Sick leave: well-regulated checks

January 04, 2023

When a doctor prescribes sick leave for an employee, the latter will receive compensation from the company, in addition to Social Security benefits. These provisions are provided for by the Labor Code or, possibly, by the collective agreement of the company. Employers and Social Security, responsible for compensating employees in the event of sick leave, have the right to carry out checks on these work stoppages for health reasons.

Control of sick leave by employers

Employers have the right to verify through a medical control sick leave if the absence of an employee for health reasons is justified. Thus, they can call on a practitioner of their choice and send it to the employee's home at any time. The doctor in question is responsible for ensuring that the work stoppage is legitimate. In order for the check to be carried out, the employee must communicate the address at which he will reside during his sick leave. Normally, the insured must be present at the place indicated between 9 a.m. and 11 a.m. and between 2 p.m. and 4 p.m.

If the employee is not at this address during the statutory hours, the employer may decide to suspend the payment of the indemnities. Indeed, this is the only sanction he is authorized to apply in the event of unjustified sick leave. The other response measures (dismissal, reprimand, etc.) can be condemned by the courts, according to experts in social law. To find out more, visit mediverif.fr.

Checks carried out by Social Security

If the employer was unable to carry out the visit, the medical check up can be done under the initiative of the Health Insurance Fund. The latter will be responsible for verifying the situation of the employee in question and may summon the latter for an examination carried out within the medical service of the Social Security.

If the examining doctor issues a negative opinion at the end of the counter-visit, it is possible that the daily allowances of this employee will be suspended. However, in some cases, L'Assurance Maladie only receives these notices late, or not at all, which can constitute an obstacle to follow up on irregularities. Only employees with sick leave of more than 45 days, or those who have interrupted their work three times in a row during the year are subject to priority checks.

Verifications concern not only the legitimacy of work stoppages but also their duration and extension, as well as the obligations of the employee. Indeed, the latter is required, throughout his work stoppage, to stop all activity, professional or personal. The notice of unjustified leave also gives rise to a return to work notification.

Sick leave: principle of medical expertise

In the event that the practitioner in charge of the medical control sick leave disagrees with the employee, the latter can ask his attending physician to send proof of the leave. A new examination can then take place. The employee can also protest if the controller exceeds the limits of his benefits. This is the case for example when this professional communicates the details of the pathology of the employee to the company. If the medical check is favourable, the doctor may again prescribe a work stoppage so that the daily allowances resume, no earlier than 10 days after the suspension thereof.

The request for medical expertise is made to the Caisse Primaire d'Assurance Maladie. In the event of a result against the employee, the latter may, as a last resort, appeal to the Social Security Amicable Appeal Commission (CRA).

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