ZUS Issues New Guidelines for Employers on Sick Leave Audits

The Polish Social Insurance Institution has published a new guidebook clarifying the regulations and procedures for employers conducting mandatory checks on employees utilizing sick leave.

New Guidelines on Sick Leave Audits

ZUS has released a new guidebook on how to conduct audits on the use of sick leave, based on amended provisions of the sickness benefit act that clarify when the right to benefits is lost.

The loss of the right to benefits may result from the improper use of the leave period or a determination by ZUS that the certificate was issued unjustifiably. In the former case, the medical certificate remains valid, but the employee loses sickness pay or sickness allowance. The ZUS guidebook titled „Kontrola prawidłowości wykorzystywania zwolnień od pracy” addresses this specific type of audit.

Who Can Inspect Employees on Sick Leave?

If the patient is still receiving sickness pay—meaning for the first 33 days of incapacity to work in a calendar year, or 14 days for individuals over 50—this period is subject to inspection by the employer, regardless of company size.

Conversely, in cases of prolonged illness where the individual is already receiving a sickness allowance, the period may be audited by the contribution payer, such as an employer or principal, or by ZUS. Only large payers—those who registered more than 20 insured persons for sickness insurance as of November 30 of the previous calendar year—have the right to conduct audits, though they may also request ZUS to perform them.

Smaller payers cannot independently audit the period during which an employee or contractor receives a sickness allowance and must rely solely on ZUS.

The period during which an individual receives a care allowance can be audited under the same rules as the sickness allowance period, meaning audits may be conducted by ZUS or a large payer.

What Employers Inspect During Sick Leave Audits

The employer may check whether the circumstances specified in Article 17 paragraph 1 of the act on cash benefits from social insurance in case of sickness and maternity apply. Under this provision, with a new wording effective from April 13, 2026, the insured person loses the right to the sickness allowance for the entire period of absence from work if they perform gainful work or engage in activity inconsistent with the purpose of the leave during the certified incapacity.

The audit may be conducted regardless of medical indications stating that the patient “should lie down” or “may walk.”

A person receiving a rehabilitation benefit may be audited on the same basis.

Care Allowance: When Household Members Exclude Benefit Payments

When auditing a care allowance period, in addition to verifying whether gainful work or activity inconsistent with the purpose of the leave is performed, checks are also made to see if there is another person in the common household who could undertake the care.

Generally, the care allowance is not payable for a period when another family member could care for a child or other person instead of the applicant. This refers not just to the physical presence of another family member at home, but to their actual capacity to provide care. For instance, the presence of another sick family member does not prevent the payment of the care allowance or serve as grounds for depriving the right to it, as that person cannot care for anyone.

This circumstance is irrelevant when the care allowance is drawn in connection with caring for a sick child under the age of 2, in which case the presence of another family member is not examined.

Who Conducts Audits on Behalf of Employers?

Regulations do not specify in detail who can perform such an audit. ZUS notes in the guidebook that an employer who is a natural person can conduct the audit personally or delegate it to another employee, such as an HR and payroll staff member. However, due to the sensitive nature of the matter, it should be someone of good reputation who inspires trust and knows the audit rules and data protection regulations.

ZUS also permits outsourcing the audit to an external company, noting that the agreement between the employer and the external entity must specify the scope and purpose of processing personal data necessary for the audit. The employer who commissions the external entity remains the administrator of personal data and must ensure data protection laws are not violated.

Who to Target for Sick Leave Audits

A large payer may, but is not required to, audit any insured person to whom they pay sickness pay, sickness allowance, care allowance, or rehabilitation benefit. However, ZUS advises in the guidebook to specifically target individuals who meet certain risk criteria.

How to Initiate an Audit and Issue an Authorization

An audit is initiated on the basis of an authorization issued to the controller and presented to the person being audited.

The audit may be conducted by a person who receives personal authorization in accordance with the template specified in special provisions. The authorization is valid together with an employee ID or identity document, the number and date of issue of which must be stated in the authorization.

ZUS points out that the employer is also required to issue a personal authorization to a person performing an audit commissioned to an external entity.

Where Sick Leave Audits Can Take Place

Audit activities are conducted at the place of residence, place of stay, workplace of the audited person, the place where they conduct non-agricultural activity, or another place if necessary due to the purpose of the audit.

Therefore, there are no geographical restrictions.

Rights and Obligations of Audit Parties

The controller has the right to perform specific verification actions as justified by the purpose of the audit, and is obligated to follow statutory procedures.

The audited person is obligated to cooperate and provide explanations. However, preventing an audit or failing to provide explanations does not mean the person will automatically lose the right to the benefit, as a court in an appeal proceeding may determine that improper use of leave was not proven.

Audit Protocol: When It Is Created and How to File Objections

An audit protocol is prepared and sent to ZUS only if irregularities are found. If the payer finds no irregularities during the audit, no protocol is prepared.

The audit protocol is prepared in two copies, one of which is delivered to the audited person. Changes to the protocol are made by issuing an annex to the audit protocol.

The audited person has the right to file objections to the findings within 7 days of receiving the protocol or annex, while indicating appropriate evidence.

ZUS reviews the objections along with the protocol, and the audited person is informed in writing of how the objections were handled.

When ZUS Issues a Decision on Benefit Loss

The audit protocol serves as the basis for ZUS to initiate proceedings regarding the termination of the right to sickness allowance, care allowance, or rehabilitation benefit, and acts as evidence in those proceedings. Based on the payer’s findings and its own proceedings, ZUS issues a decision stating the lack of right to the benefit.

However, ZUS may conclude after analyzing the case that, contrary to the employer’s findings, improper use of leave did not occur, in which case no decision of loss is issued.

Sickness Pay: The Employer, Not ZUS, Decides

Furthermore, ZUS will not issue a decision regarding the loss of the right to sickness pay because it is not a social insurance benefit, meaning the decision is made by the employer.

Consequently, the protocol concerning the sickness pay period is not sent to ZUS unless the employee files an objection. In such cases, ZUS reviews the objection, but the final decision to deprive the right to sickness pay rests with the employer.