Day 1: Employee Calls in Sick
When an employee reports sick, the employer must register the absence, notify the arbodienst (occupational health service) within two working days, and -- critically -- not ask about the nature of the illness. This is explicitly prohibited under Dutch privacy law and the Arbowet.
What the employer can do: Ask when the employee expects to return, ask about ongoing work tasks that need handover, ask whether the employee can do adapted work, and maintain regular contact within reason.
What the employer cannot do: Ask what the illness or diagnosis is, request a doctor's note (the bedrijfsarts system replaces this), dock pay below the legal minimum (70% of salary, subject to minimum wage floor), or dismiss the employee.
The opzegverbod during ziekte (dismissal prohibition during illness) under Article 7:670 lid 1 BW is absolute. You cannot terminate an employee who is sick for 2 full years. There is no workaround.
About 10% of sick leave episodes last longer than 6 weeks -- but these account for 81% of all absenteeism days.
The Arbodienst and Bedrijfsarts
The arbodienst (occupational health and safety service) is a certified external organization that every Dutch employer is legally required to contract with. The key professional within the arbodienst is the bedrijfsarts (company doctor / occupational physician).
The bedrijfsarts works for the system, not for the employer. They are independent medical professionals bound by medical ethics and confidentiality, not allowed to share the employee's diagnosis with the employer. They assess functional work capacity -- what the employee can and cannot do -- not what is medically wrong with them.
The employer receives a recommendation about work capacity and reintegration, NOT a medical report. The bedrijfsarts tells the employer: "This person can work 4 hours per day at a desk" -- not "This person has depression."
Cost of Arbodienst Contracts
| Contract Type | Cost per Employee per Year | Notes |
|---|---|---|
| Basiscontract (minimum legal) | EUR 30-50 | Pay-per-use model; additional charges per consultation |
| Standard/All-in contract | EUR 100-200 | Includes bedrijfsarts consultations, case management |
| Full-service/Maatwerk | EUR 150-250+ | Includes preventive medical exams (PMO), training, intensive case management |
Wet Verbetering Poortwachter (Gatekeeper Improvement Act)
Enacted in 2002, this law created a mandatory, documented reintegration process designed to prevent employees from drifting into long-term disability. The name literally means "Improvement of the Gatekeeper" -- referring to gatekeeping access to disability benefits.
The Mandatory Timeline
| Week | Milestone | What Happens |
|---|---|---|
| Week 1 | Sick report | Employee reports sick; employer notifies arbodienst within 2 working days |
| Week 6 | Probleemanalyse | Bedrijfsarts assesses the situation: nature of limitations, expected duration, reintegration possibilities |
| Week 8 | Plan van Aanpak | Employer and employee jointly create a reintegration action plan with concrete goals, activities, and timeline |
| Every 6 weeks | Progress evaluation | Employer and employee discuss reintegration progress; adjust plan if needed |
| Week 42 | UWV notification | Employer must report the ongoing illness to UWV (failure = fine) |
| Week 52 | First-Year Evaluation | Comprehensive evaluation of all reintegration efforts |
| Week 88 | UWV notification letter | UWV sends a letter about the upcoming WIA application |
| Week 91 | Final Evaluation | Final assessment of all reintegration efforts before WIA application |
| Week 93 | WIA application deadline | Employee applies for WIA benefit at UWV with complete reintegration dossier |
| Week 104 | End of waiting period | Employer's wage payment obligation ends (unless loonsanctie) |
The reintegration dossier is what UWV uses to judge whether the employer did enough. Gaps, missing documents, or late actions are the number-one trigger for loonsancties.
Employer Payment Obligations
Article 7:629 BW establishes:
| Period | Minimum Payment | Common Practice (CAO) |
|---|---|---|
| Year 1 (weeks 1-52) | 70% of salary (subject to minimum wage floor) | Often 100% for first 6-12 months |
| Year 2 (weeks 53-104) | 70% of salary (NO minimum wage floor in year 2) | Often 70%, sometimes 75-80% |
For an employee earning EUR 4,000/month gross:
| Cost Component | Year 1 | Year 2 | Total |
|---|---|---|---|
| Salary (100% / 70%) | EUR 48,000 | EUR 33,600 | EUR 81,600 |
| Holiday allowance (8%) | EUR 3,840 | EUR 2,688 | EUR 6,528 |
| Employer social charges (~20%) | EUR 10,368 | EUR 7,258 | EUR 17,626 |
| Subtotal wage costs | EUR 62,208 | EUR 43,546 | EUR 105,754 |
Add replacement staff costs, productivity loss, and reintegration costs. Total real cost: EUR 70,000-100,000+ per long-term case.
