Social Security

Acquisition of a right to benefits

• In case of common disease or non-work-related injury, from the fourth day the worker is on sick leave from work.

• In case of work-related injury or occupational disease, from the day after the worker is on leave from work. The employer has to pay the full salary for the day the worker commenced sick leave.

• The right to a subsidy can not begin during a situation of strike or lockout.

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Duration / Extensions / Relapses

The benefit shall be paid while the beneficiary is in a situation of Temporary Disability (TD) and shall last for:

• In the event of an injury or disease, irrespective of the cause, 365 days extendable by a further 180 days when it is assumed that, during this time, the worker may be discharged from medical care due to their recovery.

• In the event of observation periods due to an occupational disease, 6 months extendable by a further 6 when deemed necessary for the research and diagnosis of the disease.

When calculating the maximum duration and possible extension periods, relapse and observation periods will be included.

Express extension:

• After the 365 days are up, the INSS (or the ISM) through the bodies responsible for evaluating, classifying and reviewing permanent disability of workers, will be the only body with the authority to grant theexpress extension up to a maximum of 180 additional days, as long as it is assumed that the worker may be discharged from medical care due to their recovery.

When the cover for TD arising from occupational contingencies has been agreed with a Mutual Society for WRI and OD of the Social Security, this Mutual Society will submit the proposal for an extension to the INSS (or the ISM), and said proposal shall be understood as being accepted by the managing body if they do not state their objection within 5 days after it is received.

• The decision of the provincial director of the Managing Body granting the extension for TD shall be a compulsory requirement in order to continue receiving the financial benefit, except in the situation described in the previous paragraph.

• During this situation, the benefit shall be paid through direct payment by the responsible Managing Body or Collaborating Body, as of the first day of the month after the date of the decision of the INSS (or ISM) through which the express extension was granted.

If the worker was receiving contributory unemployment benefits when the TD started, the SPEE will only continue paying the TD benefit, through delegated payment, when the Managing Body grants the express extension, up to a maximum limit of the duration of unemployment benefit. 

• The obligation to make contributions remains throughout the extension.

Extension of Conditions:

• When the TD situation ends due to the maximum period of 545 days elapsing, the condition of the disabled individual must be examined within a maximum period of 3 months in order to determine their degree of permanent disability.

Nevertheless, in those cases where the need for medical treatment persists due to the expected recovery or improvement in the worker's condition, with a view to their returning to work, the medical condition of the interested party that made it advisable to delay the classification may be delayed for the required period. Under no circumstances can this period go beyond the 730 days following the date on which the TD began.

The obligation to pay contributions will not continue during these periods.

• If the termination has occurred due to the elapsing of the maximum time period or due to medical discharge with a declaration of permanent disability, the effects of the TD situation will be extended until the permanent disability classification is carried out (this classification is considered to have been carried out on the date of the decision of the Managing Body's Provincial Director). This will be the date on which the financial benefits for this situation begin, except when these benefits exceed those that the worker is already receiving, in which case they are backdated to the time when the TD expired.

• In the event of medical discharge before the maximum period of duration comes to an end, without a subsequent declaration of permanent disability, the requirement to make contributions will remain for as long as the employment relationship continues or until the maximum period of duration expires, if this occurs after said declaration of no permanent disability.

Relapses:

• When there has not been a period of working activity of over 180 days between two TD processes and it is the same disease or pathology, it is considered to be a relapse.

• If there has been a period of working activity of over 180 days or it is a different disease, it is considered to be a new TD process.

• When the entitlement to the TD has finished due to the maximum period elapsing and having been granted medical discharge, workers without a declaration of permanent disability will only be able to create a new TD process for an identical or similar disease:
  
  
  • If it spans a period of working activity of over 180 days or
  • If, spanning a period of under 180 days, the INSS (or ISM ),  through the competent bodies for assessing, classifying and reviewing the worker's permanent disability, issues the sick leave certificates for the sole purposes of the TD financial benefit.

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Loss or suspension of the right to a benefit

Rights to benefits may be denied, annulled or suspended, due to:

• The beneficiary committing a fraudulent act in order to obtain or keep a subsidy.
• Working, either as a worker employed by another person or self-employed.
• Refusing or abandoning treatment without reasonable cause.

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Extinction of the right to benefits

• Due to having used up the maximum period established for that particular temporary disability situation.


• Due to release from medical care, with or without declaring the worker as permanently disabled.


• Due to being entitled to receiving a retirement pension.


• Due to the beneficiary failing to appear at any of the official examination appointments established by the medical practitioners who are members of the National Social Security Institute, or the Social Insurance for Industrial Accidents and Occupational Diseases of the Social Security.


• By death.

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