured person himself. Does the employee remain helpless in such a situation? No - if he does not agree with the issued decision, he may appeal against it.

Forced return to work

If the insured person is temporarily unable to work due to illness, he or she must obtain an appropriate certificate confirming this fact, issued by the attending physician on the ZUS ZLA form. In this case, the insured is entitled to sick pay or sickness benefit, respectively.

The provisions of the Act on cash benefits from social insurance in the event of sickness and maternity specify situations where the payment of the benefit does not cover the entire period specified in the exemption. An example may be the recovery of the ability to work, determined as a result of an inspection by a ZUS certifying physician.

The disability pension authority has the right to summon the insured who is on sick leave to appear within the prescribed period for a check-up by a ZUS certified doctor or a consultant doctor, or to provide the results of any auxiliary examinations. On the basis of these activities, the doctor may determine an earlier date of termination of incapacity for work than the one indicated in the ZUS ZLA medical certificate. A relevant statement will be issued to ZUS ZLA / K.

Importantly, ignoring the summons is not a way to avoid the inspection, because preventing the examination or access to the examination results within the prescribed period will result in the expiry of the medical certificate from the day following that date.

Appeal against the decision

In such a situation, the insured does not remain helpless. He has the right to appeal against the decision of the ZUS certifying physician to the ZUS medical commission within 14 days from the date of receipt of the decision, also through the ZUS unit competent for the place of residence.

The objection may be filed in writing or orally for the record. Such a protocol is prepared by an employee of an organizational unit of ZUS.

When examining the objection or the allegation that the decision is defective, the medical commission performs a judicial assessment on the basis of the documentation attached to the application and after conducting a direct examination of the health of the person against whom the decision is to be issued.

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If the decision of the ZUS medical commission still does not satisfy the insured, he / she has the right to appeal to the court. They should be brought within 30 days from the date of delivery of the opinion of the pension authority, in accordance with the instruction contained in the decision.