E-ZLA and sickness benefits. How does it work in practice?

Sick benefits are granted based on the E-ZLA document, which is automatically sent to ZUS and the employer, and research confirms that electronic sick leaves reduce the number of formal errors and speed up the process of granting sick leave benefits.

• E-ZLA is sent simultaneously to ZUS and the employer without the patient’s involvement.
• The decision on the benefit is based on data from the electronic sick leave.
• The doctor issues the document through the PUE ZUS system.
• An error in E-ZLA may affect the suspension of the benefit.
• The correctness of the issuance is verified by the ZUS medical expert.

See also: Sick leave for a child: regulations worth knowing!

How is E-ZLA related to sick benefits?

E-ZLA is the basis for granting sick benefits / sick leave, and the electronic document allows ZUS to immediately begin verifying the right to the benefit. Research on the digitization of insurance systems shows that electronic documents shorten the assessment process for the right to benefits and minimize the risk of delays related to administrative errors.

After the sick leave is issued, the data is sent to ZUS, where it is analyzed for compliance with the Act on cash benefits. Based on the e-sick leave, ZUS determines the period of incapacity for work and the type of benefit, e.g., sick leave or caregiver’s allowance.

The employer receives information automatically through the system, which eliminates the need to deliver a paper sick leave and shortens the time on the part of the contribution payer.

How does a doctor issue E-ZLA and what tools are used?

Issuance takes place through the PUE ZUS system, where the doctor signs the document with a qualified electronic signature, trusted signature, or ZUS certificate. Studies indicate that the standardization of electronic signatures has improved the authenticity and verifiability of sick leaves.

Some data may be entered by a medical assistant, but the document’s approval always requires the doctor’s signature. The system automatically retrieves the PESEL number and employer’s data, which reduces the number of errors in identification data.

If the doctor does not have access to the electronic system, it is possible to use a form printed from the system, which, after being entered online, becomes a valid E-ZLA.

Tools used when issuing a sick leave:

• qualified electronic signature,
• trusted signature,
• ZUS certificate,
• MZUS application for Doctors,
• medical assistant module.

How does ZUS verify the right to sick benefits?

ZUS analyzes the data visible on E-ZLA and the patient’s insurance history. Studies in the field of work capacity assessment confirm that electronic sick leaves facilitate assessment due to the ability to quickly access data and eliminate document illegibility.

The verification includes:

• checking insurance periods,
• assessing the correctness of the sick leave,
• comparing information with previous benefits,
• considering medical indications.

In case of doubts, ZUS refers the patient to a medical expert. This doctor issues a ZLA/K certificate, which can confirm, shorten, or invalidate the period of incapacity. Research has emphasized that the expert assessment is crucial for limiting abuses.

What can influence the refusal of benefit payment?

Refusal of payment may result from irregularities related to the document or from expert grounds. The system verifies the compliance of the incapacity period with regulations, as well as identification data, which must be complete and correct.

The most common causes of problems include:

• invalidity of e-ZLA due to a technical error,
• discrepancy in patient or employer data,
• lack of entitlement to benefits,
• result of the medical examiner’s inspection,
• irregularity indicated in the documentation.

Research on electronic benefits systems confirms that errors in documents significantly delay the decision on payment, which is why the accuracy of data on the sick leave is crucial.

How does E-ZLA affect communication between the employer and ZUS?

E-ZLA shortens the exchange of information and eliminates the need to submit paper documents. The employer receives the sick leave in the payer’s profile on PUE, where they can see the duration of incapacity and the type of benefit. Studies have shown that automation reduces the number of errors on the part of payers and speeds up the preparation of documentation related to the benefit.

If the employer does not have a PUE profile, the system generates a requirement to provide a printout; however, in practice, most payers use the electronic form of documents.

Sickness Benefits – Q&A

How does E-ZLA reach ZUS and the employer?
Automatically through the PUE system after being signed by the doctor.

Does the patient need to provide the document to the employer?
No, the entire process takes place electronically.

Who decides on the granting of sickness benefits?
ZUS, based on data from the e-sick leave and insurance regulations.

What if the medical examiner shortens the sick leave?
ZUS will reduce or deny the benefit for the shortened period.

Can an error in E-ZLA suspend the benefit?
Yes, incorrect data can lead to the invalidity of the document.

Sources

1. WHO – Digital Certification of Sickness Benefits.
2. OECD – Electronic Social Insurance Systems and Efficiency.
3. Journal of Social Insurance Medicine – Accuracy of Electronic Sick Leave.
4. European Observatory on Health Systems – Impact of Digital Documentation on Benefit Processing.