Our mission within health insurance
Text Vårt uppdrag inom sjukförsäkringen
If you are interested in Försäkringskassan’s public health insurance commission, you can read here about the role of the administrator, doctor’s certificates and who else plays a role in a person’s sick leave.
The commission in brief
When it comes to health insurance, Försäkringskassan’s commission from the Government it to give the right compensation to the right person through effective administration that is in compliance with the law. Försäkringskassan shall also work with the healthcare sector, the Public Employment Service, the employer and other parties. The long-term goal is for as few people as possible to have to be away from their work due to illness.
Role of the administrator
The role of a Försäkringskassan administrator is to assess the work capacity of an individual who applies for sickness benefit to be able to make a decision about whether they are entitled to compensation. The assessment is based on information in the application, the doctor’s certificate and current legislation.
Doctor’s certificate – basis for describing work capacity
A person who is absent from work more than seven days must have a doctor’s certificate. The employer and Försäkringskassan use the doctor’s certificate to assess whether work capacity is impaired and the person is therefore entitled to sick pay from their employer or sickness benefit from Försäkringskassan. In other words, the doctor's certificate itself does not automatically entitle the person to compensation.
In the doctor's certificate, the doctor describes how the illness affects work capacity and indicates how long and to what extent the person needs to be on sick leave. If the doctor's certificate does not contain enough information, Försäkringskassan may request that the doctor send in additional information.
The insurance medicine advisor interprets information
Insurance medicine advisors are hired as experts in medical issues that may arise during processing. They have great medical knowledge and help the administrators understand and analyse the information in the doctor’s certificates. Insurance medicine advisors do not make any decisions about sickness benefit.
Försäkringskassan's coordination role
Försäkringskassan is responsible for coordinating rehabilitation measures for those who are on sick leave. As part of this role, Försäkringskassan works with the employer, healthcare sector, social services, the Public Employment Service, and other authorities affected by rehabilitation of the individual on sick leave.
With this, Försäkringskassan demands that those it cooperates with – whether at the individual or the structural level – help to create conditions that enable the individual on sick leave to return to work. Försäkringskassan thus ensures that the right action is taken at the right time by the person or organisation responsible for it, but does not perform any rehabilitation measures itself.
The rehabilitation chain
Work capacity is assessed differently depending on how long the person has been sick. This is called the rehabilitation chain:
- For the first 90 days a person is on sick leave, they are entitled to sickness benefit if they are unable to perform their normal work or another temporary job with their employer.
- After 90 days, a person is only entitled to sickness benefit if they cannot perform any work at all for their employer.
- After 180 days, a person is entitled to sickness benefit if they cannot perform any work on the regular labour market.
The time limits in the rehabilitation chain do not apply if Försäkringskassan assesses that a person is highly likely to be able to return to some form of work with their employer within one year from the first day of sickness. In such cases, work capacity is still assessed in relation to a job with their employer after day 180. Additionally, the time limits do not apply if it can be considered unreasonable to assess a person’s work capacity in relation to work on the regular labour market.
The rehabilitation chain only applies fully to those who are employed. For job seekers, work capacity is assessed in relation to the entire labour market right from the start of the sickness period. For self-employed individuals, work capacity is assessed in relation to the entire labour market after 180 days.