The short answer
Further incapacity after a return to work is not automatically a new case eligible for benefits. Check the general terms and conditions (GTC) for the definition of relapse, the waiting period, how days already compensated are counted and the rules applicable if the insurer has changed. Request a written position on the case.
1. Establish the chronology without making a diagnosis
Record the certified dates and degrees of incapacity, periods of return to work and notifications already made. Distinguish what is documented from what remains to be confirmed. The employer does not itself determine the medical link between two absences: medical information is handled through authorised contacts.
2. Read the clauses that determine how the case is handled
- How do the GTC define a relapse and distinguish between episodes?
- Which waiting period applies to the situation being examined?
- How are days already compensated counted?
- Which benefit conditions or limits are relevant to this case?
3. Use a contractual example with care
Sections B7/B8 of AXA's GTC for sickness daily allowance insurance, edition 01.2024, provide an example of how the waiting period, benefit duration and relapse are treated. They show why episodes and days already compensated must be checked against the applicable contract. This example establishes no rule shared by insurers, does not guarantee payment of benefits and does not constitute a recommendation of AXA.
4. Reconcile policies and benefit statements
Gather the policies and GTC editions applicable to the periods concerned, endorsements, confirmations and benefit statements. If the insurer has changed, obtain clarification of the rules governing cover and coordination of the cases: do not assume that the new insurer starts from zero.
Record the days counted and the administrative discrepancies requiring explanation. Send the necessary information through the appropriate channels, without circulating a diagnosis in HR correspondence.
5. Obtain a written position and coordinate the next steps
Ask the insurer how it classifies the case, which clauses it applies, which waiting period it uses and how it counts previous benefits. Obtain clarification of missing documents and follow up the responses, without promising the employee an outcome.
Coordinate the necessary steps with absence management and the other contacts involved. Sickness daily allowance cover and protection against dismissal are separate issues: one does not automatically entail the other.