Did you know that an employee who is absent costs your organisation around €400 a day on average? In the fourth quarter of 2025, sickness absence rose to 5.6 per cent. That means more than a temporary staffing problem: it affects your planning, raises workload and puts pressure on the employability of your team. For those reasons, good absence case management matters more than ever.
When an employee drops out for a long period, the Gatekeeper Improvement Act requires you to take timely steps, which calls for careful file-keeping and active cooperation between employer, employee and occupational physician. This is where the absence case manager comes in. This professional oversees the absence process, watches the deadlines and supports your organisation in developing a careful action plan. While the occupational physician remains responsible for the medical assessments, the case manager organises and guides the process and makes sure your organisation stays within the legal framework.
What an absence case manager does in practice
An absence case manager watches over the absence and reintegration process of an employee who is ill. In practice that means they keep the overview, watch deadlines, coordinate conversations and make sure that employer and employee take the right steps under the Gatekeeper Improvement Act. According to Arboportaal on the Act (in Dutch), the aim of the Act is to shorten absence as far as possible by acting in good time and effectively.
That is no luxury. According to the Statistics Netherlands absence dashboard (in Dutch), sickness absence stood at 5.6 per cent in the fourth quarter of 2025. At the same time, VZinfo on burnout complaints (in Dutch) shows that mental exhaustion from work keeps rising. With longer or more complex absence in particular, good direction matters.
An absence case manager is usually the fixed point of contact for employer, employee, occupational physician and any other professionals. It is not about medical treatment or medical assessment but about guiding the process: who does what, when, and how is progress recorded?
Which tasks does a case manager have?
The tasks lie mainly in the organisational and communication field. Think of:
- watching deadlines under the Gatekeeper Improvement Act
- scheduling review moments
- drawing up and maintaining the action plan
- coordinating contact between employer, employee and physician
- recording steps in the absence file
- following the progress of the reintegration
- spotting when extra effort is needed, such as an occupational capacity assessment or the second track
That makes the case manager the director of the process. Meanwhile the occupational physician remains responsible for the social-medical guidance and for advising on capacity, possibilities and limitations. Anyone who wants to know more about that division of roles can read our explanation of what an occupational physician actually does.
The case manager watches the process, not the diagnosis
An important distinction: the case manager does not have to know what is medically wrong with an employee. According to Arboportaal on the responsibilities of employer and employee (in Dutch), an employer may not ask what exactly someone has. Absence guidance is about what someone can still do, what is needed for recovery and what return to work is possible.
The NVAB is clear about this in its guidance on case management in absence (in Dutch): a case manager carrying out process tasks, or working on the instruction of someone other than the occupational physician, may not see or process medical data. That matters for privacy and for clear responsibilities.
The case manager and the employer's role
For employers a case manager matters because absence quickly has a big impact on the organisation. It is not only about continued wage payment but about planning, cover, workload in the team and the risk of mistakes in the file or missed deadlines. According to Arboportaal on the Gatekeeper Improvement Act (in Dutch), UWV can impose a wage sanction when insufficient reintegration effort has been made.
A case manager helps employers keep a grip on that process. That means, among other things:
- making sure the physician's problem analysis is followed up in time
- watching that employer and employee make an action plan together
- organising periodic reviews
- escalating in good time when things stall
- making sure the reintegration report is complete and logically built up
In practice we see this becoming important as soon as absence runs longer than a few weeks, or when several interests are in play at once. Think of a return to one's own work, adjusted work, workload in the team or doubt about how lasting the recovery is. Our article on reintegration after long-term absence step by step fits well alongside this.
When should an employer appoint a case manager?
With longer absence, someone has to watch the process. In practice employers may decide themselves who fills that role, for instance an HR professional, a manager or an external specialist, as long as the division of roles is clear. What matters above all is that one person keeps the overview and guides progress actively.
For employers it is wise to record in advance:
- who the case manager is
- on whose behalf this person acts
- which information may and may not be shared
- how alignment with the occupational physician is arranged
- who is responsible for building the file and following up
A good basic contract with the occupational health service also helps organise that cooperation clearly.
The case manager and the employee's position
For employees a case manager is often the fixed point of contact during an uncertain period. Certainly with long-term absence, it can be reassuring when someone explains which steps follow, which agreements apply and what is expected from both sides.
That does not mean the case manager decides on medical substance. The employee discusses complaints, capacity and recovery with the occupational physician. The case manager translates the outcome into steps in the process, such as a review, working arrangements or putting suitable work in place.
