Belgium health funds under fire after review finds questionable sickness benefit payments

Belgium’s health insurance funds, known as “ziekenfondsen” or “mutualities”, are facing growing criticism after a new government study found that many long-term sickness benefits may have been wrongly paid.

A sample check by Belgium’s national health insurance institute, the RIZIV/INAMI, seen by newspaper De Standaard, showed that around one in four people who had been off work for more than a year received benefits for too long or without proper justification.

The study looked at 2,000 cases in 2025, focusing on people under 28 and people under 40 with mental health conditions. In both groups, officials decided that about 25% of sickness claims should have ended earlier or been reduced.

In most of those cases, inspectors concluded that the person could in principle return to a similar job. This applied to 70% of younger claimants and 84% of younger people with mental health problems.

The findings add pressure on Belgium’s mutualities, which manage compulsory health insurance payments and support people on long-term sick leave. Socialist mutualities were criticised in particular, with higher rates of incorrect payments than other funds.

Belgian Health minister Frank Vandenbroucke has sharply criticised the system over the weekend. He said the mutualities “must completely reinvent themselves” and warned that their future is at stake if they fail to reform.

The debate has become increasingly political in recent months. Parties including the Flemish nationalist N-VA and the liberal MR have questioned whether the mutualities are too powerful and whether their doctors are independent enough when assessing sick leave claims.

Vandenbroucke has also suggested linking the organisations’ public funding more closely to performance, such as helping vulnerable patients access vaccines, treatment programmes, and family doctors.

Despite the criticism, the minister said abolishing the mutualities altogether would not solve the problem. A parliamentary hearing on the issue is expected in Brussels this week.

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