1970-01-01 00:00:00
The INSS (National Social Security Institute) will once again require first-person advice for requests for sickness benefit for certain types of illnesses and for two categories of insured persons.
The change comes after the Government identified a significant increase in applications and grants for these groups through Atestmed, an online system which removes the need for in-person expertise.
“We start to see behavior that deserves attention. It’s like a yellow light,” he says. Sheet the president of INSS, Alessandro Stefanutto.
According to him, insured people who need help due to diseases of the musculoskeletal system and connective tissue (such as back pain and joint injuries) will automatically be subjected to an in-person examination.
Even the unemployed who are still in the so-called grace period (in which the right to benefits remains even without contributing to the INSS) or the optionally insured, who contribute of their own free will, will have to undergo a medical examination before having aid granted .
Stefanutto denies that the decision is a tacit acknowledgment by the public administration that Atestmed did not work. The system is one of the government’s main bets to save resources in Social Security, whose tendency to increase spending is a central concern for the economic team.
According to him, in an era when the waiting list for in-person exams lasted months and generated high retroactive payments (the amount is calculated from the date of the initial request), the adoption of the system was a “risk calculated”.
“In that state of war, Atestmed is like ‘opening the doors because it’s cheaper.’ When you start to get things right and you see an improvement in skills in terms of number of days, an improvement in concessions, more data, we have l ‘obligation to improve the system, both to grant better, and to spend what is necessary, not to spend more,’ he says.
Claims will continue to be accepted by Atestmed, but there will be changes to the system to direct these policyholders to in-person scheduling. There is no need for standards, says the president, just operational changes.
The idea is for the measure to be implemented this October, but the final details are still under discussion. One possibility is that only certain musculoskeletal diseases are tested in person, focusing on those with atypical behavior, as appears to be the case with dorsalgia (back pain).
Data sent by the MPS (Ministry of Social Security). Sheet show that back pain was the main condition for the granting of sickness benefits between October 2023 and September 2024. 185.8 thousand requests were accepted for this disease, representing 62% of the requests submitted in the period.
Data for 2023 also showed an increase in subsidies for disability benefits for the entire musculoskeletal disease group.
From an investigation carried out by researcher Rogério Nagamine, former secretary of the RGPS (General Social Security Scheme), based on information from the MPS, it appears that the INSS granted 452.5 thousand disability benefits in 2023 for cases in which the CID code (international classification of diseases) was related to this category. The number is 43.5% higher than that observed in 2022.
A growth higher than the general rate of expansion of the benefit, which last year recorded 2.2 million applications accepted, with an increase of 26.6% compared to 2022.
Only back pain had an even more significant increase, equal to 50.8% over the period. The benefits went from 66.1 thousand in 2022 to 99.7 thousand benefits last year. The monthly average, which was around 5,000 thousand approvals, reached 12 thousand in December 2023.
The Government’s perception is that there is a growing increase in sickness benefit claims due to back pain. When taking this case to forensics in person, the idea is to check whether this behavior was caused by the introduction of document analysis via Atestmed. The expectation is to be able to draw the first conclusions within 12 months of the change.
From a first analysis carried out by the INSS in April it also emerged that the duration of the benefit for the CID for musculoskeletal diseases was 93.4 days for the benefits through Atestmed, higher than the 82.77 days observed from the visits of person. In other words, the insured ends up receiving payments from the government for longer. In most other codes the situation was the opposite.
In that state of war, Atestmed is like ‘opening the gate because it’s cheaper’. As we begin to resolve this issue and see improvements in skills in terms of number of days, improvements in concessions, more data, we will have an obligation to improve the system.
Stefanutto underlines that the behavior of the benefits for the unemployed and the optionally insured has also begun to deviate from what has historically been observed in in-person evaluations. Therefore, they will also be redirected to forensics.
“Insured unemployed and voluntary taxpayers, it is not a prejudice, but the circumstance itself can lead to greater abuse of the instrument. [Está] With an income, it’s natural. We must take this concrete world and carry it [para as decisões do órgão]”, we read.
Other categories of insured, such as workers with formal contracts, will continue to have their benefits analyzed through Atestmed, as long as the disease is not among those that will require an in-person examination. According to Stefanutto, there was no significant difference in benefit behavior in these groups.
He also underlines that the partial restoration of the obligation for in-person assessments is only possible because the average waiting time has fallen to less than a month: the period could be longer in some regions, such as the North-East, but the measure will be applied to all of Brazil.
On the other hand, it is not possible to restore in-person skills for all groups, as this would recreate the bottleneck that contributed to queues in the past.
“I cannot make all insured people return to the exam because a specific group might abuse the right to use the tool. I need to remove this group, improve their behavior until we arrive at a more perfect tool. These improvements will be more constant” , he says.
The president of the INSS also underlines that not all those who take the exam in person will have their request rejected. “We imagine a larger number will be denied, but will still retain a grant,” he says.
Stefanutto estimates that the increase in disability benefits was the price paid to open access to sickness benefit through Atestmed, but claims that the measure also allowed more detailed data to be acquired from the certificates, many of which have not yet been cataloged in digital media format.
“Of course there must have been concessions, one or the other, that may not have been granted, but now there is data that puts us on the path to improving the situation,” he says.
For researcher Rogério Nagamine, the adjustments are positive, if they happen, but “they are also the recognition that the measure has generated an increase in expenses”. According to him, spending on sick pay increased by 21% in 2023 compared to the previous year.
“Contrary to the official discourse that Atesmed would generate savings, this management measure created a certain lack of control in the evolution of the sickness benefit capital, which grew by around 80% between September 2023 and July 2024. Of course , it is essential to reduce the queue, but this must be done responsibly, without granting benefits to those who are not entitled to them or increasing the space for fraud”, warns the expert.
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