It is important for employees to know that:
- the employer may not ask for a medical diagnosis
- the occupational physician advises independently
- there is a right to a second opinion when there is doubt about the physician's advice
- with a difference of view about the reintegration, an expert opinion from UWV is possible
Those safeguards also follow from Arboportaal on the responsibilities of employer and employee (in Dutch).
What an employee notices in concrete terms
An employee notices a case manager above all through structure and clarity. For instance:
- there is one recognisable point of contact
- agreements are recorded and followed up
- progress is discussed regularly
- there is timely alignment with physician and employer
- reintegration options are worked out practically
That can help prevent misunderstandings, certainly when recovery is uneven or when returning to one's own work is not yet feasible.
Working with the occupational physician
Cooperation between case manager and occupational physician only works well when each role is sharply bounded. According to Arboportaal on the physician's legal position (in Dutch), the physician works independently and protects the employee's privacy. The physician may advise the employer about expected duration of absence, fitness for work and adjustments, but may not share medical details.
The case manager then uses that advice to shape the process further. For instance by:
- discussing suitable work with the employer
- scheduling review moments
- watching the actions from the action plan
- feeding back when things stall
- organising extra support when needed
The difference with delegated tasks
In practice, confusion sometimes arises between a case manager acting on the employer's behalf and a professional working under the physician's delegated tasks. They are not the same.
When someone works under the physician's responsibility, they can carry out supporting tasks in the medical domain within strict limits. The physician then remains ultimately responsible. When a case manager works as a process guide on the employer's behalf, the emphasis lies on direction, planning and file-keeping, not on medical guidance.
That distinction also matters in UWV's assessment. At a WIA application, UWV looks at whether employer and employee have reasonably made enough reintegration effort, as described in UWV's Gatekeeper working guide (in Dutch). Anyone who wants to know more about limiting the risks can also read our explanation of how to avoid a wage sanction from UWV.
When does a case manager add the most value?
Not every absence file is equally complex. Even so, a case manager adds most value in situations such as:
- absence that lasts longer than expected
- psychological absence or burnout complaints
- uncertainty about capacity
- several professionals involved
- a first track that threatens to stall
- doubt about whether the second track has to start
- organisations without an internal HR or absence specialist
That is relevant, because psychological complaints occur more often and often lead to longer absence. The rise in burnout complaints according to VZinfo (in Dutch) underlines it. In such cases not only medical guidance matters, but careful process guidance, managing expectations and clear communication.
Sometimes further investigation is needed to get a better view of reintegration chances. An occupational capacity assessment may then be the right fit.
What to watch when choosing a case manager
When you appoint or buy in a case manager, look not only at experience with absence but at clarity of role. A good case manager:
- knows the Gatekeeper Improvement Act and watches the deadlines
- communicates clearly with employee and employer
- keeps direction without sitting in the physician's chair
- understands privacy rules and medical boundaries
- can translate advice into workable arrangements
- spots when extra expertise is needed
It is also wise to test how cooperation with the occupational health service or physician is arranged. Certainly in a labour market with a shortage of occupational physicians, good alignment matters, so that medical expertise and process direction reinforce each other rather than overlap.
A case manager is therefore not an extra administrative link but a practical director of the absence process. It is precisely by bounding that role well that employer, employee and physician gain more clarity, better cooperation and more grip on a lasting return to work.
With good case management you keep a grip on absence and help people return sooner and more carefully.
With a clearly organised absence process, you as an employer, HR professional or occupational physician keep more overview and can act faster and more carefully towards sustainable employability.
Key takeaways
- An absence case manager watches the process, the deadlines and the progress, but always leaves assessment of the medical situation to the occupational physician.
- With one fixed point of contact you make cooperation between employer, employee, HR and physician clearer and prevent misunderstandings.
- Good file-keeping and timely follow-up limit the chance of reintegration stalling and reduce risks such as a wage sanction.
- With long-term or complex absence, for instance with psychological complaints, a case manager can add a great deal through structure, alignment and direction.
- Recording roles, tasks, privacy arrangements and mutual alignment in advance lets you work more calmly and more purposefully on absence guidance.
- A preventive approach, with attention to spotting things early and to sustainable employability, reduces the chance of long-term absence.
By making clear arrangements together and bringing in the right expertise at the right moment, you create an absence process in which everyone knows where they stand. That way you work step by step towards healthy work, sustainable employability and an organisation where absence weighs less heavily on employees and managers alike.