Disputes with ZUS

Social Security Law - Representation in disputes with ZUS

Social security law is one of the most complicated branches of law, in which the citizen often feels powerless when confronted with the clerical machinery of the Social Insurance Institution. Decisions by the disability authorities are not always accurate and in line with the facts or the applicable regulations, resulting in wrongful denial of benefits.

The firm offers comprehensive legal assistance at every stage - from intra-instance proceedings (ZUS, KRUS), through proceedings before the Disability Assessment Boards, to court representation before the Labour and Social Insurance Courts in all instances.

Scope of services provided

Pensions and Initial Capital

We assist in obtaining the right to benefits in the case of a refusal decision by the Social Insurance Institution and in cases of verification of their amount.

  • Disability pension:

    Representation in total or partial incapacity pension cases, as well as in cases for the reinstatement of the right to a pension.

  • Survivor's pension, social security pension and supplementary allowance:

    We assist in obtaining social pensions for adults who are totally incapable of working due to illness or disability and whose impairment of bodily functions arose before the age of 18, during their education (up to the age of 25) or during their doctoral studies. We also provide support in the process of obtaining a Supplementary Allowance to the Social Pension, introduced in order to equalise the amount of the Social Pension with the level of the lowest salary for persons incapable of independent existence. We also offer support in obtaining survivor pensions for deceased family members.

  • Bridging pensions:

    We assist in obtaining a bridging pension for people who worked in special conditions or performed work of a special nature. We offer comprehensive support - from analysis of documents and confirmation of periods of work to representation before the Social Insurance Institution and the Courts in order to obtain the benefits due.

  • Compensation for work in special conditions:

    Claiming a pension supplement, in relation to work performed in harmful conditions before 2009.

  • Initial capital:

    Proceedings for the redetermination of initial capital.

  • Supplementary benefit:

    Assistance in obtaining the incapacity benefit.

Accidents at Work, Sickness Benefits, Rehabilitation Benefits, Support Services

We support clients in situations of sudden loss of health, accidents in the workplace and when the Social Insurance Institution refuses to pay the benefits to which they are entitled.

  • One-off post-accident compensation:

    Appeals against decisions denying entitlement to compensation for accidents at work and disputes over the amount of benefits (challenging an underestimated percentage of injury).

  • Supplementary damages and compensation:

    In addition to Social Security benefits, we help assert supplementary claims directly from the employer or insurer (compensatory pensions, compensation for pain and suffering).

  • Sickness benefit:

    Appeals against decisions denying entitlement to benefits (e.g. in relation to allegations of bogus employment).

  • Rehabilitation benefit:

    Assistance in obtaining benefits after the benefit period has been exhausted when further treatment promises recovery.

  • Reimbursement of benefits unduly received:

    Defending clients from whom the Social Security Administration demands the return of previously paid benefits or pensions.

  • Supporting benefit:

    The law firm offers full support in obtaining the Support Allowance, which has been available to adults with disabilities since 2024. This benefit is designed to provide additional financial assistance to those who require ongoing support in their daily living.

Medical Jurisprudence and Appeals Procedure

Being effective in insurance cases requires not only legal knowledge, but also the ability to navigate medical and treatment procedures.

  • Objection to the decision of the Social Insurance Institution's Medical Examiner:

    Drafting professional objections to the ZUS Medical Committee. This is a key stage of the proceedings before the pension authority - its omission or formal errors may block the possibility of later asserting rights before the Court.

  • Objections to the opinions of expert witnesses:

    Substantive polemics against expert opinions during the trial. We formulate allegations concerning the examination methodology, the omission of medical records or erroneous final conclusions regarding incapacity and its degree.

Proceedings before Disability Assessment Boards

A proper disability certificate is much more than just a document for many people and their families - it is the foundation of financial security. In the face of a chronic illness, the costs of specialist treatment, private medical visits, rehabilitation or rising medical bills become a huge burden on the household budget.

Our law firm helps you through the process of a disability award that will enable you to collect benefits that will realistically ease the burden on your loved ones and provide additional resources for your life and treatment. We provide professional and efficient case management at every stage of the proceedings:

  • Determination of the degree of disability

    We represent clients in cases of obtaining a degree of disability appropriate to the state of health before County/Municipal Disability Assessment Boards. We ensure that the certificate fully reflects the state of health and the difficulties in the patient's everyday functioning.

