Commencement of the entitlement / Duration /Extension/ Loss or suspension/ Termination

The benefit will be paid during the time the beneficiary is considered temporarily disabled (TD) and this will last for:

• In the event of accident or illness, whatever the cause, 365 days extendable for a further 180 days when it is presumed that, during this period, the worker may be medically discharged on recovery. However, in the special situation of Temporary Disability from the 39^th week of pregnancy, the benefit will be paid until the date of delivery, unless the worker had previously begun a situation of risk during pregnancy, in which case she will continue to receive the benefit corresponding to this situation as long as it is maintained.

• In the event of observation periods required for occupational disease, 180 days extendible for a further 180 when this is deemed necessary to assess and diagnose the disease.

For the purposes of the maximum period of duration and its possible extension, relapse and observation periods will be counted, except for medical leave due to secondary incapacitating menstruation, in which each process will be considered a new one without being counted for the purposes of the maximum period of duration of the Temporary Disability situation, and its possible extension.

This right may be denied, cancelled or suspended due to:

• Fraudulent conduct on the part of the beneficiary to obtain or conserve the benefit.
• Salaried or self-employed.
• Rejection or abandonment of the treatment for no reasonable cause.
• The beneficiary failing to attend a summons from the doctors attached to the National Social Security Institute and the Mutual Societies Partnering with Social Security for an examination and medical check-up will lead to the right being provisionally suspended pending verification of whether this was justified. The procedure for suspending the right and its effects will be determined by the regulations.

1. Entitlement to benefit will cease:

   • On expiry of the maximum 545-day period from the date sick leave commences.
   • Medical discharge due to recovery or improvement that allows the worker to carry out their usual work.
   • For the worker being discharged, with or without a declaration of permanent disability.
   • When a retirement pension is granted.
   • 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 Security Mutual Society Partner.
   • Due to death.
   • In the case of the thirty-ninth week of pregnancy, it shall be until the date of delivery.

   When calculating benefit duration, relapses will be considered part of the initial process. A relapse will be considered to be part of an initial process when sick leave is granted for the same or similar pathology within 180 calendar days of the previous medical discharge date. In the case of secondary disabling menstruation, each process shall be considered as a new one and shall not be considered as a relapse of a previous one.

   
   If a permanent disability case is initiated before the five hundred and forty-five calendar days of temporary disability benefit have elapsed and entitlement to permanent disability benefit is denied, the National Social Security Institute, through its medical inspectorate, shall have sole authority to issue, within 180 calendar days of the denial, a new sick leave for the same or a similar pathology. In such cases, the temporary disability process will be resumed, until a maximum of 545 days have expired.

2. When the benefit entitlement expires once the 545 calendar days set in the previous section have elapsed, the worker must be examined within a maximum of 3 months in order to appraise their state of disability and assign the relevant degree of permanent disability.

   Nevertheless, in those cases in which medical treatment is still required in view of a possible recovery or improvement in the state of the worker and their subsequent return to work, if the worker's clinical situation makes it advisable to postpone that classification, it may be postponed for the necessary period, but the period of TD leave and the extension may not, under any circumstances, exceed 730 calendar days.

   During the periods provided for in this section, of 3 months and the delay in classification, there will be no obligation to pay Social Security contributions.

3. Once the right to TD benefit has concluded due to expiry of the 545 calendar day period, with or without permanent disability having been declared, the worker will only be entitled to apply for further TD financial benefit for the same or a similar pathology once a period exceeding 180 calendar days has elapsed since the permanent disability ruling.

   This new entitlement will be granted, provided that on the date sick leave is again granted, the worker fulfils all the requirements to receive the TD benefit resulting from a common disease or injury, work-related or otherwise. For these purposes, the contribution period to qualify for TD benefit due to common disease will only include the contributions made after the permanent disability resolution.

   However, when considering the same or a similar pathology and 180 calendar days have not elapsed since permanent disability was denied, a new TD process may commence, once only, when the INSS considers, through the corresponding bodies authorised to appraise, grade and review the worker's permanent disability status, that they may recover and become capable of working. For this, the INSS will authorise sick leave for the sole purpose of the TD benefit.

4. The medical discharge with a proposal for permanent disability, regardless of when it is issued, will terminate the situation of temporary disability.

5. When the temporary disability is terminated by medical discharge with a proposal for permanent disability, or by the expiry of the 545 calendar days, the worker will be in the situation of prolongation of the economic effects of the temporary disability until notification of the decision classifying the permanent disability.

   In the cases referred to in the previous paragraph, when the permanent disability benefit is recognised, its effects shall coincide with the date on which the decision recognising said benefit is issued by the managing body, unless it is higher than that which the worker was receiving as a prolongation of the effects of the temporary disability, in which case those effects shall be retroactive to the day following the date on which the temporary disability expires.

   If the TD ends prior to conclusion of the 545-calendar-day period and the worker is not subsequently declared as having a permanent disability, social security contributions shall have to be paid until the employment relationship is terminated or until the aforementioned 545-calendar-day period expires, if this were to take place after the declaration stating there to be no permanent disability.