2023-09-01 15:27:34
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New Sickness Allowance: Which diseases allow release by the INSS? Sickness aid is the benefit of the INSS for insured persons who are unable to work due to illness or accident.
As the purpose of the aid is to support people who are temporarily unable to carry out their work activities, It is important to emphasize that it is not the disease that entitles you to the benefit, but the incapacity generated by it.
However, there are diseases that, by law, exempt the insured person from fulfilling the grace period (one of the mandatory requirements for sickness benefit).
In addition, we have noticed that a specific group of diseases has been more common among workers, generating disability and, consequently, the right to social security benefits.
That’s what we’re going to talk about today. Continue reading and get your questions answered!
Report your case * By filling out this form, I agree that the personal data provided above will be used to return contact, sending information and advertising content about products, services and general matters, under the terms of the General Data Protection Law.
Requirements for applying for sick pay
The benefit for temporary incapacity – as the sickness benefit is currently called – is due to the insured person who is unable to work, due to illness or accident of any nature.
For concession, it is necessary to fulfill the following requirements:
Grace period of 12 months
Have the status of insured
Prove incapacity for work
See below for details on each of them.
Grace period of 12 months
The grace period is the minimum amount of monthly payments that the insured must have to receive a pension benefit.
So that you can better understand how the shortage count is done, let’s look at an example:
Joana had an employment relationship that began on 01/15/2018 and ended on 03/01/2018. as grace periodMaria has 3 months (since 1 day worked within the month counts as 1 full month of grace period).
In order to apply for sickness benefit, the insured person must meet at least 12 months of grace period.
quality of insured
In order to qualify as insured, the person must be affiliated with Social Security and make monthly contributions.
Signed portfolio workers are mandatory insured, as the employer has the duty to make the monthly payment of your INSS. Other insured persons must make their own contributions.
In some situations, the insured person who stops contributing manages to maintain the quality of insured, in the grace period.
Here are some of the free periods:
For mandatory insured persons, the general rule of grace period after the last contribution is 12 months;
Insured persons who are receiving sick pay or disability retirement have a grace period of up to 12 months after the end of the benefit;
For optionally insured persons, the general rule of grace period after the last contribution is 6 months.
Incapacity for work
Compulsory insured persons (with a formal contract) in urban or rural areas must prove absence from work with a medical certificate for more than 15 days.
Since the first 15 days of leave will be paid by the company and the INSS will have to pay for the aid from the 16th day.
On the other hand, individual taxpayers, optional taxpayers, independent workers and domestic employees can apply for the benefit when they become incapacitated.
Proof of disability is done through medical documents such as certificates, exams, medical records and prescriptions.
Before having the benefit granted, a medical expertise with an INSS expert, at which point the documents will be verified by the health professional.
Illnesses that do not require a grace period for sickness benefit
Now we will talk about the exceptions in which it is not required to comply with the 12-month grace period for granting sick pay.
Attention: the other requirements must be fulfilled normally.
According to Article 151 of Law 8.213/91the insured person suffering from any of the serious illnesses listed below will not need to comply with the grace period:
1. Surgical acute abdomen
2. Stroke (acute)
3. Mental alienation
4. Cancer
5. Severe heart disease
6. Blindness
7. Paget’s disease
8. Parkinson’s disease
9. Multiple Sclerosis
10. Ankylosing spondyloarthritis
11. Leprosy
12. Severe liver disease
13. HIV
14. Severe kidney disease
15. Irreversible and disabling paralysis
16. Radiation by specialized medicine
17. Tuberculosis
This right also serves policyholders who wish to claim by disability retirement.
Disability caused by an accident also waives a grace period
The grace period requirement will be waived in cases where the INSS insured has suffered an accident of any nature (including work accident) or if you have been affected by a occupational disease or from work.
It is enough to already have insured status at the time the accident or illness occurred, in addition to proof of incapacity.
Report your case * By filling out this form, I agree that the personal data provided above will be used to return contact, sending information and advertising content about products, services and general matters, under the terms of the General Data Protection Law.
Most common illnesses on sick pay
There are diseases that end up generating inability to work, whether due to physical injuries or psychological damage, which impair the performance of activities and social interaction of the individual.
Upon being diagnosed and with proof that the disease reduces the full exercise of its function, it is the right of the insured person to seek sickness benefit.
Here are some more common examples of illnesses that give rise to the right to benefit for temporary disability:
Fibromyalgia;
Disc hernia, low back pain and other pathologies that affect the spine;
Carpal tunnel syndrome;
RSI (Repetitive Motion Injuries) and Work-Related Musculoskeletal Disorders (DORT);
Depression;
Burnout syndrome;
Panic disorder, among others.
When sickness benefit can be converted into disability retirement
Disability retirement (or benefit for permanent disability) is the form of retirement granted when the insured person’s health condition is serious and he is permanently unable to work.
Initially, the INSS may not accept the direct request for disability retirement, considering that the worker’s disability is momentary.
Therefore, the most appropriate thing is to seek the granting of sickness aid and check whether the disability persists or not.
here we see the importance of medical care and to always have up-to-date reports, as they are the ones that will attest to the continuity or not of the disability caused by the disease.
Over time, if the INSS expertise indicates that the health condition has not improved, then the insured person will be able to access disability retirement.
Malignant neoplasm entitles to conversion of disability retirement benefit
Here at the office, we are dealing with the case of a 64-year-old man with malignant neoplasm of the lung, a condition that completely and definitively disables him for the exercise of any work activity.
In this specific situation, all mandatory requirements were met and we achieved the conversion of your sickness benefit to disability retirement.
In the decision, the judge determined that:
“The INSS implements, in favor of the plaintiff, the disability retirement benefit, and makes the payment of the installments due since the date of the administrative request (11/04/2019), discounting the amounts eventually paid as sickness allowance in the administrative means from that date”.
Process No. 1014770-88.2020.4.01.3500.
Sickness aid denied
Refusal of sick pay is quite common and can happen for several reasons, such as lack of insured status, incomplete documentation e grace period less than necessary.
However, issues related to the INSS itself also influence the negative.
The lack of action by medical specialists in all areas of medicine in the body’s expertise can result in negative reports. The physician may not recognize the illness or injury and assume the insured person is fit for work.
In situations where sickness benefit is denied, there are two options available to the insured person:
File an appeal with the INSS
The administrative appeal must be filed within 30 days after the body’s denial, through MY INSS and has no procedural costs.
Then, the request is forwarded to the Board of Appeals of the Social Security Council.
The insured must clearly present the errors in the process, therefore, a correct reasoning will make all the difference. If the administrative appeal is not certain, it is possible to seek the judicial route.
File a lawsuit
A lawyer specializing in social security law can take prior measures to protect the right of the insured person, such as carrying out a more complete survey of documents, carrying out a thorough review of the rejection, among others.
Furthermore, seeking quality legal advice can avoid unnecessary wear and tear and costs, as it is not enough to just file a lawsuit.
The right professional will propose solutions that best suit your interests.
Conclusion
Today we explain more details about the well-known sickness benefit, which is actually a benefit motivated by the incapacity of the insured person, and not by the disease itself.
It is essential to understand this point, as we see many people seeking help with the wrong justification, which causes rejection of requests and more dissatisfaction.
Now you know how each mandatory requirement for granting the aid works, and in which situations the insured person may have the grace period waived.
Partner: Marques Sousa & Amorim – Law Firm
#diseases #release #INSS