Disability
Disability is a complex matter whose regulations change regularly.
As a general practitioner, it is not easy to stay informed of all the adjustments and side effects of disability. In addition, a structured network is created around the patient, in which the general practitioner, occupational physician and consulting physician play a role.
Declaration of disability
Patients who are incapacitated for work following an illness or accident are entitled to sickness benefits if they meet certain conditions .
To this end, they must send a certificate of incapacity for work to the advising doctor of their regional health insurance fund.
Specific certificate
The declaration must be made with the certificate of incapacity for work :
The first part is completed by the patient, the second part by the treating physician .
To determine the validity of the disability, the following information is necessary :
- start and end date of the disability;
- diagnosis or symptomatology;
- signature and date of signing.
The Riziv number should also not be missing. In addition, it is possible to provide contact details (email address) and encode the context (ICD10 and/or ICPC2).
During the first year of disability, this certificate is required to cover each period of disability. In the event of an extension , these periods must follow each other without interruption . This also applies if an incapacity for work is extended during a period of part-time resumption of work, approved by the advising doctor.
After the first year of incapacity for work, this certificate is no longer necessary .
Timely submission
The patient must submit the first declaration to the advising doctor of the regional health insurance fund within a specific period. This period varies depending on the situation.
If in doubt, it is best to advise your patient to send the certificate within two calendar days .
Extra information
- The start of incapacity for work is the first day on which work is stopped (not the first day after the period of guaranteed wages).
- During the first year of disability, benefits are stopped on the end date stated on the disability declaration.
- For self-employed persons , benefits can only start from the date on which the certificate of incapacity for work was signed . This applies to both the first certificate and to each renewal declaration.
- If you are incapacitated for work for a full week, you must state Sunday as the end date . If not, your patient will lose the benefit for Saturday.
- If your patient is insured abroad , you must use the international certificate of disability.
- If your patient is an employee, you must also prepare a certificate for the employer . Please state the start and end date of the disability. Medical information is not communicated. The report 'illness' or 'accident' is sufficient.
Information about the certificate of disability can be found on the Riziv website.
Recognition of disability
The legislation defines recognition of disability for employees and the unemployed as follows:
'A worker who has ceased all work as a direct consequence of the onset or aggravation of injuries or functional disorders recognized as reducing his ability to earn to one third or less than one third of what a person, of the same status and with the same education, can earn through his activity in the professional category to which the professional work belongs, performed by the person concerned when he became incapacitated for work or in the various professions that he has or could have practiced on the basis of his vocational training.
During the first six months of primary incapacity for work, this reduction in the ability to earn is evaluated in relation to the profession of the interested party, insofar as the condition can evolve favorably or be cured in the short term.'
- Loss of two-thirds of the ability to earn
In practice, it concerns the inability to work in an acceptable and sustainable manner.
- Reference professions
- During the first six months of incapacity for work, the advising doctor takes into account the profession that the patient practiced immediately before the incapacity for work.
- After six months, other professions are taken into account depending on the patient's professional experience and the qualifications he has acquired.
Example
A young saleswoman without specific qualifications works in the sale of heavy materials and suffers from lower back pain. She can resume her profession as a saleswoman in a perfumery, praline or clothing store.
- During the first six months of incapacity for work, the advising doctor takes into account the profession that the patient practiced immediately before the incapacity for work.
The recognition of disability for self-employed persons is described in Article 19 of the Royal Decree of 20 July 1971 .
'During the periods of primary incapacity, the beneficiary shall be recognized as being incapacitated for work if, due to injuries or functional disorders, he has had to put an end to the performance of tasks related to his professional activity as a self-employed beneficiary and which he observed before the onset of the incapacity for work. Furthermore, he may not engage in any other professional activity, whether as a self-employed person, as an assistant, or in any other capacity.
If the beneficiary was no longer exercising a professional activity at the time when the state of incapacity for work commences, the latter will be valued in relation to the professional activity as a self-employed person that he most recently exercised.'
Financial consequences
If the patient is incapacitated for work, he loses a large part of his income. After all, disability benefits are lower than professional income.
- Employees
During the period of primary disability (first year), the benefit is 60% of the capped gross salary. Depending on the status of the insured, this may be even lower.
From the second year onwards, the calculation varies depending on whether your patient is the head of the household, cohabiting or single.
Read more on the information page for members.
- Unemployed
For the first six months, the benefit is equal to unemployment benefit, with a maximum of 60% of the basic salary.
From the seventh month onwards, the benefits amount to 60% of the capped gross salary.
From the second year onwards, the calculation varies depending on whether your patient is the head of the household, cohabiting or single.
Read more on the information page for members.
- If the self-employed person is incapacitated for work for less than eight days , he or she will not receive any benefits . This is the so-called caren period.
- If the self-employed person is incapacitated for work for more than seven days , he or she can receive a lump sum benefit from the date on which the certificate of incapacity for work was signed . The benefit varies depending on whether your patient is head of household, cohabiting or single. From the second year onwards, the amount also depends on whether or not the company is closed down.
Partial return to work
The purpose of the partial return to work is the complete or partial reintegration of the patient. It offers an employee who is no longer (or not yet) suitable for work the opportunity to perform a reduced or modified activity during the recognized period of incapacity for work.
To be eligible for a partial return to work , the patient must :
- have stopped all activities at the beginning of the incapacity for work (at least one day) and have been recognized as incapacitated for work according to art. 100 §1;
- maintain a reduction of at least 50% in the medical field (art. 100 §2);
- perform a job compatible with his current state of health;
- ask the advising doctor in advance for permission to work part-time during the period of incapacity for work.
For self-employed persons, the purpose of exercising a part-time activity is:
- either full professional reintegration through an adapted or gradual return to work (the period can be limited);
- or partial long-term reintegration if a full return to work is impossible for medical reasons.
For the part-time activity, the patient must request and have prior permission from the advising physician.
Professional reintegration
Since the end of 2016, a reintegration program can be started for sick people.
With this initiative, which is being introduced gradually, the government wants to facilitate the return to the labor market for some sick people through a gradual return to work, an adapted or different job, or vocational retraining.
Role of advising physician
In addition to providing information about and implementing health insurance, the advising physician is responsible for:
- the verification of disability;
- the socio-economic reintegration of persons who are disabled.
In addition, the advising physician also participates in the procedure for vocational retraining .