The Third-Year Penalty (Loonsanctie)
If UWV determines at week 93-104 that the employer's reintegration efforts were insufficient, UWV imposes a loonsanctie: the employer must continue paying the employee's salary for up to one additional year (weeks 105-156).
The employer did not explore reintegration with another employer when internal reintegration was not feasible. Starting second-track exploration too late -- after week 52 -- is the single most common reason for a loonsanctie.
Other common triggers: passive approach (waiting for recovery instead of pursuing adapted work), missing documentation, ignoring bedrijfsarts advice, and not pressuring uncooperative employees through documented wage sanctions.
Re-integration Obligations
First Track (Spoor 1) -- Own Employer
The employer must explore all possibilities to return the employee to work within the organization: same role with adapted conditions, different role matching residual capacity, or gradual return building up hours.
Second Track (Spoor 2) -- Other Employer
If first-track reintegration is not possible, the employer must pursue placement with another employer through a reintegratiebureau. The employer pays for this -- it is not optional.
When to start second track: Absolutely no later than the first-year evaluation (week 52). Starting too late is the number-one reason for loonsancties.
| Service | Typical Cost |
|---|---|
| Second-track reintegration -- standard | EUR 3,000-5,000 |
| Second-track -- intensive/complex cases | EUR 5,000-8,000 |
| Workplace adaptation/ergonomic assessment | EUR 500-2,000 |
| Training/reskilling programs | EUR 1,000-5,000 |
| Mediation (if conflict involved) | EUR 1,500-3,000 |
WIA Assessment at 104 Weeks
At approximately week 91, the employee applies for a WIA benefit. UWV assesses the degree of disability and whether it is permanent.
Two Outcomes
IVA (Fully Disabled): Employee is 80-100% disabled with no chance of recovery. Receives 75% of last earned salary from UWV for life. The IVA benefit is NOT charged back to the employer -- actually the "least bad" outcome for the employer's premium.
WGA (Partially Disabled): Employee is 35-80% disabled, or 80-100% with a chance of recovery. WGA benefit costs are charged back to the employer through differentiated premiums for up to 10 years.
The Differentiated WGA Premium -- The 10-Year Tail
When one of your employees enters the WGA, the benefit costs are attributed to your company, increasing your differentiated WGA premium for up to 10 years, calculated with a 2-year lag.
Employer size categories (2025 thresholds):
| Category | Total Wage Bill | Premium Determination |
|---|---|---|
| Small employer | Up to ~EUR 1,082,500 | Sectoral rate (not individually differentiated) |
| Medium employer | ~EUR 1,082,500 - 4,330,000 | Weighted average of sector rate and individual rate |
| Large employer | Above ~EUR 4,330,000 | Fully individually differentiated |
Average WGA premium for 2026: 0.96% of wage bill.
Eigenrisicodrager (Self-Insurer for WGA)
Instead of paying the differentiated WGA premium to UWV, an employer can become an eigenrisicodrager (own-risk bearer): you pay no WGA premium to UWV but bear full financial responsibility for WGA benefits for up to 10 years per case.
Most eigenrisicodragers purchase private WGA-ERD insurance at 0.5-2.0% of wage bill -- often cheaper than the UWV differentiated premium for employers with good absence management.
Application is to the Belastingdienst, effective dates January 1 or July 1 only, submitted 13 weeks before the effective date.
Burnout as a Specific Case
Burnout is recognized under Dutch law as a form of occupational illness. Under the Arbowet, employers have specific obligations to prevent psychosociale arbeidsbelasting (PSA) -- psychosocial work-related stress.
59% of all occupational disease claims in the Netherlands were psychological disorders -- burnout, depression, PTSD. Stress-related absenteeism has risen 36% in five years.
Average burnout duration: 10 months, with complex cases extending to 12-18 months. This means most burnout cases trigger the full Poortwachter process.
The American Management Culture Connection
American-led subsidiaries face disproportionately high burnout risk because headquarters may push performance expectations calibrated to US at-will employment. Dutch employees cannot simply be replaced if they "can't handle the pressure," and the legal and financial consequences are vastly more expensive than in the US.
