Reimbursement During The Sick Leave

Work and daily business bring negative situations such as temporary incapacity for work. Various factors influence this, but the most common is an illness. Following that, workers cannot perform their daily work tasks, and sick leave starts.

During sick leave, workers have the right to reimbursement upon meeting certain conditions prescribed by Law. The article provides an overview of the legal framework and rules related to temporary incapacity for work.

Law on Compulsory Health Insurance

The Law on Compulsory Health Insurance and the Rulebook on Conditions and Ways of Exercising Rights from Compulsory Health Insurance prescribe the legal basis related to workers’ sick leave benefits.

Temporary work incapacity occurs when an employee is absent from work due to illness or injury, i.e. other circumstances determined by Article 39 of the Act mentioned above, which prevents the insured from fulfilling his work obligations by the employment contract, other contract or act.

Under these circumstances, the insured person has the right to reimbursement.

The selected doctor of medicine should report the period of temporary incapacity.

As mentioned earlier, absence from work due to illness or injury, or other circumstances determined by Article 39 of the Act, is considered temporary incapacity for work. Under these circumstances, the employer must pay the insured a salary.

The insured can prove temporary incapacity for work with a report on temporary incapacity. The selected medical doctor issues this document.

Who has a right to reimbursement?

The right to reimbursement related to temporary incapacity for work has an insured person who is:

  • Temporarily unable to work due to illness or injury, i.e. if he is in a health facility for treatment or medical examinations,
  • Temporarily prevented from performing work due to treatments or medical examinations that the insured can’t get done outside his/hers working hours,
  • Isolated as a germ carrier or due to the occurrence of an infection in his environment, or temporarily unable to work due to the transplantation of living tissue and organs for the benefit of another insured person of the CIHI,
  • Appointed as a companion of an insured person in need of treatment or a medical examination at a contracted person of the CIHI outside the place of residence, i.e. the place of residence of the departing insured person,
  • Assigned to care for a sick member of the immediate family (child and spouse) under the conditions prescribed by Law,
  • Temporarily unable to work due to illness and complications related to pregnancy and childbirth,
  • Temporarily prevented from working due to the use of maternity leave and the right to work half-time by the regulations on maternity and parental benefits,
  • Temporarily inability to work due to the use of leave in the event of the death of a child, in the case of a stillborn child or the death of a child during the use of maternity leave,
  • Temporarily unable to work due to a wound, injury or illness that is a direct consequence of participation in the Homeland War,
  • Temporarily unable to work due to a recognized work injury or occupational disease.

Precondition – previous insurance

One of the prerequisites for the payment of salary compensation is previous insurance. The insured receives compensation at the expense of the funds of the Croatian Institute for Health Insurance. The reimbursement belongs to the insured in the amount prescribed by the Law. The day before the start of incapacity for work, the insured person must have continuously completed insurance with the CIHI for at least nine months or twelve months with interruptions in the last two years.

If the insured does not meet the conditions, he receives 25% of the budget base for the entire month and full-time.

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