Cosmetic Surgery: Entitled to Sick Leave or Subject to the Deductible?
An employee wants to undergo gastric bypass surgery and calls in sick. The employer wonders: Does this count as legitimate sick leave, or should the employee use vacation days or take unpaid leave for this? These types of questions come up regularly for HR and managers, especially regarding procedures that also have a cosmetic nature, such as breast reduction or eyelid surgery.
You can always report sick; the decision rests with the company doctor
An employee may always report sick if he or she feels unable to work. The reason does not have to be shared with the employer. Only the company physician determines whether the employee is actually unable to work and whether he or she is entitled to continued pay.
A supervisor is therefore not permitted to decide on their own whether the procedure “counts or does not count” as a reason for sick leave. That determination is reserved exclusively for the company physician.
Medical Indication: Entitlement to Continued Pay
Certain cosmetic procedures may be medically indicated. For example, gastric bypass surgery due to severe obesity or breast reduction surgery for chronic back and shoulder pain. If the treating physician and the company physician substantiate this, the absence is medically justifiable. The employee is then entitled to continued pay during sick leave.
A case before the Rotterdam District Court involved an educational support staff member who, suffering from back and neck pain, underwent breast reduction surgery abroad. The employer stopped paying her wages, arguing that the procedure was not medically necessary and that the condition had therefore been intentionally caused. The judge disagreed. The medical records and the company doctor’s opinion clearly showed that the symptoms had persisted for years and that the procedure was a legitimate medical intervention. The employee was ultimately paid her full wages.
No medical indication: in that case, at your own expense
If an employee undergoes cosmetic surgery without a medical necessity—such as a facelift or liposuction—this does not constitute an illness as defined by law. In that case, the employee must take vacation time or opt for unpaid leave. This must be agreed upon in advance to avoid misunderstandings.
What if complications arise?
Complications following cosmetic surgery may result in legitimate sick leave. For example, if someone develops a fever or contracts a wound infection after the procedure, making it impossible to work. In such cases as well, the company doctor’s assessment is decisive.
If in doubt: consult the company physician
Managers or HR professionals would be wise to contact the company physician immediately if they have any doubts. The physician can assess whether there is a medical indication or complication, and whether continued pay is warranted.
Conclusion
Cosmetic surgery is not always a private matter without implications under labor law. If the procedure is medically necessary, the employee may still be entitled to continued pay during sick leave. However, if there is no medical necessity, the employee is responsible for any resulting absences.
So make sure you have clear agreements in place, and if in doubt, always consult the company doctor. This will help you avoid disputes over continued pay and prevent you, as an employer, from unjustifiably withholding wages. As the ruling by the Rotterdam District Court shows, doing so can actually work significantly against you.
This blog was written by Stijn Blom, Esq., an employment law attorney at Arbeidsadvocaat.nl B.V. Stijn has extensive experience in employment law and assists employers and employees on a daily basis with a wide range of employment law issues. From dismissal cases to drafting watertight contracts and policies—with his practical and personalized approach, he helps employers and employees move forward. Want to learn more? Visit Stijn’s page.
Arbeidsadvocaat.nl is happy to assist you if you have any questions about employment contracts. Please feel free to contact us .
April 2025