Long-standing dispute with the Social Insurance Institution over sickness benefit successfully resolved

Recently, the Regional Court, Labour and Social Security Division, issued a final judgment dismissing the appeal of the Social Insurance Institution (ZUS), thus ending a dispute between the Client and ZUS, which had lasted for over four years, concerning the correct calculation and payment of sickness benefit to an employee injured in an accident at work.

The Client asked us for help with a decision received from ZUS ordering him to return the sickness benefit paid to the employee. After analysing the evidence, we decided that an appeal should be lodged with the court and that the ZUS decision, which we considered to be flawed, should be overturned. The Client commissioned us to handle the case and, thanks to our assistance, obtained a favourable ruling.

In the decision we appealed, ZUS ruled that the client’s employee was not entitled to sickness benefit from accident insurance in the amount of 100% of the assessment basis, but should receive sickness benefit in the amount of 80% of the assessment basis, because the accident at work he suffered, in the opinion of ZUS, was indeed an accident at work, but its sole cause was the violation by injured employee of health and safety regulations. As a result, the Client was obliged to reimburse the employee for the overpaid sickness benefit in the total amount of a few thousand PLN.

The Law Firm’s attorneys lodged an appeal with the court, demonstrating that the Client’s decision to pay the injured employee sick pay amounting to 100% of the assessment basis was entirely correct, as the sick leave on the basis of which the payment was made concerned an accident at work, recognised by the accident investigation team as an accident at work.

During the accident investigation, the accident investigation team appointed by the Client did not find that the accident at work was caused solely by the injured employee’s violation of health and safety regulations, which would be considered intentional or gross negligence. Nor was it found that the injured employee was intoxicated or under the influence of intoxicants or psychotropic substances. The accident investigation team only found that the injured employee had not exercised due care and concentration during work.

During its investigation and at the court proceedings, ZUS failed to prove that the employee contributed to the accident at work through his own fault or gross negligence. ZUS’s claims were also contradicted by the findings and opinion of the expert appointed by the court.

The court of first instance fully agreed with the position of the Law Firm’s attorneys that the Social Insurance Institution’s decision was completely unjustified and that the Client had paid the injured employee the correct amount of sick pay. The court of first instance emphasised that a lack of concentration and due care on the part of an employee is one thing, but deliberate and conscious disregard for hazards at work, or conscious (or grossly negligent) violation of health and safety regulations by an employee is another.

ZUS challenged the decision of the court of first instance and lodged an appeal, which was, however, dismissed by the Regional Court.

Thus, the case ended in complete success for our Client. After several years of court battles, we obtained a favourable judgement for our Client. In view of this ruling, our Client will not have to reimburse ZUS for the sickness benefit paid to the employee.