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Publication date: 15.05.2024
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The Supreme Court came to the conclusion that leaves of incapacity for work from doctors - FOPs confirm the right to payment
The CAS of the Supreme Court expressed its position regarding the payment of benefits based on a certificate of incapacity for work issued by a doctor conducting medical practice as an FOP. It is about the decision of the Supreme Court of December 5, 2022 in case No. 440/2621/21.
In this dispute, the company appealed to the court the decision of the Executive Directorate of the Social Insurance Fund of Ukraine in the Poltava region regarding the return of illegally spent insurance funds and the payment of a fine.
This decision was made based on the results of a documentary check, during which a violation of the policyholder's use of insurance funds was found, namely:
accrual and payment of benefits for temporary incapacity for work were carried out based on a certificate of incapacity for work issued in an incorrect manner (the certificate of incapacity for work was issued by a non-treating doctor of a health care institution, regardless of the form of ownership, and not by a doctor conducting economic activity from medical practice as a sole proprietorship).
Courts of previous instances, having satisfied the claim, came to the conclusion that insured persons have the right to receive, in the event of an insured event, material support, insurance payments and social services provided for by the Law of Ukraine "On General Mandatory State Social Insurance" of September 23, 1999 No. 1105-XIV (hereinafter - Law No. 1105).
The Supreme Court, reviewing the case in the cassation procedure, indicated that the basis for awarding temporary disability benefits is a certificate of disability issued in accordance with the established procedure.The court came to the conclusion that a certificate of incapacity for work is a basis for the appointment of temporary incapacity for work benefits, if it is issued by a doctor who has the right to issue certificates of incapacity for work, namely:
• a treating physician of a health care institution, regardless of the form of ownership, or a physician conducting economic activity from medical practice as a sole proprietorship);
• contains all the necessary details (surname of the doctor who issued the certificate of incapacity for work, signature and seal of the doctor, seal of the health care institution "For certificates of incapacity for work", etc.
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Courts of previous instances established that the leaves of incapacity for work were issued on behalf of the FOP, the main activity of which is general medical practice, which is confirmed by an extract from the EDR. These sheets contain impressions of the seal and signatures of the latter.
The panel of judges noted that the insured patient has state guarantees for the realization of his rights, in particular, for appropriate material support and insurance payments, at the same time he has the right to choose a treating doctor, and therefore the deprivation of the patient - an insured person of the right to such material support or insurance payments without establishing the absence of this patient's right to such payments is a violation of the principles of social insurance established by Law No. 1105.
Therefore, in the absence of the patient's responsibility regarding the correctness of filling out the sick leave sheets, and also taking into account that the very fact of the occurrence of an insured event according to the investigated sick leave sheet is not questioned by the Fund body, there are no grounds for returning the funds of the Fund, which were paid in accordance with the indicated sick leave sheet.
