When does the CNS contact the insured person or employer concerning financial benefits?
The CNS informs the insured or the employer every time of each significant expiry or change of coverage or responsibility for coverage throughout the period of preliminary enquiry and allocation of sickness benefit or the ending of sickness benefit.
On distingue les informations suivantes :The kinds of information are categorised as follows :
- If the periods of declared incapacity for work reach six weeks in the course of a reference period of sixteen weeks, the CNS invites the insured by letter to return the form used by his/her treating doctor.
- A reminder by non-registered mail is sent to the insured at the end of the eighth week of incapacity drawing his or her attention to the consequences which will ensue from failing to return the R4 report as requested (see above).
- Notice from the Social Security Medical Board estimating the insured to be fit for work results in a decision by the CNS. This decision will include the information that the certificates of incapacity for work owing to sickness or accident for the twelve weeks to come cannot be used to claim benefit from the CNS, unless a new medical factor should arise to justify the prolongation of incapacity, supported by a detailed account from the treating doctor.
- The CNS notifies the insured of the withdrawal of financial benefits in the case that he or she evades a medical control or examination without viable motive. It also informs the insured of the suspension of benefits for the period of time that the insured stays abroad without prior authorisation, or is in prison or custody.
- The CNS notifies the employer and the employee on the twentieth day of the month at the latest that the legal entitlement to benefits has expired at the beginning of said month or that responsibility for benefit payment has reverted from the CNS to the employer.
- The CNS informs the non-salaried worker for whom the suspension of financial benefit has finished at the beginning of the month as well as informing the non-salaried worker for whom suspension has started at the beginning of the same month.
- In the case that the Social Security Medical Board diagnoses total invalidity, the insured and the pension fund are notified of the cessation of sick pay benefits effective from the first day of the month following that in which the diagnosis was made. The same procedure applies for the month before benefit payments expire.
- With due reference to provisions of Article 125-4 of the Labour Code (termination of work contract by right of law), the CNS notifies the insured and his or her employer of the date of termination of payment of sickness benefit. This notification, addressed to the interested parties before the ending of the legal right to benefit, serves an informative function only, given that contesting limitations to the right to benefits is ruled out, in conformity with Article 83 of the Social Security Code.
What are the obligations of the insured person with regard to their employer?
- Inform the employer immediately of interruption of work for reasons of sickness, even if only for half-day interruptions, whether it be following the stipulations of the statutes of the CNS or in accordance with the current terms of contract of employment
- For every case of incapacity for work which exceed two working days, the medical assessment of incapacity for work must be sent to the employer (2nd section) so that the employer is sure to receive it on the third day.
What are the obligations of the insured person with regard to the CNS and the CMSS (Medical Board of Social Security)?
For every case of incapacity for work which exceeds two working days, the medical assessment of incapacity for work must be sent to the CNS (1st section) so that the CNS is sure to have received it on the third day.
If incapacity for work is prolonged beyond the period originally foreseen, send the medical assessment justifying the prolongation to the employer (2nd section) and to the CNS (1st section), within at least two days after the end of the second day of what had been originally foreseen as the day on which you would have resumed work. A failure to send these forms may result in a warning and fines.
Be sure to appear for any medical control to which you may be called.
I am on sick leave: when may I leave the country?
A stay abroad during an incapacity for work may be authorized, upon presentation of a prior request:
- Serious illness of the person declared incapable of work (e.g. cancer, CVA, severe heart failure, sclerosis,...), for a determined period, following positive advice of the docter and the CMSS (Medical Board of Social Security);
- right to palliativ care of the person declared incapable for work for the duration of the palliative care
- invalidity procedure;
- death occurred abroad of a 1st degree blood relative, 1st degree relative or partner;
- birth abroad of a child of the person declared incapable of working.
A stay abroad cannot be authorised in other cases.