  • Conducting proceedings before the Provincial Disability Assessment Board

    We prepare substantive appeals to the Provincial Disability Assessment Board against unfavourable decisions of the County/Municipal Disability Assessment Board. We are fighting not only for the degree of disability itself, but above all for the key indications in the decision - such as the need for constant care or the involvement of the carer in the treatment process. It is these provisions that determine the right to the highest level of care and financial benefits, which help to cover the high daily costs of living with an illness.

  • Judicial proceedings

    If it has not been possible to obtain a fair decision in the proceedings before the Provincial Disability Assessment Board, we represent clients in the court proceedings, taking care of the correct course of the entire proceedings. We place particular emphasis on issues related to the fairness of expert opinions, as it is their conclusions - reflecting the actual state of health - that are of key importance for the outcome of the case.

Disputes with ZUS - Entrepreneurs and Employees

We provide legal protection in cases where the pension authority disputes the existence of the legal relationship on which the insurance is based.

  • Appearance of employment:

    Representation in cases in which the Social Security disputes the fact that an employee is employed and refuses to pay benefits.

  • Contribution base:

    Disputes concerning the Social Security's questioning of the amount of the declared contribution base (defence against allegations of deliberate overstatement of the base in order to obtain higher benefits).

  • Controls on contributors:

    We offer professional legal support during inspections conducted by ZUS inspectors. We represent entrepreneurs during the submission of explanations and prepare comprehensive arguments in response to enquiries and summonses from the pension authority. We monitor the correctness of the course of all inspection activities and draft substantive objections to the inspection protocol. Our activities focus on eliminating erroneous factual and legal findings already at the stage of the explanatory proceedings, which allows us to implement a strategy that maximises the chance of a positive outcome and successful completion of the inspection.

Do you have a problem with ZUS?

Contact us

mobile phone +48 888 779 919

email: sprawyzus@kancelariakuklewicz.pl

    FAQ ZUS matters

    Who can apply for a social pension?

    A social pension is granted to adults who are totally incapable of working due to impairment of the organism's functions arising before the age of 18, during education (up to the age of 25) or during doctoral studies.

    What is the top-up supplement to social security pension?

    It is a benefit introduced to align the amount of the social pension with the level of the minimum wage. It is granted to persons who are totally incapable of working and who are at the same time incapable of leading an independent life. The supplementary allowance is paid together with the social pension.

    What is a support service?

    This is financial assistance for adults with disabilities to support those who require ongoing assistance in daily living. The amount of this benefit is determined by a decision of the Provincial Disability Assessment Board establishing the level of support needs of the person concerned.

    Is the support benefit only available to Polish citizens?

    No, the support allowance is not only available to Polish citizens. If strictly defined residency and legal conditions are met, foreigners are also entitled to the support allowance, including citizens of the European Union, the European Economic Area, the United Kingdom, Switzerland, as well as foreigners from outside the European Union with an appropriate residence card.

    What is a one-off compensation from ZUS and to whom is it due?

    The one-off compensation is due to an insured person who has suffered permanent or long-term damage to his or her health as a result of an accident at work or occupational disease. Members of the family of an insured person who has suffered death as a result of an accident at work or occupational disease are also entitled to a one-off compensation (the amount of such compensation may be as high as approximately PLN 100,000.00).

    When can you claim rehabilitation benefit and how much is it for?

    Rehabilitation benefit may be applied for once the benefit period, which is normally 182 days (in the case of pregnancy or tuberculosis 270 days), has been exhausted, provided that further treatment or rehabilitation promises a return to working capacity. The rehabilitation benefit is granted for the period necessary to restore the ability to work, but no longer than for 12 months.

    Can you work while receiving a total incapacity pension?

    Yes, you can work while receiving a total incapacity pension. A declaration of total inability to work is not equivalent to a ban on work. The Social Insurance Institution understands this as the loss of the ability to work under normal conditions, but allows you to be active, e.g. in sheltered work conditions or with appropriate adaptation of the workstation to your health limitations.

    What is the amount of rehabilitation benefit?

    The rehabilitation benefit for the first 3 months is 90% of the sickness benefit assessment basis, for the remaining period it is 75% of this basis. If the inability to work occurs during pregnancy, the rehabilitation benefit is 100% of the sickness benefit assessment basis.

    What should I do if I receive an unfavourable decision from the ZUS Assessor?

    In such a situation, it is crucial to file an objection to the ruling with the ZUS Medical Board.

    What is the deadline for submitting an objection to the ruling of the ZUS Assessor of Public Health?

    The time limit for submitting such an objection is 14 days from the date of receipt of the decision of the Social Insurance Disability Assessment Officer.

