EurWORK European Observatory of Working Life

Stricter rules for sick leave introduced

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Government changes to the national health insurance system last year first became noticeable for people on sick leave in January 2009. The social partners have different views on the new rules, highlighting both opportunities and risks. Trade unions fear a lack of awareness of the changes and that people may be adversely affected during difficult economic times. Employer organisations believe that the changes will allow people to maintain their working capacity and support themselves.

As a result of the new requirements for measures aimed at early and active rehabilitation introduced by the Swedish government in the summer of 2008, employers’ responsibilities to take action in relation to people on sick leave – for example, by offering them alternative jobs or tasks as well as rehabilitation – have increased. The new rules were presented to parliament for a decision on 1 July 2008.

Content of new health insurance rules

The new rules imply a new ‘chain of rehabilitation’ with clear time frames for the Swedish Social Insurance Agency (Försäkringskassan) to evaluate employees’ work capacities (SE0805049I, SE0802029I). A limit has also been introduced for how long people can receive sick leave payments – normally 364 days, after which people can apply for an extension of payments up to a maximum of 550 days.

During the first 90 days of sick leave, the first assessment of an employee’s work capacity will be made. Another such assessment will follow after this period in order to determine whether the employee will ever be able to return to the workplace, will be in need of further rehabilitation or whether another job will be more suitable. After 180 days, the Swedish Social Insurance Agency will estimate if the employee is able to return to work and if the person can find another job in the labour market. Compensation in the case of work incapacity (Aktivitetsersättning) can be obtained from the age of 19 years and the so-called ‘sickness compensation’ (Sjukersättning) can be obtained by people aged between 30 and 64 years.

In January 2009, the first group of people passed the limit of 180 days of sick leave. If the Social Insurance Agency determines that a person on sick leave is able to resume work but might have to find another job, the sick leave payment will cease and the person might risk losing their existing employment. In January, some people on sick leave received the first letters from the Social Insurance Agency stating that they will no longer receive sick pay. As a result, the trade unions fear that more people will lose their jobs in the current period of a deepening economic crisis and rising unemployment.

Views of trade unions

According to an article (in Swedish) published in December 2008 in the industrial trade union workers’ paper Dagens Arbete, in January 2009, about 28,000 people would be at risk of losing their sick leave payments and would have to apply for income support. Several trade unions have been recording their members on long-term sick leave and plan to organise special teams offering help to members appealing to the Social Insurance Agency if they are excluded from receiving sick pay. The trade unions expect many members to fall through the safety net between the Swedish Public Employment Service (Arbetsförmedlingen) and the Social Insurance Agency. For example, the Public Employment Service might consider an employee too sick to work and the Social Insurance Agency might deem the worker too well to be on sick leave.

The Swedish Metalworkers’ Union (IF Metall) commented in another newspaper article (in Swedish) that neither the union members nor the policymakers are truly aware of the consequences of the new rules. The outcomes of the new rules are difficult to predict and the government, trade unions and employer organisations have not been able to make a precise prognosis of the effects of how the new rules will affect people on sick leave. The various actors estimate the risks differently. IF Metall doubts the competences of the Social Insurance Agency’s administrators to evaluate people’s working capacity.

In a joint press release, the Swedish Trade Union Confederation (Landsorganisationen i Sverige, LO) and the Swedish Confederation of Professional Employees (Tjänstemännens Centralorganisation, TCO) demand ed action from the government in this matter. Both LO and TCO fear that about 76,000 people might risk losing their sick leave payments or are at risk of becoming unemployed. The trade unions want the government to introduce a guarantee for insured workers that no one should lose their sick leave payment unless the employer can prove that they have offered proper and reasonable rehabilitation measures in order to facilitate the employee’s return to work.

Views of employers

The Confederation of Swedish Enterprise (Svenskt Näringsliv) states that the new rules are meant to counteract a health insurance system that has led to too many people receiving early retirement pensions who thus remain excluded from the labour market for the rest of their lives. According to a statement (in Swedish) by the Confederation of Swedish Enterprise, the new rules will make it possible for people to re-enter the labour market and increase their capacity to support themselves. The confederation also looks positively at the fact that the new rules encourage employers to initiate support measures at an early stage, believing it will make a difference and help people to maintain their work capacity. Furthermore, the confederation emphasises that the Social Insurance Agency’s evaluation of an employee’s work capacity is not to be used by the employer in order to justify dismissals.


During the current economic crisis, both trade unions and employer organisations have been critical of the new rules in one way or another, not least because the rules interfere with the power of collective agreements for the social partners. It seems that the social partners now disagree on the effects that the new rules might have and that the Confederation of Swedish Enterprise has taken a more positive outlook.

Karolin Lovén, Oxford Research

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