15,000 Long-Term Sick Belgians Receiving Benefits Live Abroad
Nearly 15,000 people who receive long-term sickness benefits from the Belgian government are living outside the country, according to new data from the National Institute for Health and Disability Insurance (RIZIV). The revelation, reported by VRT NWS, comes amid an intensifying national debate over Belgium’s soaring long-term sickness numbers and the financial sustainability of its social security system.
The Numbers Behind the Story
As of the end of 2025, Belgium had 576,643 long-term sick individuals — a record high. Of these, 14,713 beneficiaries (approximately 2.6% of the total) reside abroad. The overseas cohort has grown by roughly 40% over the past five years and 58% since 2020, far outpacing the 22% overall increase in long-term sickness during the same period.
The most popular destinations are neighboring countries: France hosts 6,637 beneficiaries (45% of the total), followed by Spain with 1,880 (12.8%), and the Netherlands with 1,434 (9.7%), as The Brussels Times reports.
Why Are Beneficiaries Living Abroad?
Professor Lode Godderis, head of external prevention service IDEWE and professor of occupational medicine at KU Leuven, offered several explanations during an interview on Radio 1. The most straightforward is cross-border work: many people live in France or the Netherlands but work in Belgium. Under EU social security coordination rules, they receive benefits from the country where they last contributed — in this case, Belgium.
“Belgium is a small country, surrounded by France and the Netherlands,” Godderis explained. “So if Dutch people who live in the Netherlands and work here fall ill, they receive their benefits from Belgium.”
A second explanation involves return migration. When immigrants who worked in Belgium become unable to work, many return to their countries of origin. Godderis noted that in Limburg, for instance, many workers of Italian heritage return to Italy. Similarly, some Belgian beneficiaries may move to countries like Spain for a lower cost of living or a warmer climate.
The Oversight Challenge
Monitoring medical eligibility across borders is notoriously difficult. Under the current system, Belgian health insurance funds must rely on foreign doctors to assess whether a beneficiary remains eligible for disability payments — doctors who may not be familiar with Belgian regulations.
“The health insurance fund then has to ask a doctor in Spain, for example, whether that person is still entitled to disability benefits,” Godderis said, “while that doctor probably doesn’t know very well how things work here in Belgium and what the rules are.”
Godderis noted that teleconsultations offer new possibilities for oversight, but the system remains fundamentally challenged by cross-border cases.
A Broader Crisis in Long-Term Sickness
This revelation lands in the middle of a heated political debate about Belgium’s long-term sickness crisis. The number of long-term sick has surged from 165,000 in 1993 to 300,000 in 2011 and now to over 576,000. Just ten days before this story broke, RIZIV surveys revealed that approximately one in four long-term sick beneficiaries may be receiving benefits incorrectly or for too long, as VRT NWS reported.
Health Minister Frank Vandenbroucke has demanded explanations from the health insurance funds and proposed re-examining over 100,000 cases. The government, led by Prime Minister Bart De Wever, needs to find at least €5 billion in budget savings, making long-term sickness benefits a prime target for cuts.
Political and Regional Dimensions
The issue is further complicated by Belgium’s regional divide. Wallonia has far higher long-term sickness rates (~10% of working-age population) compared to Flanders (~7.3%), with some poor Walloon towns exceeding 15%. This has led some Flemish politicians to call for stricter controls or even an independent Flemish health insurance system.
Left-wing parties, including the PVDA, have warned against stigmatizing the sick. Sofie Merckx, a PVDA member of parliament and medical doctor, has argued that the government is treating the sick as suspects. Professor Godderis echoed this caution: “When I look at the discourse of recent weeks, it seems as if those 500,000+ people are all profiteers — I struggle with that. I’m not going to deny that there is abuse, but I think that sometimes it’s too quickly assumed that people are receiving benefits incorrectly.”
What’s Next?
The 14,713 overseas beneficiaries represent only 2.6% of all long-term sick, but their rapid growth raises important questions. Will the government propose specific measures targeting overseas beneficiaries, such as mandatory in-person re-assessments? How do other EU countries handle similar cross-border situations? And perhaps most critically, how many of these beneficiaries are genuinely eligible versus potentially fraudulent?
As Belgium grapples with its long-term sickness crisis, the overseas dimension adds a layer of complexity that will require both national policy responses and European-level coordination to address effectively.