Reintegration process flow when launched by the health insurer

The advising physician for the health and disability insurance company is one of the parties that can launch a reintegration process. How does that work? What is the difference with processes launched by the employer or employee? And what forms of financial intervention can an employee claim?

The reintegration legislation not only allows employees and employers to launch a process at their own initiative for a long-term sick employee; but the advising physician for the health insurance company can also do this.

Why does the health insurance company launch a reintegration process?

The FPS Public Health has imposed objectives on the health insurance companies concerning the reintegration of employees with long-term illnesses. At the end of 2018, approximately 17% of the reintegration processes were launched by the health insurance company. This figure is bound to increase.

How does the health insurance company do this?

A first selection by the health insurance company determines which employees with long-term illnesses are eligible. The employee falls back on guaranteed wages during the first month that an employee goes on sick leave and is unable to come to work. The employer will continue to pay the employee during this period.

The health insurance company provides a benefit as from the second month of illness. At the end of the second month, the company checks to see whether the employee will be able to return to work in the near future or not. If this is to be the case sooner rather than later (e.g. after a broken arm), nothing else will happen. If the employee is facing a (very) long period of rehabilitation (e.g. therapy after cancer), then a reintegration process is not an option either. All other situations of long-term illness can be considered.

The advising physician refers these employees to the occupational physician. The latter assesses whether reintegration is possible.

What does the ‘economic capacity’ of an employee mean?

However, things are not so simple. Other legislation issued by the FPS Public Health also remains in force. The legislation on health and disability benefits stipulates that doctors of the health insurance company can assess the ‘economic capacity’ of employees in relation to their health.

In order to be suitable for the labour market, an employee must be at least 66% fit for work. The possibility of being employed within one’s own professional category can be examined during the first six months. Afterwards, the labour market will be looked at more broadly.

For example, in the course of a reintegration process, the health insurance company may find that there is no longer any economic incapacity. At that point, the employee is suspended by the health insurance company and loses the benefit. Because this is an ongoing reintegration process, the RVA provides financial support. The employer must then issue a C3.2 for temporary unemployment due to (medical) force majeure.

Even during a reintegration process that has not been launched by the health insurance company, the health insurance company can establish that there is no longer a two-thirds economic incapacity.

Who pays for the costs of a reintegration process launched by the health insurance company?

The health and well-being legislation stipulates that the employer must bear the costs of the compulsory medical examinations within the framework of the health and well-being legislation. This also applies to the reintegration examination, regardless of who applied for it.

Is there a difference between processes launched by an employee or employer?

In principle, no; but there is one exception. If an advising physician launches a process, the occupational physician cannot make an E decision (reintegration not yet possible for medical reasons).

For example, a reintegration process could have still been launched for employees for whom it is not very opportune. Co-Prev, the umbrella organisation of the external services, has already raised this issue. A possible solution could be to use a ‘quick scan’ in the form of a questionnaire to have an initial screening carried out.

How can Mensura help?

Mensura can assist you with the reintegration of employees with long-term illnesses in a practical and policy-related way. 

If you would like more information, please don’t hesitate to contact us by email or by calling +32 2 549 71 00.