Occupational Health Services – Is an Agreement Required?

An occupational health examination carried out without an agreement with the employer. Does the medical certificate remain valid?

As a rule, an employer should refer employees to an occupational health service provider with which it has a written agreement. This requirement arises from the Occupational Health Service Act, which provides for preventive medical examinations to be carried out as part of organised cooperation between the employer and a primary occupational health service unit.
This does not mean, however, that a certificate issued by an occupational health physician at another facility will be invalid. What matters most is that the examination is carried out correctly, including the issuance of a referral containing information on working conditions in the position concerned and a certificate confirming that there are no medical contraindications to performing the work.

At the same time, using a facility not covered by an agreement entered into by the employer may give rise to additional risks. These become particularly relevant in situations involving disputes or scrutiny, such as an inspection by supervisory authorities or proceedings relating to an accident at work. In such cases, the organisation of preventive medical examinations and the circumstances in which the certificate was issued may be subject to detailed scrutiny.

For this reason, although the certificate itself is not necessarily ineffective from the outset, entering into a written agreement with an occupational health provider and referring employees to facilities covered by that cooperation is recommended from the perspective of legal protection. This helps reduce interpretative risk and avoid potential doubts as to whether the employer’s obligations have been properly fulfilled.

Occupational health and the employer’s obligations

Under Article 229 of the Labour Code, an employer must provide employees with occupational health examinations and cover their cost. This obligation covers three types of examination:

initial medical examinations for persons being hired, or for young workers transferred to other positions and other employees transferred to positions involving factors harmful to health or onerous working conditions;
periodic examinations, on the date specified by the occupational health physician
return-to-work examinations following an incapacity for work lasting more than 30 days due to illness.

Each of these examinations must be carried out by an occupational health physician.

Does every employer have to enter into an agreement for the provision of occupational health services?

Under Article 12(1) of the Occupational Health Service Act of 27 June 1997:
“Initial, periodic and return-to-work medical examinations of employees and other healthcare services are provided under a written agreement entered into by the entity required to provide them, referred to in Article 5(2), hereinafter referred to as the ‘client’, with a primary occupational health service unit, hereinafter referred to as the ‘service provider’.”

This provision clearly indicates that preventive medical examinations should take place within a framework of formal cooperation between the employer and an occupational health provider. This means that the obligation to enter into a written agreement applies to every employer, regardless of the number of employees. Even a company employing only one person should have an agreement with the facility to which it refers employees for examinations.

It is worth remembering that an agreement with an occupational health provider should not merely state that the facility will carry out preventive medical examinations. It should precisely define the terms of cooperation between the employer and the medical service provider, so as to ensure that examinations are properly organised and statutory obligations are fulfilled.

In particular, the agreement should include:

identification of the parties, namely the employer and the primary occupational health service unit;
identification of the persons covered by the services, primarily employees referred for preventive medical examinations;
the scope of healthcare, covering at least the services the employer is required to provide under labour law;
arrangements for organising and providing services, including how examinations are booked and how medical certificates are delivered;
how the persons concerned are informed of examination results and certificates issued;
arrangements for the employer to monitor performance of the agreement;
the employer’s obligations towards the medical facility, particularly regarding the provision of information on working conditions, including harmful factors or onerous conditions, and access to the necessary documentation;
financial settlement terms, including the fees, how they are determined, payment deadlines and settlement procedures;
the term of the agreement, termination conditions and dispute resolution arrangements.

An agreement with an occupational health provider must be in writing and entered into for a term of at least one year.

Its minimum scope is specified in Article 12(2) of the Occupational Health Service Act of 27 June 1997.

An employer is not restricted to working with a single facility. Companies operating in several locations may enter into separate agreements for occupational health services in different cities.

Who bears the cost of employee medical examinations?

The legislation leaves little discretion in this respect. The employer is responsible for financing employees’ preventive medical examinations, whether initial, periodic or return-to-work medical examinations. If, for organisational reasons, an employee pays for the appointment personally, the employer should reimburse the expenses incurred. It should also be remembered that preventive medical examinations should, as a rule, take place during working hours. The employee retains the right to remuneration for that time, confirming that the obligation to organise and finance examinations rests with the employer rather than the employee.

Referral for occupational health examinations – what should an employer keep in mind

One of the employer’s basic obligations is to issue a correct referral for preventive medical examinations. The document is prepared in two copies: one is provided to the occupational health physician carrying out the examination, and the employee receives the other.

The employer should also retain a copy of the referral and keep it in the employee’s personnel file. This document should be kept in the employee documentation together with the medical certificate and other documents relating to the employment relationship.

Employer obligations regarding occupational health – key principles

Practice shows that errors concerning preventive medical examinations most often arise not from a lack of examinations, but from improper organisation of the overall process. An employer should therefore ensure not only that the employee is referred to an occupational health physician, but also that a number of formal obligations are fulfilled. In particular, the employer should:

enter into a written agreement with the occupational health provider carrying out employees’ preventive medical examinations;
refer employees for examinations to a facility covered by that agreement;
correctly issue referrals for initial, periodic and return-to-work medical examinations, taking into account working conditions, including any harmful factors or onerous conditions;
provide employees with referrals and retain copies in the employee documentation;
include medical certificates in employees’ personnel files;
monitor the expiry dates of medical certificates and refer employees for subsequent periodic examinations in good time;
cover the cost of preventive medical examinations and ensure that they can, as a rule, be carried out during working hours;
not allow persons to work without a current medical certificate confirming that there are no contraindications to working in the position concerned.