Excess work incapacity during and after the COVID-19 pandemic in Poland: evidence from population-level social insurance data

Abstract

Background: COVID-19 disrupted occupational health and social protection systems; but, evidence on its medium- and long-term effects on work incapacity remains limited. Objective: To quantify excess temporary and permanent work incapacity in Poland during and after the COVID-19 pandemic using population-level social insurance data. Methods: This observational study used quarterly Social Insurance Institution administrative data (2015–2024) on rehabilitation benefits and disability pensions, by sex and ICD-10 chapter. Expected pre-pandemic trends (2015–2019) were modelled using log-linear regression. Excess incapacity for 2020–2024 was identified by comparing expected to observed incapacity rates. Results: Temporary work incapacity increased substantially and remained elevated, resulting in 104,392 more rehabilitation benefits than expected, mostly after the acute pandemic phase. The largest increases occurred for mental disorders (over-80% above expected levels by late 2024) and musculoskeletal diseases, particularly among men (over-30% in some periods). In contrast, permanent work incapacity declined below expected levels, with 49,281 fewer disability pensions awarded, predominantly among men. The largest reductions were observed for circulatory diseases (up to 27% below expected levels) and neoplasms (19%), while musculoskeletal conditions were the only group with excess permanent incapacity, primarily affecting women. Conclusions: Our findings reveal a divergence between excess temporary work incapacity and reduced permanent disability, likely reflecting the combined effects of health system disruption, delays in benefit adjudication, and pandemic-related mortality displacement. These results have implications for social insurance and rehabilitation policies, underscoring the need to strengthen mental health care, return-to-work pathways and monitoring of disability adjudication.