Sick Leave and Reintegration in the Netherlands

If you become ill and are unable to work, both you and your employer have specific legal obligations aimed at getting you back to work as soon as reasonably possible. These obligations are primarily laid down in the Gatekeeper Improvement Act (Wet verbetering poortwachter), one of the most important pieces of legislation governing sick leave in the Netherlands. In this article, you will learn exactly what your employer must do, what is expected of you, how the reintegration process works step by step, and what happens if either party fails to meet their obligations.

The Gatekeeper Improvement Act (Wet verbetering poortwachter)

The Gatekeeper Improvement Act (Wet verbetering poortwachter) was introduced on 1 April 2002 to improve the reintegration of sick employees and reduce the inflow into disability benefits. Before this law, many sick employees ended up receiving long-term disability benefits without adequate efforts to return them to work. The Act places clear responsibilities on both employers and employees and sets strict deadlines for the various steps in the reintegration process.

The core principle of the Act is that both you and your employer must make active and demonstrable efforts to achieve your return to work. This applies during the entire two-year period of illness. The UWV (the Dutch Employee Insurance Agency) monitors compliance and has the authority to impose sanctions if either party falls short.

The Act works in conjunction with several other pieces of legislation, including Article 7:629 BW (continued salary payment during illness), Article 7:658a BW (employer's reintegration obligation), and Article 7:670 BW (the dismissal ban during illness). Together, these provisions create a comprehensive framework that protects your position while requiring active participation in your recovery and return to work.

Employer obligations during sick leave

Your employer carries the primary responsibility for the reintegration process. The law imposes extensive obligations, and failure to meet them can result in significant financial consequences for the employer. Here is what your employer must do:

Report your illness to the company doctor

Your employer must report your illness to the company doctor or occupational health service (arbodienst) within seven calendar days of your first day of sick leave. This ensures that a medical professional is involved from the start of your illness.

Arrange an assessment by the company doctor

Within six weeks of your first day of illness, the company doctor must assess your situation and provide a problem analysis (probleemanalyse). This analysis describes your limitations, the expected duration of your illness, and the possibilities for your return to work. This is the starting point for the entire reintegration process.

Create a plan of action (plan van aanpak)

Within eight weeks of your first day of illness, you and your employer must agree on a plan of action (plan van aanpak). This plan describes what both parties will do to achieve your return to work. It includes the reintegration goal, the concrete activities to be undertaken, and the agreements about how progress will be monitored. The plan must be reviewed and updated at regular intervals (in practice typically every six weeks).

Appoint a case manager

Your employer must appoint a case manager (casemanager) who coordinates the reintegration process and serves as your point of contact. This can be someone within the company (such as an HR manager) or an external professional.

Offer adapted or alternative work

Your employer must actively look for work that suits your abilities, taking into account your medical limitations. This obligation has two dimensions. First, your employer must explore whether your own position can be adapted (for example, reduced hours, modified tasks, or workplace adjustments). Second, if returning to your own position is not possible, your employer must look for other suitable work within the organisation.

Maintain a reintegration file

Your employer must keep a complete reintegration file (re-integratiedossier) that documents all activities, assessments, and agreements. This file is essential because the UWV will review it after two years when assessing your WIA application. If the file is incomplete or shows insufficient effort, the UWV can impose a salary payment penalty on the employer.

Your obligations as an employee

As an employee on sick leave, you also have legal obligations. The reintegration process is a shared responsibility, and you are expected to actively participate. Failure to meet your obligations can have consequences for your sick pay and, in extreme cases, even for your employment.

Cooperate with the reintegration process

You must cooperate with all reasonable reintegration activities. This includes attending appointments with the company doctor, participating in the creation and review of the plan of action, and following the recommendations of medical professionals. You must also actively contribute to finding solutions for your return to work.

Accept suitable work

If your employer offers you adapted work or alternative work that is considered suitable given your medical limitations, you are obliged to accept it. What counts as “suitable” depends on your specific situation, including your education, experience, salary level, travel distance, and medical limitations. Over time, the definition of “suitable” may broaden, but this is always assessed on a case-by-case basis. If you disagree about whether the offered work is suitable, you can request a second opinion through your employer’s occupational health service or a UWV expert opinion.

Provide necessary information

You must provide the company doctor with all relevant information about your illness and limitations that is necessary for the reintegration process. Note that you are not required to disclose the nature of your illness to your employer directly — only the company doctor needs this information. You must, however, inform your employer about what you can do and what limitations you have.

Do not hinder your recovery

You must refrain from activities that the company doctor has determined could hinder or delay your recovery. What is and is not permitted depends on your specific limitations and the company doctor's assessment. This does not mean you must stay at home at all times, but you should follow the guidance of your medical professional regarding activities that could conflict with your recovery.

The role of the company doctor (bedrijfsarts)

The company doctor (bedrijfsarts) plays a central role in the reintegration process. Understanding the company doctor's function and your rights in relation to them is important.

