Main changes to sick leave for temporary incapacity for work

On 1 August 2021, the new form of Emergency Ordinance No 158/2005 on social health insurance leave and allowances, as amended by Emergency Ordinance No 74/2021, entered into force.

What are the main changes to sick leave?

The main change is that doctors will be able to issue sick leave certificates for temporary incapacity for work only in two stages, and will also be obliged to draw up a plan for monitoring the progress of the illness, the structure of which is laid down in the rules implementing the law, which the insured person is obliged to follow. Except in the case of certain special diseases, medical and surgical emergencies, and certain infectious diseases for which isolation is required, and when the insured person is hospitalized, the follow-up plan is not required. Sick leave for maternity, for the care of a sick child, and in the case of maternal risk may also be granted in a single stage without the need for a follow-up plan.

What does the doctor’s follow-up plan involve?

On 30 July 2021, the Order of the Minister of Health No 1398/729/2021 was published, which sets out the model of the disease evolution plan and what it must contain.

Thus, the follow-up plan will contain the two assessment steps. In the first stage, an initial assessment will be carried out, medical indications will be given, referral tickets will be issued for necessary investigations, the initial sick leave will be determined, and appointments will be made for further assessment.

In the second stage, the evolution of the illness that caused the temporary incapacity for work is followed, and data related to the clinical reassessment, the medical indications in this phase, as well as data related to the extension of the sick leave and the justification of this measure, if necessary, will be noted. Insofar as doctors do not comply with the obligation to draw up the plan for the evolution of the illness, they may be fined between 5,000 and 10,000 lei.

The National Health Insurance House stated in a press release dated 30 July 2021 that if the insured person is unable to go to the doctor’s office for medical leave, the attending physician (family doctor or outpatient specialist) can provide consultations at home or remotely. It will therefore be possible to monitor the illness’s progress and extend the sick leave, if necessary, at a distance.

In the first stage, sick leave may be a maximum of 4 calendar days for sick leave granted by the family doctor and 15 calendar days of sick leave granted by outpatient specialist doctors.

In the second stage, in the event of continued temporary incapacity for work, ascertained on the basis of the assessment of the response to the initial treatment and/or the results of laboratory tests, functional and/or imaging investigations recommended, the family doctor or, where appropriate, the outpatient specialist doctor monitoring the condition may issue the certificate of continued sick leave for a maximum of 7 days for the family doctor and a maximum of 30 days for the outpatient specialist doctor.

Doctors will therefore have to follow the evolution of the patient’s illness and how the patient reacts to the prescribed treatment, and only if, following the necessary tests and investigations, there is no favorable evolution a certificate of further sick leave will be issued.

Secondly, another important change concerns the number of days to be paid by the State for sick leave for temporary incapacity for work granted during quarantine. It is thus stipulated that, in the event of a quarantine measure being introduced on return to Romania for a person who has traveled for personal reasons to an area where at the time of travel, there was an epidemic, epidemiological or biological risk with a high pathogenic agent, the State will only pay for five days of the sick leave granted.

Prior to the amendment, the law provided that the state would pay the full compensation upon entry into quarantine, regardless of the duration of the quarantine. It was considered necessary in order to make people who travel for personal reasons to areas where there is an epidemic/epidemiological risk and who, on their return to Romania, enter sick leave for quarantine so as not to become a risk factor for the people they come into contact with.

A penalty has also been added for employees who work for more than one employer and who, after obtaining their sick leave certificate, present their sick leave certificate to only one employer and continue to work for the other employer. These employees could be fined between 1,000 and 2,000 lei.

Changes have also been made to the calculation basis for non-earners who take out optional insurance for sick leave and maternity benefits. In this case, the maximum monthly calculation basis for social insurance benefits is determined as the average of the gross monthly earnings of the last 6 months of the 12 months of the insurance period, up to the monthly limit of 3 gross minimum wages per country. Before the amendment, the limit was set at 12 gross minimum wages.

For persons who take out optional insurance in order to receive maternity leave and maternity benefits, the maximum monthly basis for calculating benefits shall be determined as the average of the insured earnings for the last 6 months of the 12 months of the insurance period, up to the monthly limit of 12 gross national minimum wages guaranteed in payment.