Almost 52 per cent of the Netherlands' 8.1 million employees reported sick at least once in 2024, while long-term absence keeps rising. For employers that brings not only organisational challenges but financial consequences, since an employee who is ill costs an average of more than €400 a day. With long-term drop-out in particular the consequences mount quickly, certainly now that psychological complaints lead to long-term absence more often and the number of WIA disability applications rose by 13 per cent last year.
Reintegration after long-term absence calls for more than good intentions. As an employer you face clear obligations under the Gatekeeper Improvement Act. It matters to work towards a return to work step by step together with the employee, the case manager and the occupational physician. That process starts on the first day of illness and covers everything from the sickness report and the problem analysis to drawing up an action plan, carrying out reviews and possibly starting a second-track process.
Reintegration is not only about rules and forms, though. It concerns people whose capacity is temporarily reduced, and teams that come under pressure as a result. The choices you make affect fitness for work, absence guidance and sustainable employability. In this article we show you step by step how to prevent problems, delay and wage sanctions as far as possible.
When does the process begin?
With long-term absence, reintegration does not start after a few months but on the first day of illness. The Gatekeeper Improvement Act asks employer and employee to work actively on a return to suitable work from the start. According to Arboportaal on the Gatekeeper Improvement Act (in Dutch), those obligations already begin in the first week after the sickness report.
That is not only a legal duty but practically sensible. Long-term absence often has big consequences for planning, deployment and cost. Absence figures also show that the average duration of absence is rising and that psychological complaints in particular lead to long-term drop-out more often. Which is exactly why a clear step-by-step guide to reintegration after long-term absence matters: it gives structure, makes expectations clear and helps bring in the right professionals in time.
For employers that means recording the absence well, keeping in touch and involving the occupational physician or occupational health service in good time. For employees it means cooperating actively with recovery and return. For the occupational physician it means assessing what someone can still do, without sharing medical details with the employer.
Step 1 to week 8
Step 1: the sickness report and first contact
On the first day of illness you record the sickness report according to your own absence protocol. It matters that you focus on the practical consequences for the work and not on the medical diagnosis. Only the occupational physician may assess whether someone is unfit for work; that is emphatically not a task for the employer, as Arboportaal on the role of the occupational physician (in Dutch) explains.
Good first contact often makes the difference. Not to apply pressure, but to stay involved, give clarity and discuss what is needed. In practice we see that a lack of clarity at this stage easily leads to misunderstandings later.
Step 2: bringing in the occupational physician
When long-term absence threatens, the occupational physician draws up a problem analysis by week 6 at the latest. It sets out what the limitations are, which possibilities still exist, what recovery is expected and which steps seem to fit. That analysis forms the basis for the rest of the process.
If you want to understand better what this professional does in absence guidance, our overview of what an occupational physician actually does helps. It is also good to know that every employer has to work with an occupational health service or physician through a basic contract, as explained in our article on what a basic occupational health contract is and what it must contain.
Step 3: the action plan in week 8
By week 8 at the latest, employer and employee draw up the action plan together. According to the Dutch government on rules and obligations during illness (in Dutch) and Arboportaal, a return to work is central during the first two years of illness, possibly in adjusted or other work.
A good action plan is concrete. Think of:
- which duties are temporarily possible
- how many hours can be built up
- which obstacles have to be resolved first
- who takes which action
- when progress is reviewed
For employers what matters most here is that arrangements can be tested. For employees it matters that the plan is feasible and realistic. For the occupational physician it matters that capacity is translated well into work possibilities.
What happens after week 8?
Regular reviews
The action plan is not a document that disappears into a file. Employer and employee have to discuss progress regularly and adjust the plan where needed, in practice at least every six weeks. That matters, because capacity can change. Sometimes recovery goes faster than expected, but regularly it turns out that tasks, hours or workload have to be adjusted again.
With psychological complaints this is extra relevant. TNO and Statistics Netherlands, among others, signal that workload and other psychosocial factors play a large part in long-term absence. A return in exactly the same circumstances is then often not immediately suitable. Think of adjusted hours, different priorities or temporarily less complex tasks.
Suitable work is central
According to Arboportaal on the responsibilities of employer and employee (in Dutch), the employer has to adjust the work, the workplace or the equipment where necessary. The starting point is always suitable work: work that matches what the employee can manage at that moment.
That calls for tailoring. For one employee, suitable work may mean temporarily working fewer hours. For another it means an adjusted set of duties or a different workplace. For the occupational physician it matters to describe those possibilities clearly, so that employer and employee can act on them.
