Rehabilitation benefit – amount and rules. Who is eligible for benefits? [WE EXPLAIN]

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Rehabilitation benefit (ZUS rehabilitation allowance) is granted to a person who no longer receives sickness allowance, but whose health condition promises recovery and return to work. However, not everyone can apply for benefits. For this reason, we decided to check who is entitled to it and what is its amount.

Who is entitled to a rehabilitation benefit?

You are eligible for rehabilitation allowance sickness insurance. This insurance is obtained in the following cases when:

1. you are worker,
2. you do homework,
3. you are a member of an agricultural production cooperative or a cooperative of agricultural circles,
4. you work for a fee on the basis of a referral to work when you are serving a prison sentence or are temporarily arrested,
5. you are working on the basis of agency contract or contract of mandate or another contract for the provision of services, or you work with such a person, including working on the basis of an activation contract, e.g. you are a nanny,
6. you drive non-agricultural activity or you work with such a person,
7. you are a clergyman
8. you are doing alternative service.

You may also receive a rehabilitation allowance when you are covered accident insurance. This insurance is obtained when:

1. you are an employee
2. you are a member of an agricultural production cooperative or a cooperative of agricultural circles,
3. you are on alternative service,
4. you perform work on the basis of an agency contract or contract of mandate or other contract for the provision of services or you work with a person who performs such a contract or you are a nanny, i.e. you work on the basis of an activation contract,
5. you run a non-agricultural activity or cooperate with a person who carries out such activity,
6. you perform work for remuneration, on the basis of an assignment to work, while serving a sentence of imprisonment or pre-trial detention,
7. you are a clergyman
8. you receive a salary as a deputy or senator,
9. you receive a sports scholarship,
10. you receive a scholarship as a student of the National School of Public Administration President of the Republic of Poland, Lech Kaczyński,
11. you receive a scholarship during training, internship or vocational preparation for adults, on the basis of a referral issued by the poviat labor office or by another entity, and during postgraduate studies on the basis of the provisions on employment promotion and labor market institutions.

If you run a non-agricultural activity or cooperate with a person who conducts such activity, or you are a clergyman, the right to rehabilitation benefit from accident insurance depends on the timely payment of due social security contributions.

Rehabilitation benefit – who is entitled to?

The rehabilitation benefit is granted to a person insured with the Social Insurance Institution (ZUS), who can no longer receive sickness benefit (the limit has been reached), but is still unable to work. In practice, this means that a patient may apply for state funding after 187 days of illness or 270 days in the case of pregnancy and tuberculosis. In order to receive the benefit, the patient must prove that his health condition promises recovery and return to work. It is the ZUS certifying physician that decides whether or not a person will receive a salary.

1. Check: What are the rights of a pregnant woman?

Rehabilitation benefit – how long can you download?

Rehabilitation benefit may be taken for the entire period of illness, but it cannot exceed twelve months, that is a full year. There are cases where ZUS certifying physician he did not consent to receive the benefit. Then you can appeal against its decision. It is also worth remembering that a person may also apply for a benefit whose assessment has granted consent to receive a premature pension.

See: ZUS inspected sick leaves – it took 100 million simulators

Application for a rehabilitation benefit – what does it look like?

A person who intends to apply for a rehabilitation benefit should submit an application to the nearest ZUS office along with a package of documents that will allow the examining physician to familiarize himself with the history of his illness. The file should contain information about the patient’s health condition along with the opinion of the attending physician, an interview from the workplace (not applicable to people who have their own business), as well as a certificate of payment of social security contributions. If a person is incapable of work due to an accident that happened at the workplace, the application for rehabilitation allowance should be submitted together with the accident card from the workplace, as well as a report with the detailed circumstances of the incident.

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How much is the rehabilitation benefit?

The rehabilitation benefit for the first three months is 90% of the wage paid while receiving sickness benefit. In the case of pregnant women and people unable to work due to an accident at the workplace, the patient receives 100%. In the following months, only 75% of the basic salary is paid.

Rehabilitation benefit – who is not entitled to?

Rehabilitation allowance is not payable in strictly defined cases. You will not receive any benefit if you are entitled to:

1. retirement or disability pensions,
2. unemployment benefit,
3. pre-retirement allowance,
4. pre-retirement benefits,
5. leave for health reasons,
6. parental supplementary benefit,
7. teachers’ compensation benefit.

In addition, rehabilitation benefits are not granted then:

1. for the periods in which you retain the right to remuneration under special provisions,
2. during the period of unpaid leave or childcare leave,
3. during pre-trial detention or imprisonment,
4. for the entire benefit period, if the inability to work was caused by an intentional crime or misdemeanoras stated in a final court decision,
5. for the calendar month in which you performed paid work or used the period for which the benefit was granted contrary to its purpose,
6. if after exhausting the sickness benefit you came back to work, for which you have sickness insurance or you are guaranteed the right to benefits for the period of sickness,
7. you are subject to compulsory social insurance for farmers.

Read: If work is harmful – maybe compensation?

What after the rehabilitation benefit?

If there is a situation where a person receiving rehabilitation allowance (despite previous favorable prognosis) remains incapable of work, he or she may apply to ZUS for granting disability pensions. A pension is due to a person who is at least partially incapable of work and has the required contributory and non-contributory periods. Nevertheless, to obtain it, the following conditions must be met:

1. you must be unable to work,
2. you have the required – appropriate for the age – period of insurance (contributory and non-contributory period):
3. 1 year – if you became incapable of work before the age of 20,
4. 2 years – if you became incapable of work between the age of 20 and 22,
5. 3 years – if you became incapable of work between the age of 22 and 25,  
6. 4 years – if you became incapable of work between the age of 25 and 30,
7. 5 years – if you became incapable of work after reaching the age of 30, this period must fall within the last 10 years: before the date on which you applied for a disability pension or before the date on which your incapacity for work arose,
8. your incapacity for work arose during the contributory or non-contributory periods specified in the Pension Act, or within 18 months from the end of these periods. This requirement does not apply if you are completely incapable of work and have at least 20 years of insurance – if you are female, 25 years of insurance – if you are male.

The incapacity for work and its degree are assessed a certifying physician of the Social Insurance Institution in the form of a certificate. The examining doctor determines:

1. whether the person is incapable of work and to what extent,
2. when the incapacity for work arose,
3. why the person is incapable of work (e.g. due to an accident on the way to work),
4. whether this incapacity for work is permanent or temporary, and if temporary, for how long,
5. whether a given person is incapable of independent existence permanently or for a specified period of time,
6. is it advisable to retrain in order to be able to perform another job.

The Social Insurance Institution, on the basis of a certificate issued by a certified doctor or a medical commission, issues decisions on granting a disability pension.

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