What the company doctor does

The company doctor assesses your medical situation and advises both you and your employer on what you can and cannot do. The company doctor determines your functional limitations (what tasks or activities you cannot perform due to your illness), provides a prognosis for recovery, and recommends suitable work or adjustments. The company doctor's advice forms the basis for the plan of action and all subsequent reintegration decisions.

Independence of the company doctor

Although the company doctor is typically engaged (and paid) by your employer, they are bound by medical professional standards and must act independently. The company doctor is not allowed to share your diagnosis with your employer. They may only communicate your functional limitations (what you can and cannot do) and an expected timeline for recovery. If you feel the company doctor is not acting independently, you have the right to seek a second opinion.

Your right to a second opinion

Since 1 July 2017, you have the statutory right to request a second opinion from another company doctor. This second opinion must be arranged through your employer’s occupational health service arrangement (arbodienstregeling) — it is not a free choice of any doctor. Your employer must facilitate this and bear the costs. Additionally, you can request a so-called expert opinion (deskundigenoordeel) from the UWV, which provides an independent assessment of your ability to work or the adequacy of the reintegration efforts.

Disagreeing with the company doctor

If you disagree with the company doctor's assessment — for example, they believe you can return to work but you do not feel able to — do not simply ignore their advice. Instead, formally request a second opinion or a UWV expert opinion. Ignoring the company doctor's advice without going through proper channels can be treated as non-compliance with your reintegration obligations.

First and second track reintegration

The reintegration process distinguishes between two "tracks" (sporen), each with its own focus and requirements.

First track (eerste spoor): return to your own employer

The first track focuses on your return to work with your current employer. This is always the primary goal and should be explored first. Under the first track, your employer must examine whether you can return to your own position (possibly with adjustments) or whether there is other suitable work within the organisation. This includes positions at other locations or departments. The first track takes priority over the second track, and efforts here should be intensive and well-documented.

Second track (tweede spoor): finding work with another employer (when applicable)

If it becomes clear that returning to your current employer is not possible within a reasonable period, the second track must be activated. The second track focuses on finding suitable employment with a different employer. The first-year evaluation (week 52) serves as a reference point, but the UWV assesses this on a case-by-case basis — depending on the circumstances, starting earlier or later may be justified. Under the second track, your employer must facilitate job search support, which may include hiring a reintegration agency, offering training or retraining, or providing career coaching.

Step-by-step timeline of the reintegration process

The Gatekeeper Improvement Act sets specific deadlines for the various steps in the reintegration process. Here is a complete overview of the timeline:

Day 1: Report sick

You report your illness to your employer according to the company's sick leave procedures. Your employer must register your absence and notify the company doctor or occupational health service within seven days.

Week 6: Problem analysis

The company doctor assesses your situation and produces a problem analysis (probleemanalyse). This document describes your medical limitations, the expected recovery period, and the possibilities for your return to work. It forms the basis for the plan of action.

Week 8: Plan of action

Together with your employer, you create a plan of action (plan van aanpak). This plan sets out the reintegration goal, the activities to be undertaken, the responsibilities of each party, and the timeline. Both you and your employer must sign the plan.

Regular evaluations (typically every 6 weeks)

You and your employer must regularly evaluate the plan of action. In practice, this is typically done every six weeks, although the law does not prescribe a fixed interval — the requirement is that evaluations take place at regular and reasonable intervals. If progress is not as expected, the plan must be adjusted. These evaluations must be documented and added to the reintegration file.

Week 42: Report to UWV

Your employer must report your ongoing illness to the UWV at the 42-week mark. This notification triggers the UWV's monitoring of the reintegration process.

Week 52: First-year evaluation

After one year, you and your employer conduct a thorough evaluation of the reintegration process so far. This is also the point at which the second track should be considered if the first track has not been successful.

Week 87–88 (guideline): Final evaluation and reintegration report

Around weeks 87–88, you and your employer create a final evaluation of the reintegration efforts. The reintegration report (re-integratieverslag) compiles all documentation, including the problem analysis, plan of action, evaluation reports, and any expert opinions. This report must be submitted to the UWV as part of your WIA application.

No later than week 93: WIA application

You must submit your WIA application to the UWV no later than the 93rd week of your illness. Week 88 is often cited as a guideline for starting this process, but the legal deadline is week 93. The UWV uses the reintegration report to assess whether both you and your employer have made sufficient efforts.

Week 104: End of the two-year period

After 104 weeks, the employer's salary payment obligation ends, the dismissal ban expires, and the UWV decides on your WIA application. This marks a major transition point: from this moment, your income either comes from WIA benefits, unemployment benefits, or new employment.

Sanctions for non-compliance

Both you and your employer face consequences if you fail to meet your reintegration obligations. Understanding these sanctions helps you ensure compliance and protect your rights.

Sanctions for the employer

If the UWV determines that your employer has not made sufficient reintegration efforts, it can impose a salary payment penalty (loonsanctie). This means your employer must continue paying your salary for up to one additional year (a third year) beyond the standard two-year period. This is a severe financial penalty and serves as a strong incentive for employers to take their reintegration obligations seriously. The UWV assesses the employer's efforts based on the reintegration report submitted at the 88-week mark.

