New regulations in Poland, effective January 1, 2027, will eliminate medical commissions in disability benefit cases, aiming for faster decision-making.
Changes to Disability Assessment Rules
New rules for assessing disability, including those related to disability benefits, are intended to expedite the decision-making process. Physicians will no longer assess cases in multi-person panels.
The changes, partially implemented April 13, 2026, expand certain assessment powers to other medical professions, such as physiotherapists and nurses.
Disability Benefit Eligibility Requirements
To be eligible for a disability benefit, an insured individual must meet specific criteria. An exception applies to those who can demonstrate at least 20 years of contributory and non-contributory insurance (women) or 25 years (men) and are totally disabled.
Contributory and Non-Contributory Periods
The required contributory and non-contributory period depends on when the disability arose. For disabilities occurring within the last decade before applying for benefits, a specific period applies, unless the insured individual proves at least 25 years of contributory insurance (women) or 30 years (men) and is totally disabled.
No contributory or non-contributory period is required if the disability is caused by a work-related accident.
Definitions of Total and Partial Disability
Under the law, a person is considered disabled if they have completely or partially lost their ability to earn a living due to impaired bodily functions and are unlikely to regain that ability even after retraining.
Total disability means the loss of ability to perform any work. Partial disability signifies a significant loss of ability to perform work consistent with existing qualifications.
ZUS Assessment Criteria and Assessment Period
When assessing the degree and expected duration of disability, and the prospects for recovery, ZUS considers various factors. Disability is typically assessed for a period not exceeding five years, unless there is no expectation of recovery within that timeframe.
If an individual entitled to a disability benefit is within five years of retirement age, the disability assessment may extend to the age of retirement, if the disability persists.
Changes Effective January 1, 2027: Appeals Without Medical Commissions
Starting January 1, 2027, appeals against a medical assessor’s decision will no longer be reviewed by a three-person medical commission, but by a single medical assessor. This change aims to address staffing shortages within ZUS.
Timeline for Decision-Making and Appeals
Ordinances will be issued electronically within 30 days of the commencement of proceedings. ZUS will notify the interested party of any circumstances causing delays.
If the deadline is exceeded, the interested party can file a request for expedited processing with ZUS, which must be resolved within 7 days.
Delivery of ZUS Decisions: Electronic Format and Proof of Validity
Decisions will be delivered electronically or as a printed copy if electronic delivery is not possible or requested. Printed copies will indicate that the original decision was issued electronically with a qualified electronic signature.
A printed copy serves as proof of the content of the electronically issued decision.
Appeals Process and Challenging Decisions
Individuals have 14 days from the date of delivery to file an appeal with ZUS. ZUS may not consider late appeals, but may reinstate the deadline in justified cases.
The chief medical assessor can challenge a decision within 14 days of its issuance and refer the case for reconsideration.
Who Will Handle Appeals After January 1, 2027?
Medical commissions will no longer review appeals. Instead, the chief medical assessor or their deputy will refer the case for reconsideration by a medical assessor.
The medical assessor, upon reconsideration, is not bound by the scope of the original appeal or challenge.
Complex Cases: Three Assessors Instead of a Commission
In particularly complex cases, the chief medical assessor may refer the case for reconsideration by three medical assessors, but this group will not have the status of a “medical commission.”
Basis for a Decision on Benefits
A decision on disability benefits is based on an assessment determining the presence of total or partial disability. Only after such an assessment is made can ZUS issue a decision granting the benefit.