    Is there a fee for an objection to a ruling by a ZUS Assessor of Public Health?

    No, there is no fee for an objection against the decision of the Social Insurance Assessor.

    What should I do if I receive an unfavourable decision from the Social Insurance Company?

    In such a case, one should be prepared to assert one's rights in court, as an unfavourable decision of the Social Insurance Institution may be appealed to the Court (District or Regional depending on the case) with jurisdiction over the place of residence of the appellant.

    What is the deadline for filing an appeal against an unfavourable decision of the Social Insurance Institution?

    The time limit for appealing an unfavourable decision of the Social Security Administration is 30 days from the date of receipt of the decision.

    How and where to lodge an appeal against an unfavourable decision of the Social Insurance Institution

    The appeal shall be sent (filed) to the General Court, but through the Social Insurance Institution which issued the decision to be challenged (i.e. the appeal shall be sent or filed with the Social Insurance Institution) .

    Are proceedings before the Labour and Social Security Court subject to fees?

    No, there is no court fee (appeal fee) or stamp duty (on the power of attorney) in court cases against ZUS and KRUS. Proceedings in social insurance cases are free of charge. If you lose, you should only expect to be ordered to pay to the Social Insurance Institution the costs of legal representation in the amount specified by the Regulation of the Minister of Justice (these costs amount up to several hundred PLN).

    How can the opinion of an expert witness be questioned?

    In the course of the trial, substantive objections (allegations) may be formulated concerning the examination methodology, the omission of medical records or erroneous conclusions regarding the degree of incapacity. In such a situation, it is necessary to request a supplementary opinion from the expert or, to a further extent, to disregard the evidence of the expert who gave an unfavourable opinion and, at the same time, to ask the Court to appoint another expert.

    What rights does the payer have during a Social Security check?

    The payer of contributions may submit explanations, respond to enquiries and summonses from the authority and make substantive objections to the inspection protocol. These actions serve to eliminate erroneous findings of fact and law already at the stage of the investigation.

    What is the allegation of sham employment?

    The Social Security may dispute the fact that the employee is employed, claiming that the legal relationship has been created for the sole purpose of obtaining benefits, which may result in the denial of payment.

    Can the Social Security Administration challenge the amount of the contribution assessment base?

    Yes, the pension authority may challenge the declared contribution base if it considers that it has been deliberately inflated in order to obtain higher benefits

    What is special conditions compensation?

    Compensation for work in special conditions is, in simple terms, a special financial allowance that permanently increases your standard pension. It is a form of compensation from the state for people who have worked for many years in jobs that are hard or harmful to health (e.g. in metallurgy, on the railways, in noisy or dusty conditions) but who have not exercised their right to early retirement or to a bridging pension.

    Can the Social Security Board challenge my contract of mandate and consider it an employment contract?

    Yes, the Social Insurance Institution has the right to question the nature of a concluded contract of mandate if, as a result of an inspection, it finds that the manner of its performance corresponds to the features of an employment contract. It is not the name of the signed contract that is decisive, but the actual terms of cooperation, such as the execution of orders from a supervisor under his/her strict direction, the setting of specific working hours and the necessity to provide services in person at the company's premises. In the event of a decision to recognise a contract of mandate as a contract of employment, the company with which you signed the contract is charged with the obligation to pay full social security contributions and interest on arrears for the entire period of cooperation. A successful defence in such a dispute requires demonstrating to the court the autonomy of the contractor and the specific features of the contract that distinguish it from an employment contract.

    The Social Security Board ordered the reimbursement of sick pay because I issued an invoice or sent an email during my leave. Can I appeal?

    Definitely yes. The case law of the common courts is much more liberal than the rigid interpretations of the Social Insurance Institution. The Supreme Court has repeatedly indicated that activities of an incidental nature that are necessary to sustain the business (such as signing a payroll or issuing a document) do not necessarily mean that the right to sickness benefit is lost. In an appeal against a ZUS decision, it must therefore be shown that the actions taken were not „gainful employment”, but merely a necessary safeguard for business continuity.

    Can the Social Security Administration challenge my B2B collaboration and order payment of outstanding contributions as for an employment contract?

    Yes, ZUS has the power to examine and question the actual content of the legal relationship linking the parties. If the authority finds that your business activity or contract of mandate in fact bears the hallmarks of an employment relationship (e.g. execution of orders at a designated place and time), it may issue a decision on including you in social insurance as an employee. In such a situation, the Social Insurance Institution will call upon the company with which you had a B2B contract to pay outstanding contributions with interest for several years back.

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