The waiting period for self-employed people in the event of incapacity

Self-employed people who are no longer able to carry out their self-employed activities due to illness or accident are entitled to benefit. However, a number of steps must be taken in order to be entitled to that benefit. The health insurance fund’s medical advisor must acknowledge the incapacity. There is also a notification deadline and a waiting period.

 

The social security status of self-employed persons


Self-employed persons are entitled, thanks to their quarterly social security contributions, to social rights such as healthcare (i.e. full or partial reimbursement of the costs of medical care) and an incapacity benefit on the grounds of illness or accident.

To be able to lay claim to those entitlements, the self-employed person must join a social insurance fund (no later than the day on which self-employed activity commences) and a recognised health insurance fund of the individual’s choosing (or the regional office of the Agency for Health and Incapacity Insurance). Anyone who combines a self-employed activity with a salaried or employed activity must be a member of the same health insurance fund or regional office for both activities.

 

Notification of incapacity


Being unfit for work means that you are forced to temporarily or permanently cease all self-employed or other activities due to illness, accident or pregnancy.

Anyone who becomes unfit for work must notify the health insurance fund of this within 28 days of the start of incapacity (or within 2 days in the case of a relapse). If the last day is a Saturday, Sunday or public holiday, you have until the end of the first working day thereafter to notify your incapacity.

This is done by means of a declaration of incapacity, which is completed by the treating doctor. If you are admitted to a recognised nursing establishment, the notification deadline is suspended. However, notification must be given immediately upon discharge from hospital.

If you submit the declaration late, you will lose 10% per day from the day on which you are entitled to the benefit until the day on which you submit the declaration. The health insurance fund will only waive the 10% penalty on benefits due in the case of force majeure or in the case of difficult financial and social circumstances.

Upon receipt of the notification form, the health insurance fund’s medical advisor will send you a number of documents, which you must complete and return: an information sheet, a questionnaire about your professional activities and a form concerning your family status (head of a family or single).

 

Entitlement to benefit after the waiting period


Submitting your notification of incapacity does not automatically entitle you to benefit.
Eligibility for daily allowances is subject to a waiting period. For self-employed persons, the duration of that waiting period in the event of incapacity is detailed in the incapacity decree for the self-employed. A ‘waiting period’ means that somebody who has already been found eligible is not entitled to any benefits for a certain period.

For self-employed persons, a waiting period of 6 months applies, starting from the 1st day of the 1st quarter for which contributions are paid to the social insurance fund. Periods of incapacity are not counted towards that waiting period. You cannot be unfit for work for that 6-month period. In addition to this waiting period, you must be recognised as unfit for work.

School-leavers who satisfy certain conditions are eligible for exemption from the waiting period. There are also exceptions for eligible salaried employees who become self-employed without any interruption; and a shorter waiting period applies to anyone who completed part of the waiting period in another system, if the switch occurs within a period of 30 days.

If you are entitled to benefit, you will receive a daily benefit from the 2nd month of your incapacity. No benefit is paid for the 1st month.

The daily allowance depends on your personal situation and the period. As incapacity benefits are not exactly generous, additional insurance (such as an income protection policy) can be taken out.
From the 2nd year onwards, you are covered by the incapacity scheme.

 

Social security credits for periods of illness


People who are self-employed as their main profession and who stop working due to illness or incapacity can preserve their social security entitlements by requesting social security credits. During the recognised quarterly periods of incapacity, they retain their entitlement to child allowance, health insurance and pension, without paying any social security contributions.

N.B. The waiting period under the scheme for employees was doubled from 6 to 12 months before the right to incapacity benefits was introduced on 1 May 2017. The number of days that must be worked during that period was also increased.
There have been no changes to the maternity allowance entitlement, as this right exists for a limited amount of time (6-month waiting period). Nor have there been any changes to benefits paid during paternity or co-parenting leave, adoption leave or converted maternity leave.

Copyright Wolters Kluwer