A doctor determines the percentage of someone who is incapacitated for work based on an official scale. Anyone who is recognized as more than 2/3rds incapacitated for work is completely incapacitated for work. Anyone who is recognized as disabled as a worker or employee is entitled to a guaranteed income for a period that is paid by the employer. After this, one is entitled to sickness benefit paid by a health insurance fund. Taking out additional guaranteed income insurance can help as a financial buffer if you become incapacitated for work. This is certainly interesting as a self-employed person, because they cannot fall back on anything as a worker and employee and are therefore immediately dependent on social assistance.
When incapacitated
A doctor determines the percentage of someone who is incapacitated for work based on an official scale. This is written down in the official Belgian scale for determining disability. Also called OBSI. This is called physiological disability. Anyone who is recognized as more than 66.66% incapacitated for work is completely incapacitated for work. In addition, there is also the economic disability, which will partly determine the duration of the disability: how does the disability affect working life? The doctor looks at 7 factors. The nature of the disability, age, adjustment options, the profession pursued, retraining options, professional competence and competitiveness on the labor market. Anyone who is recognized as disabled as a worker or employee is entitled to a guaranteed income for a period that is paid by the employer.
Guaranteed income by employer
Worker
For workers with one month’s seniority, the guaranteed wage is equal to the net wage for the first 7 days; they then receive 85.88% of their normal salary from the employer for 7 days. From the 15th to the 30th day of incapacity for work, workers are entitled to 25.88% of the capped gross salary + 85.88% of the part above the limit. To achieve a living income, the health insurance fund must make adjustments from the eighth day onwards. Without one month’s seniority, the worker must immediately appeal to the health insurance fund for the days of incapacity for work.
Servants
For white-collar workers, the 30 days of guaranteed wages are equal to their last net salary. However, there is also an exception to this, namely when it concerns a fixed-term employee contract of less than 3 months and one month of seniority: 100% of the gross salary during the first 7 calendar days; then 86.93% of the gross salary for the 8th to the 14th calendar day and 26.93% of the capped gross salary + 86.93% of the part above the limit for the 15th to the 30th calendar day.
Health insurance fund
In Belgium, people are legally obliged to register with one of the following health insurance funds (mutualities) as soon as they start working, when they are still studying at the age of 25 or when they are unemployed. There are 5 different health insurance companies with regional departments: the Christian Mutualities. Socialist Mutual Funds, Liberal Mutual Funds, Independent Health Insurance Funds and the Neutral Health Insurance Funds.
Sickness benefit
After the period of guaranteed income, the employee receives a statutory benefit of 60 percent of the last gross salary for one year from the health insurance fund. This is called the period of primary disability. The employee is regularly checked by the health insurance fund’s advisory doctor. The period of disability starts after one year of incapacity. From then on, the incapacitated person is monitored by the RIZIV: national institute for health and disability insurance. It is no longer the advising doctor who initially supervises the incapacitated person, but the medical council of doctors of the RIZIV. The employee continues to receive benefits from the health insurance fund:
- 65% of the capped gross salary for an employee with at least one dependent
- 55% for a single employee
- 40% for an employee living together.
Guaranteed income insurance
If you have guaranteed income insurance through an insurance institution, you can provide additional cover against disability. This way, your final income is still guaranteed for the longer term. It is important to know that you can no longer take out this insurance if you are already disabled, and many policies do not cover psychological problems or disability caused by alcoholism. The insurer will take into account the level of physiological and economic disability. A condition is that one of the two amounts to at least 25%.