Week 42, the first-year evaluation and track 2
Week 42: notification to UWV
By week 42 at the latest, the employer has to report the long-term absence to UWV. That is a formal obligation within the Gatekeeper approach. Late or incomplete follow-up of this process can cause problems later when the reintegration effort is assessed.
Around week 52: the first-year evaluation
After about one year of illness comes the first-year evaluation. This is an important moment to look honestly at whether the original goal is still achievable. Under the Gatekeeper system this is the moment for a shake-up where needed: if a return to one's own role is not realistic, the process has to be adjusted.
For employers that means you should not keep hoping for recovery without reasoning. For employees it means clarity emerges about the next steps. For the occupational physician and any labour expert it means advising more sharply about how feasible a return is.
Track 1 and track 2
Within the step-by-step guide to reintegration after long-term absence, track 1 is always the starting point: a return to one's own work, adjusted or not, or to other suitable work within the organisation. If that does not work or is no longer realistic, track 2 comes into view: suitable work with another employer.
UWV's Gatekeeper working guide (in Dutch) makes clear that UWV looks not only at the end result but at the effort of employer and employee during the first two years of illness. Which is why track 2 must not be started too late when a return within the organisation offers insufficient prospect.
With more complex processes, working with specialised parties is often wise. At Dokter Beter we also support employers with labour experts and second-track reintegration, exactly when capacity, suitable work and placement options have to be well founded.
The division of roles between employer, employee and physician
What the law asks of the employer
The employer is ultimately responsible for the process. That means, among other things:
- bringing in the occupational physician or occupational health service in time
- drawing up and maintaining the action plan
- offering and investigating suitable work
- documenting every step
- meeting the notification duties towards UWV
Anyone looking for more context on that can also read our overview of your obligations as an employer on working conditions and absence. In practice we see that file-keeping, timeliness and clear contact are what decide the outcome.
What the law asks of the employee
The employee has to cooperate actively with recovery and reintegration. That means being reachable for discussion, turning up to appointments with the occupational physician and accepting suitable work where that is reasonably possible. If an employee cooperates insufficiently, the employer may under conditions withhold wages, according to the Dutch government (in Dutch).
At the same time the employee has rights too. When there is doubt about the occupational physician's advice, a second opinion can be requested. When there is a difference of view about the reintegration process, an expert opinion can be requested from UWV.
What the occupational physician's role is
The occupational physician assesses capacity and advises on resuming work. A clear boundary applies: the physician shares no medical diagnosis with the employer, but does share the information needed to make suitable work possible. That matters for privacy and for a workable process.
Increasingly, structured descriptions of work possibilities are used for this, such as Arboportaal's BAR instrument. That helps make communication between occupational physician, labour expert and other professionals involved more consistent.
How do you avoid mistakes and wage sanctions?
One of the biggest risks with long-term absence is a process that runs but is insufficiently demonstrable or insufficiently active. At a WIA application, UWV assesses whether employer and employee have done enough together. If they have not, a wage sanction can follow: the employer then has to keep paying wages for up to a year longer.
Common mistakes are:
- bringing in the occupational physician too late
- an action plan without concrete actions
- reviews that barely happen or do not happen at all
- starting track 2 too late
- no clear record of efforts and choices
- discussion about medical substance instead of capacity and work possibilities
Which is exactly why it pays to look not only at obligations but at the quality of the guidance. A good process is careful and human. It supports recovery, prevents standstill and makes clear to everyone involved where they stand.
In practice a step-by-step guide to reintegration after long-term absence works best when employer, employee and occupational physician each take their own role seriously, act in time and keep looking at what is possible.
With the right steps you help employees back to work sooner and keep a grip on absence.
With a clear reintegration process, timely guidance and an eye for what an employee can do, you increase the chance of a fitting and lasting return to work.
Key takeaways
- Reintegration after long-term absence starts on the first day of illness and calls for quick, clear action from employer and employee alike.
- The occupational physician maps capacity and work possibilities from the start and supports you with targeted advice.
- A concrete action plan, regular reviews and careful file-keeping keep the process transparent, workable and demonstrable towards UWV.
- Suitable work calls for tailoring: keep investigating which tasks, hours and adjustments are possible inside or, if needed, outside the organisation.
- By adjusting in time you prevent delay, misunderstandings and unnecessary risks such as a wage sanction.
- With early attention to prevention and sustainable employability you build towards healthy work, faster recovery and stronger long-term fitness for work.
When we see reintegration as a shared process, in which you, the employee and the occupational physician each have a clear role, the road to recovery becomes clearer and more achievable. That way we create together a working environment in which people can not only return but keep working healthily.