In its judgment in case file reference IX U 170/25, the court reversed the Social Insurance Institution’s decision and found that the insured person was not obligated to repay a portion of the sickness benefit, which was overpaid due to errors in the ZUS system.
The case concerned an employee whose employment relationship ended on August 31, 2024. After terminating employment, the employee became incapable of work and was receiving sickness benefits. ZUS subsequently found that the benefit was calculated based on an excessively high calculation basis, as it should be subject to statutory capping after termination of employment. The pension authority therefore demanded the repayment of over PLN 3,600 as benefits unduly received.
The court disagreed with ZUS’s position. The justification emphasized that the mere payment of an overstated benefit does not necessarily mean that the insured person is obligated to repay it. Pursuant to Article 133 of the Social Insurance Institution (ZUS), the benefit was not repaid. Under Article 84 of the Social Insurance System Act, it is necessary to demonstrate that the beneficiary was properly informed of their ineligibility for the benefit or that they knowingly misled the pension authority.
In the case at hand, the court determined that the incorrect determination of the benefit amount was due to outdated data remaining in the Social Insurance Institution (ZUS) system and years of negligence related to the deregistration of the insured by one of the former contribution payers. Importantly, the obligation to deregister the employee from social insurance rests with the contribution payer, not the employee themselves. The insured did not make false declarations, did not submit false documents, and did not influence the erroneous information displayed in the IT systems.
The court also noted that ZUS failed to demonstrate that the employee was properly informed of the rules for determining the basis for calculating the benefit after termination of employment. The lack of such information precludes the possibility of deeming the benefit unduly received within the meaning of the provisions of the Social Insurance System Act.
This ruling has significant implications for employees and former employees seeking social insurance benefits. It confirms that the consequences of errors made by employers or the pension authority itself cannot be automatically passed on to policyholders. A claim for reimbursement requires demonstrating statutory grounds for liability, and the mere fact of an overpayment is not sufficient to impose on the employee the obligation to repay the funds.