Cost Modeling
Scenario A: One Burnout Case (Knowledge Worker, EUR 4,500/month gross)
| Cost Component | Amount |
|---|---|
| Year 1 salary (100%) + Year 2 salary (70%) | EUR 91,800 |
| Holiday allowance + employer social charges | EUR 27,173 |
| Replacement staff (temp/contractor) | EUR 40,000-60,000 |
| Arbodienst + reintegration | EUR 7,000-11,000 |
| Subtotal: Direct costs (2 years) | EUR 165,000-190,000 |
| WGA premium tail (if partial disability) | EUR 10,000-30,000/year x 10 years |
| Worst case with WGA tail | EUR 265,000-490,000 |
Scenario B: Annual Infrastructure Cost for a 30-Person Subsidiary
| Cost Component | Annual Cost |
|---|---|
| Arbodienst contract (all-in) | EUR 4,000-6,000 |
| Verzuimverzekering (sick leave insurance) | EUR 15,000-30,000 |
| Reintegration budget (reserve) | EUR 5,000-10,000 |
| HR/absence management time | EUR 5,000-10,000 |
| Prevention (PMO, workshops, vertrouwenspersoon) | EUR 3,000-5,000 |
| Total annual infrastructure | EUR 32,000-61,000 |
This is the cost of doing it right. The cost of doing it wrong is one or two long-term cases that exceed this entire annual budget.
US Comparison -- The Structural Difference
| Dimension | United States | Netherlands |
|---|---|---|
| Salary during illness | No federal requirement. STD (if offered): 40-60% for 3-6 months | 70-100% for 104 weeks. Mandatory by law. |
| Job protection | FMLA: 12 weeks unpaid, only employers with 50+ employees | 104 weeks. All employees. No tenure requirement. |
| Who assesses fitness | Employee's own doctor provides a note | Independent bedrijfsarts. Employer cannot choose a "friendly" doctor. |
| Employer reintegration duty | ADA reasonable accommodation (limited) | Comprehensive 2-year structured program with government oversight |
| Cost of non-compliance | Litigation risk (variable) | Mandatory third year of salary (loonsanctie) -- certain, not litigation-dependent |
| Long-term disability | Employee's problem (SSDI, private LTD) | WGA benefits charged back to employer for 10 years |
| Mental health / burnout | No specific employer obligation | PSA policy legally required, labor inspectorate enforces |
| Dismissal after illness | At-will: can terminate at any time (with ADA/FMLA caveats) | Cannot dismiss until 104 weeks passed AND reintegration fulfilled AND no recovery expected within 26 weeks |
You are the insurer. There is no opt-out. Prevention and active reintegration are the only rational economic strategy.
Verzuimverzekering (Sick Leave Insurance)
Verzuimverzekering is private insurance covering the employer's financial risk during the 104-week sick leave period. It is optional but strongly recommended, especially for SMEs.
Typical premiums: 1.5-5.5% of wage bill. For a 30-person subsidiary with a EUR 1,650,000 wage bill: EUR 33,000-57,750/year.
This looks expensive until you compare it to one long-term case costing EUR 100,000-200,000+.
Why smart employers buy it: Cash flow protection, bundled arbodienst expertise, Poortwachtergarantie (some insurers guarantee to cover loonsanctie costs if you follow their process), and peace of mind against two simultaneous long-term cases.
Key Legal References
| Reference | Subject |
|---|---|
| BW 7:629 | Employer's obligation to continue paying wages during illness (70% minimum, 104 weeks) |
| BW 7:658a | Employer's reintegration obligation |
| Wet verbetering poortwachter (Stb. 2001, 628) | Gatekeeper Act -- mandatory reintegration process and timeline |
| Arbowet (Working Conditions Act) | Employer's duty of care; PSA obligations; mandatory arbodienst contract |
| WIA (Wet werk en inkomen naar arbeidsvermogen) | Disability benefits framework (IVA + WGA) |
Sources
Official Government / Institutional Sources
- UWV - The Return-to-Work Plan
- UWV - Gedifferentieerde premies WGA en Ziektewet 2026
- Government.nl - Applying for WIA benefit
- Business.gov.nl - Absenteeism Insurance
- Business.gov.nl - Self-Insurer for Employee Insurance
- Business.gov.nl - Reintegration Obligations
- CBS - Nearly 1 in 6 Workers Have Stressful Jobs
Employment Law Firms and Practitioners
- Law & More - Sick Leave Rights Netherlands
- Spee Advocaten - Loonsanctie: How Does It Work?
- CMS Law - Second-Track Reintegration
- EmployerLegal - The Gatekeeper Act
HR / Arbodienst / Insurance Sources
- HumanCapitalCare - Absence Due to Stress Continues to Rise
- Hightekers - Sick Leave in the Netherlands 2026
- Ondernemen met Personeel - Verzuimverzekering Kosten 2026
Research compiled 2026-03-16. Figures are current as of 2025-2026 unless otherwise noted.