In Belgium, employers must generally accept a valid medical certificate when an employee reports sickness absence. Where there are doubts about the genuineness of the illness, employers may appoint a controlling doctor to verify the employee’s condition. This is an important safeguard, but it must be exercised in line with applicable rules.

Termination during sickness absence is possible in Belgium but must be approached with caution. Dismissal cannot be based solely on the employee’s illness, as this would likely amount to discrimination on the grounds of health. Employers must therefore ensure that any dismissal of an employee during sickness absence is based on legitimate reasons unrelated to the medical condition, such as a genuine organisational change or other objective business need.

In cases of long-term incapacity, employment may be terminated on the basis of medical force majeure, but only after a formal procedure has confirmed that:

• the employee is permanently unable to perform the agreed work; and
• no suitable alternative role is available.

This process must involve the occupational health physician and can generally only be initiated after at least nine months’ continuous incapacity. Employers should also be mindful of ongoing legislative developments linked to the “Back to Work” policy, aimed at strengthening reintegration and monitoring processes.

In Italy, sickness absence is regulated through an electronic medical certification system. Medical certificates are transmitted directly to the National Social Security Institution (INPS). While this removes the obligation for employees to provide certificates directly to employers, employees are still responsible for ensuring certificates are correctly submitted and for notifying their employer of their absence.

Employees benefit from a job protection period (the so-called periodo di comporto), typically defined by the applicable National Collective Bargaining Agreement. During this period:

• employment is protected; and
• the employee remains entitled to pay (subject to applicable rules).

Dismissal due to sickness absence is generally only possible once this protection period has been exhausted. Employers may then consider termination if the employee remains unable to work or repeatedly falls ill.

Recent reforms have introduced additional protections for employees suffering from serious illnesses (such as cancer or chronic conditions), including:

• access to extended periods of unpaid leave with job protection; and
• additional paid leave for medical treatment.

These measures reinforce employee protection and mean employers should carefully assess both the timing and grounds for any dismissal decision.

The Netherlands places significant obligations on employers to support employees’ return to work. These include:

• preparing a problem analysis;
• agreeing a plan of action; and
• conducting regular evaluations.

Failure to comply may result in significant penalties, including an obligation to continue salary payments for an additional year.

Employees are generally protected from dismissal during the first 104 weeks of sickness absence. Termination due to sickness absence is only possible after this period and requires that:

• the employee has been unable to perform their role for at least 104 weeks;
• recovery within a further 26 weeks is not expected; and
• no suitable alternative work is available within the organisation.

Termination can then proceed through a settlement agreement with the employee or following approval from the Dutch Employee Insurance Agency (UWV). Employers therefore need to take a proactive and well-documented approach throughout the sickness absence process.

For employers, the key considerations are:

• ensure robust procedures for monitoring and verifying sickness absence, including lawful use of medical controls;
• ensure any dismissal decision is based on objective grounds unrelated to an employee’s health condition;
• understand and comply with mandatory protection periods (e.g. periodo di comporto in Italy or the 104-week rule in the Netherlands);
• follow formal procedures for long-term incapacity, including medical assessments and reintegration obligations; and
• keep up-to-date with legal developments, particularly those aimed at strengthening “Back to Work” policies and employee protections.