Intyg för sjukpenning
Here, you can find information on how to fill in the doctor’s certificate for a patient applying for sickness benefit, and who is responsible for what. You can also find information on alternatives to sickness benefit.
Alternatives to sick-listing and routes for return to work
Your patient’s employer shall carry out the measures necessary to facilitate your patient’s return to work. This could involve adjusting the patient’s work situation, work tasks, working hours, or workplace.
If the patient can work, but not travel to the workplace in the usual manner, they can request compensation for work-related travel. This means that, instead of receiving sickness benefit, the patient receives compensation for the additional expenses they incur for travel to and from work. The patient applies for compensation for travel using the same form as that used to apply for sickness benefit. The patient can also contact Försäkringskassan as early as the sick-pay period and announce that they intend to apply for travel allowance.
The prerequisite for receiving compensation for additional expenses for work-related travel is that the patient would otherwise be on full-time sick leave. The compensation shall make it possible for the patient to work full-time or part-time.
Days 1–14, the employer pays compensation for work-related travel. Beginning on day 15, Försäkringskassan pays.
An employer can receive an allowance to commission investigations about what can be done to prevent sickness absence or make it easier for your employees to return to work.
If your patient has been on sick leave for some time, work training may be a good idea. Work training means that the patient comes to a workplace without any requirements related to performance. The patient trains in certain work tasks to regain their work capacity and get help in work steps that they cannot handle due to their illness. Someone else then performs the work tasks that the work-training individual cannot perform or handle in time. Work training is not intended to replace the time it normally takes to learn a new job.
Work training shall be planned by the employer or the Public Employment Service together with Försäkringskassan, which assesses whether it is an effective rehabilitation measure for this particular patient. During the work training, Försäkringskassan can pay out rehabilitation allowance to the patient.
Work training can be one of a group of rehabilitation measures needed to enable the employee to return to work. Work training is often combined with other measures, such as adaptation of the workplace and working hours, or other assistive devices.
What to do if you think work training may be appropriate for your patient
If you believe work training would help a patient return to work, contact Försäkringskassan. If Försäkringskassan determines that work training is suitable, we will draw up a plan together with you (the doctor), your patient and their employer or the Public Employment Service.
The plan shall contain information about
- the goal of the work training.
- how many hours per day the patient will perform work training.
- what work tasks the patient will train.
- by whom, how and when the work training will be followed up.
How much work training should the patient perform?
If the patient is receiving sickness benefit, they must perform work training at least one-fourth of their normal working time. Work training normally lasts no more than three months.
Patients receiving sickness compensation or activity compensation are not subject to the same requirements related to the time or scope of occupational rehabilitation. The conditions and circumstances of each individual case are the deciding factors.
What is sickness benefit?
Sickness benefit is compensation the patient can receive if they are unable to work due to illness.
When should I issue a doctor’s certificate?
You issue a doctor’s certificate if you determine that the patient cannot work due to illness.
A doctor’s certificate is normally not needed during the first seven days of a sickness period. In some cases, a patient may need a doctor’s certificate from their first sick day. In such cases, the decision about this is made by the employer or Försäkringskassan.
If your patient has reported sick for more than seven days, they must provide their employer with a doctor's certificate. During the first 14 days the patient is sick, their employer pays them sick pay instead of their regular salary.
Beginning day 15, the patient can apply for sickness benefit from Försäkringskassan.
Some employers do not pay sick pay. The patient can then apply for sickness benefit from Försäkringskassan instead. Even in such cases, the patient requires a doctor’s certificate from day 8. However, it is Försäkringskassan who needs to see it.
Those who do not have an employer can receive sickness benefit from Försäkringskassan. This applies to those who are
- a job seeker
- on leave with parental benefit
- on leave with pregnancy benefit
- a student.
If your patient has reported sick for more than seven days, they must provide Försäkringskassan with a doctor's certificate in order to apply for sickness benefit.
How do I write a statement that gives Försäkringskassan the right information?
To be able to assess whether a person is entitled to sickness benefit, Försäkringskassan needs a doctor’s certificate that provides a medical explanation as to why the person cannot work.
The doctor’s certificate shall, among other things, show how the activity limitations due to illness affect work capacity, and what the doctor is basing this assessment on.
The doctor’s certificate must contain sufficient information to enable Försäkringskassan to assess work capacity. What can be deemed sufficient varies depending on the illness and what work tasks the person has.
In order for Försäkringskassan to be able to use the doctor’s certificate as a basis for decision-making, there must be a clear distinction between what is the patient’s account of things and what is your own professional assessment.
The term disability refers to a loss or deviation in physical or mental function. The impairment has to be a demonstrable variation from what can be considered normal. For disabilities that cannot always be observed directly, e.g. mental functions, an observation of how the patient behaves can reveal these. For example, the doctor may detect memory and concentration difficulties using targeted questions or standardised questions and tests. As a doctor, you may note whether the patient has trouble maintaining a train of thought or forgets what they have just been talking about.
