SZV loses lawsuit about sick-benefits

POSTED: 02/5/15 6:52 PM

St. Maarten – Social insurance Bureau SZV lost an administrative lawsuit that focuses on the right to sick-benefits that warrants wider attention. SZV wanted to terminate the sickness benefit for a 30-year-old man who suffers from sickle cell disease, a severe and hereditary form of anemia. The condition forces the man to report sick to his employer every now and then.

To his astonishment he found that, two years after he first reported sick because of his condition, SZV terminated his sick-benefits, based on an article in the national ordinance sickness insurance. This article states: “The right to sick-benefits for the same sickness-cause expires after a period of two years.”

SZV interpreted this article literally without considering that the man actually works regularly for his employer with the exception of the couple of days a year he is forced to report ill.

Attorney Roy Moes and Cor Merx took on the case and they managed to convince the court that the interpretation SZV gives to the article is wrong. In fact, the right to sickness benefits expires in a case where someone suffers during two years from the same condition or when all absences due to that condition counted together amount to two years of absence.

The court pointed to the inconsistency of the SZV-interpretation of the article: “The plaintiff (who had claimed over a period of two years only a couple of day for sick-benefits) would receive only sick-benefits for a couple of days, while someone who is sick for two years straight due to the same illness, would receive sickness-benefits for two years. A reasonable explanation or justification for this difference has not been provided, while the law does not offer a basis for it.”

The attorneys told the court that the SZV never cuts the sick-benefits for employees who regularly report ill with common complaints like migraine. “The defendant did not contradict this, so it seems that the defendant applies the interpretation of the plaintiff in those cases. Without a further explanation the court does not see why the SZV has acted differently in the case of the plaintiff,” the court ruling states.

The court ruled that the two-year period expires after someone has been absent due to illness for two years straight, or when someone has reported ill on different occasions for the same reason and when these absences together amount to a period of two years.

The court therefore declared the appeal against the SZV-decision justified and ordered the insurer to take a new decision within six weeks. In this decision, the SZV has to consider the considerations mentioned in the court ruling.

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