Recently, employers are increasingly looking for control of their employees’ sick leave, and false sick leave generally lasts less and is usually caused by colds, elevated body temperature, headaches, digestive problems, and the similar.
The Sarajevo Canton Health Insurance Institute says that the number of different employers contacting the Sickness Control Institute is increasing.
In the first four months of 2023, approx. 1,450 actions from the domain of control and supervision, of which 110 targeted sick leave checks (with more controlled periods of sick leave) at the employer’s request, is explained to Fena news agency from the Health Insurance Institute of the Canton of Sarajevo, adding that a total of 80 sick leave checks were carried out in the segment of planned checks.
At the same time, they note that the number of requests for sick leave control has increased, and thus the number of controlled sick leave.
When asked if any false sick leave was determined (e.g. that the insured had no reason for sick leave), the institute replied that the authorized inspectors of the institute perform control of temporary incapacity for work based on the employer’s request, and everything is in accordance with positive legal regulations, and the control is carried out exclusively refers to the correct application of the provisions of the Rulebook on the procedure and criteria for determining the temporary inability to work of the insured.
Furthermore, they point out that out of the total number of targeted sick leave inspections performed upon the employer’s complaint, in 4.3 percent of the inspected cases, the controllers of ZZO KS concluded that they were not conducted in accordance with the Rulebook on procedures and criteria for determining temporary incapacity for work due to illness, injury or other circumstances.
When asked how much money was spent on sick leave last year, they say that last year BAM 8,844,419 was spent on compensation for temporary incapacity to work.
“For the first four months of 2023, approx. 2 million BAM were spent, with the fact that usually at the end of the year, the cost on this basis increases significantly due to the fact that some employers submit requests for reimbursement only at the end of the business year, for the entire year,” concludes the Institute of Health Insurance Sarajevo Canton.
Expenses and false sick leave
Last year, the Institute of Health Insurance of the Herzegovina-Neretva Canton conducted 92 field checks of the justification of sick leave (control of the Health Record), which, according to the institute, is a regular activity of the Service for the Control of Health Insurance Rights.
On top of that, in 2022, they carried out the control of 3,827 requests for reimbursement of temporary inability to work (sickness), which are charged to the funds of the Institute.
They also note that unjustified or false sick leave is usually shorter, lasting a small number of days, and based on experiences from BiH and the surrounding area, such sick leave is most often opened with the diagnosis of elevated body temperature, headache, digestive problems, colds, etc.
ZZO HNK for sick leave that lasts a small number of days does not have insight into the data in real time, considering that the same is not transcribed electronically, and therefore it is not possible to monitor every opening of sick leave in the area of the canton in real time.
Sick leave that lasts a smaller number of days, i.e. up to 42 days, is controlled by the Institute at the request of the employer. This means that any employer can ask the Institute to check sick leave for his employee. Based on the employer’s request, the inspectors of the Institute go to the field and directly inspect the health record of the insured to verify the justification of sick leave.
When we talk about sick leave for more than 42 days, they are under the jurisdiction of the Primary Medical Committee of the health center, in which three specialist doctors determine the need for continued sick leave, so there is very little room for abuse of sick leave. In addition, any such sick leave is subject to control by the Service for the Control of Health Insurance Rights, they state from the Institute of HNK and add that in order to open a sick leave based on the care of a family member, the opinion of a competent specialist doctor is required on the basis of which the selected doctor prescribes sick leave.
Employers submit requests to check the justification of sick leave of their employees, and lately the Institute has recorded a slight increase in requests from employers, according to the Institute of Health Insurance of ZHK.
In the first quarter of 2023, the Institute spent 449,270 BAM on sick leave expenses, while last year the Institute spent 1,858,812 BAM on sick leave.
On the other hand, the parties from the Institute for Health Insurance of SBC say that recently they have not had an increased number of requests from employers to control their employees’ sick leave compared to previous years, and that the usual number of requests is two to three percent per month.
They also add that in some cases, which are rare, it was discovered that the insured person was temporarily prevented from working without a valid reason.
Last year, the SBB Health Insurance Institute set aside 4,046,634.19 BAM for sick leave reimbursements.
The Institute of Health Insurance of Tuzla Canton also reminds that an objection to the established temporary inability to work can be filed by the insured, a legal or natural person where the insured is employed, and the controller of the Institute.
The objection is submitted to the Second-tier Medical Commission within 48 hours of the announcement of the assessment, findings and opinion on the insured’s medical capacity.
In accordance with the Financial Plan of the Tuzla Canton Health Insurance Institute for the year 2022, the funds planned for the implementation of the Wage Compensation Program due to temporary incapacity for work at the expense of the health insurance amount to 14,800,000 BAM, the Tuzla Institute emphasizes, and point out that the expenses on behalf of the salary compensation are due to temporary incapacity for work at the expense of health insurance for the year 2022 realized in the amount of 14,799,984 BAM.