Activity limitation refers to the consequences that a disease or injury has for an individual’s ability to perform activities. Activity limitation must be assessed in relation to what can be expected in daily life, or for a specific work task.
Example 1 – mobility
The patient has problems in their musculoskeletal system that can impact body functions (the disability) in the form of e.g. muscle weakness and limitation of movement (field 4).
This type of disability can have consequences for the patient in the form of difficulties changing body position, or difficulties lifting or carrying items or walking. It is this limitation of ability to perform activities (activity limitation) that must be described at the individual level (field 5).
In addition, an attempt to rate the limitation is often necessary to make the information understandable. One example of an activity limitation is when the patient is only able to get up from a chair with great difficulty in order to lie down in a bed. Not being able to lift a container of milk using just one arm is another example of an activity limitation. How far the patient is able to walk, with or without an assistive device, is another example of how the limitation can be clarified.
Example 2 – pain
The patient has pain, and the consequences for the patient’s cognitive functions must be described. This can be that the patient has a disability in the form of pain, difficulties concentrating, or reduced energy (field 4).
In the next step, it is important to clearly describe how the disability (e.g. pain) produces an activity limitation, and what form the activity limitation takes. This is because a disability in the form of pain, for example, does not necessarily lead to an activity limitation.
Describe the activity limitation by giving examples of how it affects the patient’s ability to perform activities in daily life or in the work life. Examples could be problems with memory, ability to concentrate, or ability to follow instructions.
It must be stated that the doctor’s certificate is providing an assessment of the patient’s impairments and limitations.
Here is a description of what information Försäkringskassan needs in each field of the doctor’s certificate.
Keep your language simple and easy to understand. Explain complicated medical terms so that they can be understood by both the patient and the Försäkringskassan administrator.
Field 2: Diagnosis/diagnoses for the disease causing a reduced work capacity
Here, you indicate what illness or illnesses are reducing the patient’s work capacity. This information can only be omitted if the certificate concerns suspension due to infectious disease. In cases whether an action has led to reduced work capacity, such as a surgical procedure, this must be stated in plain text along with the principal diagnosis.
Field 2: Diagnosis code according to ICD-10 (principal diagnosis)
Enter the code of the principal diagnosis here. Use as many positions as possible, with the minimum being three (minimum four for psychological diagnoses). Other diagnoses that are significant to the patient’s work capacity should be indicated in plain text.
Field 3: Course of the illness
Provide a brief description of the patient’s account of the illness and its consequences. Any relevant information in the medical record is also of interest. Such information includes development of the illness, information on onset date, any treatment given, admission date, date of surgery, or time of discharge. Only provide information related to the illnesses that reduced work capacity and are reported in field 2.
Field 4: Disabilities – observations, examination findings, results of investigations
Here, you describe the disability and its extent based on the diagnosis/diagnoses (field 2) that have caused a reduced work capacity and have been observed during your and other healthcare professionals’ examination and medical investigation.
Indicate whether the description is based on observations, examination findings or investigation results. Also provide information on observed disabilities in the form of degrees, readings and values.
Examples of disabilities:
- reduced mobility, ability to bend and stretch, rotation
- reduced power
- reduced concentration
- reduced memory function
- reduced energy.
Field 4: I am basing the information on
Here, you indicate the grounds you based your assessment on. Multiple alternatives can be selected. Under the general principles of the National Board of Health and Welfare’s insurance medicine decision support, extension of sick leave should be based on reassessment of the illness, disability and activity limitation, as well as evaluation of treatment and the course of the illness. This means that the assessment is primarily based on your own examination, and only on telephone contact or medical record information in exceptional cases.
Field 5: Activity limitation related to diagnosis (field 2) and disability (field 4)
Here, you assess and provide a clear description of how the illness limits the patient’s ability to perform the activity, as well as how extensive the consequences are. The information in this field is most crucial to Försäkringskassan’s assessment of the right to sickness benefit.
Activity limitations in the musculoskeletal system shall be described in a way that makes it clear what the patient cannot do, e.g. if the patient has difficulty moving about, reduced tolerance for sitting or a stooped body position, or cannot handle lifting or a prolonged static load on any part of the body. The limitation can also be referred to in terms of e.g. walking distance, with or without assistive device, or how long sitting or standing can be tolerated.
With psychological issues, the activity limitation could mean that the patient to varying degrees has difficulty paying attention, learning something new, understanding instruction, or beginning, carrying out or completing a task. The patient may also have difficulty handling stress, change and other psychological demands, or understanding or expressing themself verbally or in written form.
Examples of activities which may be limited are:
- changing body position
- maintaining body position
- lifting the arms above shoulder height
- walking with or without assistive device
- performing work with the hands that involves fine motor skills
- paying attention
- learning something new, following instructions
- beginning, carrying out or completing a task
- handling stress, change or other psychological demands
- understanding and expressing oneself verbally or in writing
Field 6a: Recommendations
Here, you indicate whether you think there is a need for contact with the Public Employment Service, occupational health services, or another organisation to facilitate the patient’s return to work.
