An accident at work and settlements with ZUS - part II

Service

In the case of a decision that an accident occurred at work, the employee is entitled to a sickness benefit from the accident insurance in the amount of 100%. Unfortunately, the entire process of adjudicating on an accident at work takes quite a long time, and therefore very often the accident is recognized after the payment of remuneration and submission of settlement documents to ZUS. What should an employer who is not a benefit payer do in such a situation?

An accident at work - definition

As presented in the previous part of the article, an accident at work is a sudden event caused by an external cause, causing injury or death, which occurred in connection with work (Article 3 (1) of the Act of 30 October 2002 on social insurance against accidents at work. work and occupational diseases).

In the case of an accident at work, the employee is entitled to a sickness allowance from the accident insurance, which amounts to 100% of the allowance calculation basis, from the first day of incapacity for work (there is no waiting period). If the employer is not the benefit payer, the sickness benefit for an accident at work is paid by ZUS.

The sickness allowance for an accident at work is 100% of the allowance calculation basis.

Benefit payer

The benefit payer, i.e. the entity entitled to the payment of cash benefits from social insurance in the event of sickness and maternity, may be both the employer and the Social Insurance Institution. Who it is depends on the employment as of November 30 of the previous calendar year. Only those who have been compulsorily or voluntarily registered for sickness insurance are included in the employment status.

Whether the payer of benefits is ZUS or the employer depends on the employment status as of November 30 of the previous year.

The benefit payer is ZUS, if on the last day of November of the previous year the employer reported not more than 20 insured persons to sickness insurance.

An accident at work confirmed after the payment of remuneration, when the payer of benefits is ZUS

If the accident at work is recognized only after the sick pay has been paid, the following steps must be taken:

  1. Qualify paid sickness remuneration from sickness insurance as sickness benefit from accident insurance, settling it into social insurance contributions;

  2. Correct settlement declarations, if they have already been submitted to ZUS;

  3. Reimburse the employee for the sickness contribution that was deducted from the previously paid sick pay.

The adjustment of the previously paid benefit to 100% is made by the Social Insurance Institution, if he is the benefit payer.

The correction of billing documents should be made for the months in which the employer settled the incorrectly paid benefit to the employee. In this case, the set of billing documents should consist of:

  • ZUS RSA personal report - the report should include:

    • employee's insurance title code (field 01 of block III.B.),

    • service / break code “314” (field 02 of block III.B.),

    • the period for which ZUS paid the allowance (fields 03.-04. block III.B.),

    • number of benefit days (field 05 of block III.B.),

    • the amount of the benefit equal to the amount of the sick pay previously paid by the employer (field 06 of block III.B.),

  • ZUS RCA personal report - this report should show the settled ZUS contributions (only the basis of the health insurance contribution and the amount of this contribution will change, because the sick pay is included in the basis of the health insurance contribution),

  • ZUS DRA settlement declaration - the declaration should show contributions and benefits for all insured persons taking into account the changes introduced in the ZUS RSA and ZUS RCA reports (the health insurance premium will change and block V, field 03 regarding paid benefits).

Example 1.

Mr. Grzegorz works in a small company employing 8 employees. In February 2018, he had an accident at work. The accident was found only after the payment of remuneration on February 27, 2018 and the submission of a complete set of settlement documents to the Social Insurance Institution in March. Therefore, Mr. Grzegorz received a sick pay of 80% for the duration of his sick leave. After recognizing the accident at work, he received compensation from the Social Insurance Institution (the remaining 20%). In connection with the above, the employer must correct the settlement declaration for February. The set of corrected billing documents should consist of:

  • personal report of the Social Insurance Institution (ZUS) RSA, in which the code of the benefit / break should be entered as "314" instead of "331";

  • ZUS RCA personal report with settled contributions (change in the amount of the health insurance contribution);

  • ZUS DRA settlement declaration containing contributions and benefits for all employees.