What do you need to apply for Sickness Benefit?

We're always looking to provide tips and knowledge on a wide range of topics. Today, we'll explain what you need to apply for sickness benefits.

What is Sick Pay?

First, let's explain what sickness benefit is. Also known as "Temporary Disability Benefit," this benefit is offered to citizens who, due to illness or accident, need to be temporarily away from their work for more than 15 days, whether consecutive or interspersed within a 60-day period, for the same illness.

This assistance, which is granted by Social Security, is a benefit from the National Social Security Institute (INSS) and aims to offer an alternative source of income for workers who are unable to carry out their work activities.

Who can apply for Sickness Benefit?

As it is a benefit offered by the INSS, the applicant must meet certain requirements, which are:

Have a temporary disability

This is the primary requirement. To be eligible for assistance, the worker must have some type of illness or have suffered an accident that prevents them from performing their normal activities for more than 15 days.

Insured status

Another very important – and indispensable – requirement to be able to apply for the benefit is that you are insured and are affiliated with the INSS.

Those who are considered to be insured by the INSS are those who are Employee, Casual Worker, Domestic Employee, Individual Contributor, Special and Optional Insured.

Meet the minimum monthly contribution requirement

This is the minimum requirement and refers to the minimum period of contribution to the INSS (National Institute of Social Security). To be eligible for the benefit, the worker must have contributed regularly for the last 12 months.

The INSS medical examination will also assess the exemption from this waiting period for occupational diseases, work-related accidents, and accidents of any nature or cause.

What do you need to apply for Sickness Benefit?

In addition to meeting the requirements listed in the previous topic, you must present a list of documents when applying for your benefit. The list is as follows:

Photo ID. It's important that the information is legible. This will make it easier to confirm your identity;
CPF number;
Work card, contribution slips and other documents proving payment to the INSS;
Medical documents related to your treatment. This includes medical certificates, laboratory tests, reports, prescriptions, medical certificates, etc. These documents will be analyzed on the day of the medical examination to release the benefit.
Declaration signed by the employer, stating the date of the last day worked.

How to apply for Sickness Benefit?

To receive benefits, the insured must undergo an assessment directly at the INSS. Appointments can be made by phone, by dialing 135, or online, by accessing My INSS Portal. Below, we show you the step-by-step process to access the platform:

Benefit request

In this first step, the applicant can access the portal. In addition to the website, the service can also be accessed through the Meu INSS app, available for Android and iOS.

The user must log in to the platform and select "Schedule your Expertise" from the left-hand side menu. If this is the first request, simply click "Schedule New." For requests to extend the benefit, click "Schedule Extension."

Then, the next step is to log in to the platform and choose one of the available options:

Initial assessment: if this is the first request and the worker is not yet receiving the benefit.
Extension assessment: this option is for when the citizen already receives the benefit and wishes to extend the period of receipt because they are still unable to resume their activities.
Reschedule assessment: this option is for users who have already scheduled the assessment, but were unable to attend on the scheduled date and location.

After completing this procedure, the applicant can monitor the progress of their application directly through Meu INSS, accessing the “Application Result/Disability Benefit” option.

Attend the examination

After registering and scheduling the previous step, the next step is to attend the Medical Examination. The worker will be referred to one of the INSS units for the examination.

On the day of the INSS assessment, the worker must bring their personal documents with a photo, CPF number, medical certificate, and the exams proving their disability. In specific cases, this medical assessment may be performed at the applicant's home.

After the exam is completed, the worker can monitor the progress of the request and the expert result directly through Meu INSS, using the “Request Result/Disability Benefit” option.

For those who aren't as tech-savvy, you can contact the INSS directly by calling 135. This number is a direct INSS service channel and the service is available Monday through Saturday, from 7 a.m. to 10 p.m.

What to do when Sick Pay is denied?

Unfortunately, due to a number of factors, there are thousands of requests for sickness benefit that are denied every day. When the benefit request is denied, the worker can proceed in two ways. They are:

Among the options available to those who have had their request denied, the two main ones are:

Administrative appeal at INSS

With this option, the worker must be careful about the deadline, as the administrative appeal must be filed within 30 days of the INSS's denial. This option is available through Meu INSS.

The request is forwarded to the Social Security Council's Appeals Board, and the worker's next step is to clearly explain the errors in the process. At this point, sound reasoning makes all the difference.

Filing a lawsuit

Now, if the administrative appeal is unsuccessful, it is also possible to seek legal action.

In this case, the ideal is to seek the assistance of a lawyer specialized in social security law.

After a thorough review of the case, he will be able to take the necessary steps to resolve the worker's case in the best possible way.

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