Field 6b: Planned or ongoing treatment or measures
Here, you describe what treatment or measures are planned or in progress. If possible, indicate when such measures begin and end.
Field 7: Is occupational rehabilitation relevant in this case?
Here, you indicate if there may be a need of initiatives to enable return to work, such as work training.
Field 8a: The patient’s work capacity is assessed in relation to
Here, you indicate what work or job the reduced work capacity is assessed in relation to.
If the assessment is in relation to the patient’s current work, the Försäkringskassan needs to know what it is. For example, if the patient works in eldercare, it may be important to know whether they perform administrative duties or work with heavy lifting and the like.
In case of unemployment, the assessment is in relation to the patient being able to handle a job normally found in the job market. If the patient is on parental leave, the assessment is in relation to the ability to take care of the child.
Field 8b: I judge the patient’s work capacity to be
Here, you weigh the activity limitations indicated in field 5 against the demands of the patient’s work or job. The degree of impairment and the time period for which the certificate applies must be stated. Försäkringskassan bases the sick-listing on the patient’s actual working hours, not full time. Remember to ask how many hours the patient works on average per week.
Example: A patient works 75 per cent of a full-time working week of 40 hours, that is 30 hours a week. The patient is on sick leave 50 per cent. Försäkringskassan then judges that they have a work capacity equivalent to 15 hours.
Field 9: The patient’s work capacity is judged to be reduced longer than that indicated by insurance medicine decision support because
If you sick-list the patient for a time period longer than recommended in the insurance medicine decision support, provide your reason here.
Example of information Försäkringskassan needs to be able to decide whether a patient is entitled to sickness benefit:
- If the illness does not follow the expected course, indicate in which way. The information in fields 4 and 5 should also indicate whether the ability to perform the activity still reduces the work capacity.
- If there are medical complications that make it take longer to restore work capacity, or if another condition arises that causes the disability to increase, describe the complications or conditions and explain why they delay recovery.
- If a patient is waiting for a function-enhancing medical measure that is considered a prerequisite to restoring function, specify how long the measure or treatment is expected to take. Examples of this are a hip or knee transplant or some other treatment. The employer and Försäkringskassan need this information to assess whether temporary repositioning or adapted work tasks are an option.
- If the longer sick leave period is due to a treatment in progress, such as physiotherapy or cognitive behavioural therapy, describe the reason why the work capacity is reduced during treatment. You must also state what the treatment is expected to lead to .
- If the length of the sick leave is affected by multiple illnesses that cause a longer period of activity limitation than each illness individually, provide a description and explanation of this.
- If there are factors in the working environment that cause the illness to continue or worsen, please state these.
Field 10: Prognosis – will the patient regain their work capacity in their current job? (Does not apply to job seekers)
Here, you describe the patient’s ability to return to their current work tasks or care for their child. The information is important to enable the employer and Försäkringskassan to develop a plan for return to work together with the patient.
Field 11: Would using a different means of transportation for travel to and from work enable the patient to return to work?
Here, you indicate whether travel to and from work using a different means of transportation would enable the patient to return to work despite the illness. An example of this is using a taxi.
Field 12: Contact with Försäkringskassan requested
Here, you can indicate if you would like to be contacted by an administrator at Försäkringskassan.
Field 13: Other information and clarification
Here, you can clarify anything entered in another field, or provide other information you think is important. For example, you can use it to indicate assessment scales or laboratory values.
Support in writing certificates
Who does what?
The patient shall:
- Request a doctor’s certificate.
- Apply for sickness benefit with Försäkringskassan.
- Send the doctor’s certificate to Försäkringskassan on day 15, unless the doctor agreed to do this.
- Register their sickness with Försäkringskassan on day 1 if they do not have an employer.
The doctor shall:
Write a doctor’s certificate that describes the diagnosis and disability, and indicate in what way the activity limitation reduces the patient’s work capability.
Send the doctor’s certificate to Försäkringskassan on day 15, if the patient requests this.
The doctor’s certificate is available electronically in most medical record systems.
- Decide on the right to sickness benefit
- Pay sickness benefit to the patient if all conditions are met
- Investigate your patient’s need for co-ordination and rehabilitation and, if necessary, convene a reconciliation meeting
The personal administrator is the one who determines whether a reconciliation meeting is needed.
As a doctor, you can receive compensation if you have participated in a reconciliation meeting. The fee is maximum SEK 750 for the first hour and SEK 375 for each subsequent half hour that is initiated. Send the invoice for reconciliation meeting participation to Försäkringskassan.
Preventive sickness benefit
Preventive sickness benefit is paid to enable the patient to undergo medical treatment or rehabilitation that prevents or shortens sick leave.