Sanctions for the employee

If you fail to comply with your reintegration obligations, your employer can take the following measures:

• Salary suspension (opschorting): if you do not attend the company doctor's appointments or fail to provide required information, your employer can suspend your salary payment. The salary is paid retroactively once you comply.
• Salary stop (loonstop): if you refuse suitable work or actively hinder your reintegration without a valid reason, your employer can stop your salary payment entirely for the period of non-compliance. Unlike a suspension, a stop means the salary for that period is permanently lost.
• Dismissal (only after thorough documentation): only in cases of structural and serious non-compliance can the employer apply to the subdistrict court for dissolution of the employment contract. The employer must first have issued written warnings, imposed salary sanctions, preferably obtained a UWV expert opinion, and built a comprehensive file demonstrating that the refusal is persistent and without valid reason.

The UWV assessment after two years

After two years of illness, the UWV conducts a comprehensive assessment of the reintegration efforts and determines whether you are entitled to WIA disability benefits. This assessment has major consequences for both you and your employer.

The UWV insurance physician (verzekeringsarts) and labour expert (arbeidsdeskundige) evaluate your medical situation and your ability to work. They also review the reintegration report to determine whether both parties have made sufficient efforts. Based on this assessment, you may receive an IVA benefit (for full and permanent incapacity), a WGA benefit (for partial or temporary incapacity), or no WIA benefit at all (if your incapacity is less than 35%).

The quality and completeness of the reintegration file are crucial for this assessment. Missing documentation, gaps in the timeline, or insufficient evidence of reintegration activities can lead to problems — either for you (if the UWV concludes you did not cooperate) or for your employer (if the UWV concludes the employer did not make enough effort, resulting in a salary payment penalty).

Sick leave, reintegration and settlement agreements

During the reintegration process, your employer may offer you a settlement agreement to end the employment. This can happen at any point during the two-year period, although it is most common when the working relationship has become strained, when the employer wants to avoid the cost and effort of continued reintegration, or when the employer anticipates a UWV salary payment penalty.

Signing a settlement agreement during the reintegration process carries significant risks. You give up your right to continued salary payment, reintegration support, and the protection of the dismissal ban. The UWV may view your agreement as a benadelingshandeling (detrimental action) and reduce or refuse your sickness benefits.

However, there may be situations in which a settlement agreement is in your interest — for example, if the working relationship has completely broken down and this is hindering your recovery, or if the offered compensation is generous enough to compensate for what you are giving up. In such cases, the terms must be carefully negotiated with professional legal assistance.

Frequently asked questions about sick leave and reintegration

What is the Gatekeeper Improvement Act?

The Gatekeeper Improvement Act (Wet verbetering poortwachter) is a Dutch law that sets out the obligations of employers and employees during the first two years of sick leave. It requires both parties to make active efforts toward reintegration and sets specific deadlines for assessments, plans, and evaluations. The UWV monitors compliance and can impose sanctions on either party for non-compliance.

What must my employer do when I am on sick leave?

Your employer must report your illness to the company doctor within seven days, arrange a problem analysis within six weeks, create a plan of action with you within eight weeks, evaluate the plan at regular intervals (typically every six weeks), appoint a case manager, offer you suitable adapted or alternative work, and maintain a complete reintegration file. Failure to meet these obligations can result in a UWV salary payment penalty of up to one additional year.

Can my employer force me to do different work during sick leave?

Your employer can offer you adapted work or alternative work that is considered suitable given your medical limitations. If the company doctor confirms that you are able to perform this work, you are legally obliged to accept it. If you disagree with the assessment, you can request a second opinion from another company doctor or a UWV expert opinion. Do not simply refuse the work without following these channels.

What happens if my employer does not meet their reintegration obligations?

If the UWV determines that your employer has not made sufficient reintegration efforts, it can impose a salary payment penalty. This means your employer must continue paying your salary for up to one additional year beyond the standard two-year period. This penalty is assessed based on the reintegration report at around 88 weeks of illness.

What happens if I do not cooperate with reintegration?

If you do not cooperate with reasonable reintegration efforts, your employer can take graduated measures: first written warnings, then salary suspension or salary stop. Only in cases of structural and serious refusal, after thorough documentation (including preferably a UWV expert opinion), can the employer seek dissolution of your employment contract through the subdistrict court. Always discuss any concerns with the company doctor or a lawyer before refusing to comply with reintegration measures.

Can I request a second opinion on the company doctor's assessment?

Yes. Since 1 July 2017, you have the statutory right to request a second opinion from another company doctor through your employer’s occupational health service arrangement (arbodienstregeling) — this is not a completely free choice of doctor. Your employer must facilitate this and bear the costs. Additionally, you can request a UWV expert opinion (deskundigenoordeel, subject to a fee) for an independent assessment. These options are important if you disagree with the company doctor's advice about your ability to work or the proposed reintegration activities.