If I don’t have a doctor’s certificate, will my pay be cut?
After a fall, a friend was taken by ambulance to A&E one Wednesday evening. She was discharged the following day, but was only given a sick note valid until Friday. Her GP saw her the following Monday and only issued a certificate from that day onwards. As a result, the weekend was left uncovered, with no certificate from either the hospital or her GP, whilst the accident insurance company requires continuous medical cover; otherwise, it threatens to deduct these two days’ pay. As the doctor refuses to extend her certificate retrospectively, are these uncovered days lost for good?
S., Vernier
Following an accident, entitlement to a daily allowance under the compulsory accident insurance scheme, governed by the Federal Act on Accident Insurance (LAA), arises from the third day following the accident and is conditional upon incapacity for work within the meaning of the Act on the General Part of Social Insurance Law (LPGA). This incapacity must be proven, and the burden of proof lies with you. A medical certificate is the usual means of providing such proof, but it is not conclusive evidence, as incapacity can also be demonstrated in other ways.
Sick leave
In social insurance law, incapacity is established on the basis of the preponderance of probability, i.e. the most likely scenario. In your case, the immediate succession of two medical certificates for the same condition – the one from the hospital covering up to Friday and the one from your GP from Monday onwards – creates a strong presumption that the incapacity continued over the weekend. To disregard this evidence on the grounds of an administrative oversight could contravene the principle of good faith.
The doctor’s refusal to extend the scope of his certificate is nevertheless understandable, as he can only certify what he has personally observed. He may, however, issue a reasoned opinion explaining, on the basis of his examination and the hospital records, that it is medically plausible that the incapacity was uninterrupted. Such a document, whilst not a formal certificate, strengthens the insured person’s case.
On the basis of a detailed timeline, two medical certificates and a doctor’s opinion, the insurance company should have all the necessary information. If it maintains its refusal, it must issue a formal decision, which may be challenged by way of an objection and, if necessary, taken to court.
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