Axel Ronse: “No one seems to know how many people on long-term sick leave are actually abroad”

Nearly 15,000 people on long-term sick leave receive Belgian sickness benefits while living abroad, at an annual cost of €258 million. Yet the authorities do not know exactly how many people on long-term sick leave are actually staying abroad, how much their benefits cost in total or how often they undergo medical checks. These are the findings of an investigation by N-VA parliamentary group leader Axel Ronse.

Ronse is not pointing the finger at those receiving benefits, but at a system that is failing to do its job. “In principle, there is nothing wrong with living abroad while receiving Belgian sickness benefits. Anyone who works in Belgium contributes to our Social security Social security is currently managed at the Federal level in Belgium. The most important pillars of Belgian social security are: sickness and invalidity insurance (NIDHI), pensions, unemployment insurance and child allowances. In addition, occupational illness, occupational accidents and annual holidays are dealt with at this level. Some Flemish parties have been campaigning for years for (large parts of) social security to be transferred to the Regions and Communities. social security system. If they fall ill, they are entitled to benefits from Belgium, even if they subsequently move abroad,” Ronse explains. “Unfortunately, there are serious shortcomings in the way these cases are monitored.”

Just 553 medical assessment reports

Between 2020 and 2025, the number of people on long-term sick leave officially residing abroad surged by 58% to 14,713. By comparison, the number of people in Belgium who had been unable to work for more than a year rose by ‘just’ 22%. Over the same period, annual expenditure increased from €139 million to €258 million — a disproportionate rise of 86%.

Despite this, Belgian health insurance funds requested only 1,934 medical assessments for people on long-term sick leave abroad in 2025, receiving reports for just 553 of them. Some assessments also face exceptionally long delays. At the Christian Mutuality, for example, the average waiting time for a medical assessment report from Bulgaria is a staggering 779 days. “The health insurance funds fail to intervene when the process takes too long. They simply allow these delays to drag on,” Ronse observes.

No one knows how many people are actually involved

Even more strikingly, the health insurance funds, Belgium’s National Institute for Health and Disability Insurance (INAMI/RIZIV) and the government do not even know how many people on long-term sick leave are actually abroad or living there permanently.

The €258 million figure only covers people on long-term sick leave who are officially registered as living abroad. No one knows how much is paid to people who spend extended periods abroad without being officially registered as residents there. Benefits paid to people who have been off sick for less than a year and who live or stay abroad are also missing from the figures. Actual expenditure is therefore higher, but by how much remains unknown.

There are also major gaps in the monitoring of people who move abroad. Anyone receiving Belgian sickness benefits who moves to another European country must notify their health insurance fund in writing. Yet no one keeps track of whether they actually do so.

Temporary stay or permanent residence?

Stricter rules apply to travel to countries outside Europe with which Belgium has no bilateral agreement, known as ‘third countries’. People receiving sickness benefits must obtain prior authorisation from a doctor before travelling to these countries. In 2025, such authorisation was requested 18,875 times. But how many people leave without permission? And how many applications are rejected? Once again, no figures are available.

“This system is far too lax,” Ronse argues. “Anyone who travels abroad without requesting the required authorisation should face sanctions.”

These third countries present another problem. People who officially move to one of them lose their entitlement to Belgian sickness benefits. However, those who stay there temporarily can continue receiving benefits under certain conditions. According to the N-VA, this creates opportunities for abuse: someone could remain officially registered as living in Belgium while actually residing abroad.

“What stands out is that no fewer than 4,437 benefit payments were made last year to people on sick leave who were supposedly ‘staying’ in Egypt, and another 1,842 to people in Thailand,” Ronse points out. Once again, the health insurance funds appear not to check whether these individuals are actually living there permanently.

“The fact that the INAMI/RIZIV and the health insurance funds lack such essential information is evidence of complete mismanagement,” Ronse says. “People who live or stay abroad are not monitored as rigorously as those on sick leave in Belgium. This creates unequal treatment.”

Take responsibility for medical checks away from health insurance funds

Ronse therefore wants to strip the health insurance funds of their responsibility for monitoring people on long-term sick leave.

“The health insurance funds themselves are responsible for providing the data that the INAMI/RIZIV uses to assess their performance. But they have no incentive to keep accurate records, because doing so would increase their risk of financial penalties. The only logical conclusion is that responsibility for monitoring people on long-term sick leave must be taken away from the health insurance funds immediately.”

He also wants other solutions to be explored, such as mobile teams of Belgian doctors who could carry out medical assessments on the ground.

“We are talking about substantial sums of money. We need to be willing to think outside the box,” Ronse says.

For Ronse, the investigation is far from over. He intends to use parliamentary scrutiny to establish why the health insurance funds, the INAMI/RIZIV and the responsible minister allowed these serious shortcomings in monitoring to persist for years.