A Clearer Medical Opinion Still Leaves Employers Holding the Case

A Dutch bill would narrow medical uncertainty, but timing, suitable work and wages remain the employer’s concern.

On Monday morning, a shop owner rearranges the roster again. One employee has been ill for months. Colleagues are covering shifts, temporary help costs money, and the owner is trying to offer suitable work without pushing the employee beyond medical limits. The occupational physician has given an assessment, but every next step still needs a decision.

That ordinary scene sits behind a bill submitted to the Tweede Kamer on 31 August 2026. The proposed Wet wijziging toets op de re-integratie-inspanningen en WIA-voorschotregeling would make the occupational physician’s assessment of functional capacity decisive when UWV reviews the reintegration report after two years of sickness.

The measure is not yet law. Its commencement would be set by royal decree. Still, it signals an important attempt to remove one uncertainty from a process that can become painfully difficult for both employer and employee.

Under the proposal, an employer should no longer face extended wage payment solely because UWV’s insurance physician later takes a different medical view. UWV would still judge whether the employer and employee made sufficient reintegration efforts. That distinction is the heart of the matter.

Medical judgment and management responsibility

The occupational physician determines what the employee can reasonably do. The employer must translate that judgment into hours, duties, workplace adjustments, conversations and review dates. Those are different responsibilities, even when they sit in the same reintegration process.

I read the bill as a reallocation of medical uncertainty, not a transfer of management responsibility. It should give the occupational physician’s assessment a firmer position. It does not give the employer permission to wait for the next appointment while suitable work, staffing and deadlines drift.

Official legislative material shows why the distinction matters. Medical disagreement was the main reason for 8 percent of substantive wage-payment extensions during 2022 to 2024. In 2024, 2,197 such extensions were imposed, with about 175 attributed to medical disagreement. The proposal addresses that smaller, but still serious, category.

The Council of State has raised a harder question. It warned that making the occupational physician’s view decisive could weaken UWV’s gatekeeping role. It also said the change could move some risk from the employer towards the employee and increase WIA inflow. Those possible effects deserve attention because greater certainty for one party can alter protection elsewhere in the system.

The larger risk sits in execution

For a small employer, reintegration trouble rarely starts with one dramatic mistake. It usually grows through ordinary delays. A conversation happens but is poorly recorded. Adjusted duties continue without a review date. Suitable work is discussed casually but never tested. A second-track route is considered only after options have narrowed.

Historical UWV research found that most recorded shortcomings involved reintegration that was not started, started too late or handled incorrectly. That research covers earlier years, but the pattern remains useful. Medical disagreement attracts attention because it feels unfair and difficult to control. Weak execution is less visible, yet much more directly connected to the employer’s own decisions.

This is particularly sharp in a small team. A consultancy may redistribute tasks or reduce hours more easily than an installer, restaurant or workshop. Physical and shift-based work leaves less room for adjustment. Yet the employer must still consider what work genuinely exists. Creating a fictional role helps nobody. Neither does assuming that no alternative is possible without examining the work carefully.

The shop owner from Monday morning therefore needs more than a medical note. Someone must compare the employee’s capacity with the actual roster and duties. Someone must decide what can change, for how long and at what cost. The next review date must be clear. If an external case manager supports the process, the owner still needs to understand what has been decided and why.

Sickness absence is also a cash question

CBS recorded a provisional sickness-absence rate of 5.4 percent across the economy in the second quarter of 2026. For businesses with one to ten workers, the provisional rate was lower, at 2.5 percent. One prolonged absence in a team of five can still reshape the whole company.

Wages continue while replacement capacity, occupational-health support and management time add further costs. Customer work may move more slowly. The owner may cover shifts personally. If UWV concludes that repairable reintegration shortcomings remain, wage payment can be extended for up to another 52 weeks.

That makes the case part of financial control, not only human resources administration. The payroll forecast should reflect the possible duration of wage payments and replacement costs. Insurance coverage needs to be understood before pressure arrives. Work commitments should match the capacity that remains, rather than the capacity the business hopes will return.

The bill’s WIA-advance provisions belong in this same practical picture. UWV completed more WIA claim assessments in the first four months of 2026 than a year earlier, yet 12,400 cases had been waiting longer than six months. An advance may bridge the employee’s income when wage payment ends before UWV reaches a final decision. The bill would provide a statutory basis for waiving certain advances.

Keep the case close enough to manage

The two-year point should not be treated as a clean administrative finish. Assessment delays can separate the end of wage payment from the final WIA decision. That gap affects the employee’s income certainty, the employment relationship and the company’s planning.

A calm internal review can expose problems early. The owner should be able to see the latest medical assessment, the work actually offered, the employee’s response, the next decision date and any approaching first-year or second-year milestone. Where those pieces do not connect, another document alone will not solve the problem. A real decision is missing.

The proposed law may remove a frustrating form of retrospective medical disagreement. That would be meaningful progress. But certainty in reintegration never comes from one opinion alone. It comes from treating the employee fairly, making timely choices and keeping wages, work and evidence aligned while the business continues to run.

The data, sourcing, and analysis behind this article were conducted by Linda Pavan Geraedts. AI was not used to identify sources, build the factual basis, or produce the analytical judgment contained here. AI was used only as a drafting aid. The final English text was personally reviewed, edited, and approved by Linda Pavan Geraedts before publication.

References

• Meer zekerheid voor werkgevers en werknemers bij re-integratie - oordeel bedrijfsarts leidend · Salaris Vanmorgen
• Overheid.nl Wetgevingskalender - Legislative status and scope of the bill
• Rijksoverheid - Existing reintegration duty and wage-sanction exposure
• UWV - What the RIV assessment currently measures
• UWV - WIA waiting times and advances
• UWV - Current UWV position on delayed WIA decisions
• CBS - Sickness absence and employer exposure in 2026
• Rijksoverheid - Policy development on WIA-advance waiver and financing