Employee Incorrectly Requested the Sub-district Court to Order the Self-insured Employer to Pay the Sickness Benefit

An employer and an employee had a dispute about whether the employee was ill when her employment contract was terminated. This was the reason why the employer, who was a self-insurer, did not pay the Sickness Benefit. The employee wanted the Sub-district Court to order the employer to pay the Sickness Benefit, but the Court declined jurisdiction over this request.
An employee worked under a fixed-term employment contract at a clinic for Forensic Psychiatry. The agreement ended November 1, 2023.
On September 17, 2023, the employee reported sick, but the occupational physician twice decided twice that the employee was not incapacitated for work due to illness. Therefore, the employer reported the employee recovered as of September 27, 2023. The employee twice applied for an expert opinion with the UWV, and twice the UWV decided that the employee was incapacitated for work.
In the end, the employment contract ended with effect from November 1, 2023. The employee then claimed entitlement to a Sickness Benefit because she had left the employment while being ill. Being a self-insurer, the employer had to pay the Sickness Benefit, but he failed to do so because he maintained that the employee was not incapacitated for work. The employee then requested the Sub-district Court to order the employer to pay the Sickness Benefit.
But here the employee went wrong. The Sub-district Court considered the employee's claim inadmissible since payment of the Sickness Benefit is not governed by Civil Procedural law but by Administrative Procedural law. The Sub-district Court pointed out that there has to be a UWV decision before an employee can claim a Sickness Benefit. Once this decision has been made, the self-insured employer will pay out the Sickness Benefit on behalf of the UWV. If the employer fails to do so, the employee may require payment of the UWV. Then, the UWV will pay the employee and will recover the benefit from the employer.
The Sub-district Court therefore explained the employee that she should require the UWV to determine the entitlement to the Sickness Benefit.

It is not uncommon that disputes with a self-insurer about payment of a Sickness Benefit or about reintegration of a former employee with a Sickness Benefit lead to proceedings before the wrong Court. The legislation on that point is quite often not well known.
The Sub-district Court rightly pointed out that the former employee should not lodge a complaint against a self-insured employer with the Civil Court, but that she should ask the UWV for payment if the employer fails to do so. The Sub-district Court also correctly pointed out that the entitlement to a Sickness Benefit has to be determined first.
Referring the former employee to the UWV, however, was not correct.
The Sub-district Court overlooked the fact that it is the self-insurer’s task to prepare the UWV decision on the entitlement to the Sickness Benefit. For that purpose, the self-insurer shall have an occupational physician determine the entitlement to Sickness Benefit. Usually this occupational physician is different from the one who used to supervise absenteeism due to illness when the employee was still employed. Therefore, it would by no means have been obvious in the above case, that this occupational physician would also have declared the employee not incapacitated for work.
If the occupational physician has judged that the former employee is not incapacitated for work due to illness, the UWV will, at the employer's request, decide to refuse the Sickness Benefit. Initially, the UWV only checks whether the decision has sufficiently been prepared, in other words: has the employee been examined by the occupational physician?. Then the former employee may object to that decision with the UWV.
If the former employee does so, the UWV will still fully assess whether the decision the self-insurer had prepared was correct.
If the occupational physician has judged that the former employee is incapacitated for work due to illness, usually the UWV will not make a decision to that effect.
The former employee will not need the decision, because it is likely she will agree.
If the employer disagrees with the decision, he may ask the UWV to take a decision as yet, after which the employer may lodge an objection with the UWV.
If the employer in the above case would refuse to have the former employee examined by a occupational physician, then the former employee should contact the UWV. In that case the UWV will investigate the entitlement to a Sickness Benefit and decide on it.