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Management/ Payment

Who must pay TD in the event of a relapse, if the insurance company at this time is different to the one that covered the initial accident?

  • For common diseases and non-work-related injuries:

    The body offering coverage for the TD when the relapse occurs will also pay the allowance, calculating the benefit in line with contribution bases at the time of the relapse,  irrespective of who was covered in the first process.

  • In the event of a WRI  or OD:

    • If the WRI base pension is equal to or greater than the relapse base pension: the first insurance company will pay the relapse taking the relapse base pension as the base pension. The second insurance company will be exempt from making payments.

    • If the WRI base pension is lesser than the relapse base pension: the first insurance company will pay the amount according to the base insured in the first WRI and the second company will pay the difference between the first base pension and the relapse base pension.            

This criterion will not be affected, even if more than 180 days elapse without the beneficiary working, as the process is not a cumulative as regards the maximum length of the TD. 

If the worker is unemployed when the relapse occurs and there was no sick leave at this time, the first insurance company will be responsible for the TD according to the base pension of the first process or the injury-related salaries. However, the limitations set out in Art. 222 of the LGSS will apply to the payment.

What documents must be submitted in order to process Temporary Disability for Self-Employed Workers?

At the body where the risk is agreed, the INSSor Mutual, where appropriate, a direct payment request for the temporary disability benefit, sick leave, documentation showing that you are up to date with the payment of Social Security contributions, as well as an activity declaration must be submitted.

How long does a self-employed worker have to submit the activity situation declaration? What are the consequences of not presenting the declaration?

Self-employed workers have to present a declaration on the person that directly manages the commercial, industrial or other type of establishment or, where appropriate, the temporary or final termination of the activity at the INSS within a period of 15 days from the start of the TDsituation, so that the Administration can verify the situation of the recipient's establishment during the TD situation.       
   
However, sanction procedures will only be initiated if the presentation of the declaration occurs 45 days after sick leave.    
       
Non-presentation of the declaration or an untimely declaration will be considered a minor infringement and penalised with loss of the benefit for one month.

It is an obligatory document, as a result of which it will be possible to continue with the process even if the declaration is not available. If the worker meets all the requirements, the process will be approved but the benefit will not be paid, and the suspension of the payment will be maintained until the declaration is presented.

How, and within what periods, are the medical certificates for leave, confirmation of leave, and discharge processed through the ON-LINE Automatic Data Transfer system?

There is a specific telephone support number for users of the RED  System: 901 50 20 50. 

Medical certificate: the worker must give the company its copy within 3 days from the date on which the sick leave report was issued. The company must immediately send the medical sick leave report to the INSS through the RED system, and in all cases within a maximum period of three working days from its receipt.

Confirmation report: the same deadlines as the medical sick leave report.
 
Medical discharge report: it must be submitted to the company by the worker within 24 hours of its being issued. The company will have the same periods specified.

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