Sickness benefit: INSS reviews 200,000 people released without expertise

THE sickness benefit is a benefit offered to workers unable to return to the workplace for more than 15 consecutive days.

Workers must also be insured and contribute for at least 12 months.

And due to the Coronavirus (COVID-19) pandemic, several policyholders were affected due to the impossibility of carrying out the assessment in person.

As a result, it was decided that some benefits would be released without the expertise.

However, many people had doubts about how the benefit works this year, something that will be addressed as you read on:

Summary with subtitles

• INSS reviews 200,000 sickness benefits issued without expertise; 
• Who is entitled to sickness benefit? 
• Types of sickness benefit;
• How do I check the progress of the review? 
• How does sickness benefit work in 2021? 
• Conclusion. 

INSS reviews 200,000 sickness benefits issued without expert assessment

Approximately 200,000 sickness benefits are undergoing a review by the National Social Security Institute (INSS).

It's interesting to know that benefits were released without any type of expertise in 2020, when Social Security agencies were closed to prevent Covid-19 contamination. 

Due to the worsening of the pandemic and also the need for social distancing, the Institute decided that beneficiaries would receive an advance payment in the amount of one minimum wage (R$ $1,045).

Later that year, it was determined that those who were entitled to a higher amount would later receive the difference, if their inability to return to work was proven.

In this sense, 3 million advance requests were made in our country, however, only 1 million of the requests were accepted.

And currently, 200,000 are under analysis.

Therefore, please understand that the Institute has not set a deadline for completing the review.

And to check the progress of the review of the sickness benefit, you just need to access the Meu INSS app (application IOS or Android, as well as website).

I didn't get a response, how do I receive the difference in value?

The Institute does not make it clear how the insured can receive payment.

Despite this, some experts say that you can request it in the “schedules/requests” section of the app.

Then, simply click on “updates for benefit maintenance and other services”, followed by “request for payment of benefit not received”.

According to lawyer Rômulo Saraiva, it is also possible to state that through the benefit concession letter sent by the Institute, you can know the exact value of your sickness benefit.

Therefore, the difference between R$$1,045 that was advanced and the total value of your benefit must be contested.

If the request is not granted, you can file administrative appeals in the first and second instances on Meu INSS itself.  

According to lawyer Joseane Zanardi, coordinator of the Brazilian Institute of Social Security Law (IBDP), if you do not receive the difference, you can take legal action.

Therefore, a free option where it is not necessary to have a lawyer to start the process would be the Small Claims Court.

Therefore, you simply need to visit the forum in person, bringing your personal documents such as your ID and CPF, as well as your proof of residence.

However, the option is only available for shares with values lower than 60 minimum wages, corresponding to R$$66 thousand.

Who is entitled to sickness benefit?

In general, it is necessary to meet the main requirements in order to request assistance, such as:

First of all, it is necessary fulfill the requirement of 12 monthly contributions.

However, at the time of the medical examination, you may be granted exemption from the waiting period if you have one of the following diseases listed in the Interministerial Ordinance MPAS/MS No. 2998/2001:

• Hansen's disease;
• Active tuberculosis;
• Malignant neoplasm (cancer) – as it affects the body’s cells;
• Mental alienation;
• Irreversible and disabling paralysis – diseases that impair your motor coordination, which may include tetraplegia, paraplegia, triplegia, among others;
• Blindness or monocular vision;
• Parkinson's disease – considering that it is a degenerative disease and affects the nervous system;
• Severe heart disease – chronic diseases that affect the heart and worsen with any physical exertion;
• Severe nephropathy;
• Ankylosing spondyloarthrosis that affects the spine;
• Acquired Immunodeficiency Syndrome — AIDS;
• Advanced stage of Paget's disease (osteitis deformans);
• Severe liver disease affecting the liver;
• Radiation contamination based on the conclusion of specialized medicine.

Individuals with occupational illnesses, who have had an accident at work or who have suffered accidents of any nature or cause are also exempt.

Here, we can include diseases that were caused by exposure to agents that are harmful to health (chemical, physical and biological), causing functional disturbance, which in turn leads to death, loss, or permanent or temporary reduction in the ability to work.  

Other requirements

Secondly, it is necessary have the quality of insured.

In other words, you must be a citizen affiliated with the INSS who is registered with Social Security, as well as making payments each month.

It works as a kind of social insurance.

For people who have lost their insured status, it is necessary to complete half of the 12-month waiting period from the date of re-membership. Social Security – Law No. 13,846/2019.

On the other hand, you have the right to sickness benefit anyone who proves in a medical examination that they have suffered an accident or have a certain illness that makes them temporarily unable to carry out their work.

And for an employee in a given company, it is necessary to be away from work for more than 15 consecutive or intermittent days within a period of 60 days if due to the same illness.

Types of sickness benefit

According to the needs of each insured person, two types of assistance were developed: social security or accident assistance, which we will learn about below:

Social security sickness benefit

This type of benefit is given to a person due to illness after being away from work for a period longer than 15 days.

Therefore, the reason may be an injury or illness that is not related to the activity performed at work.

The following requirements must be met in order to receive social security sickness benefit:

• Prove your incapacity.
• Minimum requirement of 12 monthly contributions;

There is also a list of illnesses that justify the payment of the benefit, such as:

• Mental disorders such as schizophrenia, depression, and similar illnesses that require professional monitoring;
• Multiple Sclerosis – as it is inflammatory and chronic at the same time;
• Blindness;
• Severe nephropathies that affect the kidneys and cause disability;

Therefore, a person who has a certain illness that was not mentioned in the list must contact the Institute in order to prove their incapacity.

Please note that the benefit will be available for a certain period of time, until you recover.

Otherwise, it is necessary to request an extension of the benefit and it will be converted into a disability pension.

Another option would be to request an extension of the aid.

Accident sickness benefit 

On the other hand, we have the benefit aimed at those who have suffered an accident or occupational illness.

This means that the person suffers from such a disease due to the activity carried out in the professional field.

Therefore, the insured person receives assistance when he or she becomes unable to work for a period of time.

Additionally, the following requirements must be met:

• 12-month grace period;
• Being temporarily unable to work;
• Insured status (affiliated with INSS, registered with Social Security and monthly contributor);
• Prove the health condition that prevents you from returning to work.

As the main difference in the type of sickness benefit social security, know that the accident insurance guarantees you stability when you return to work.

This is a right provided for by, provided for by Law No. 8,213/91, in its art. 118.

In general, the law provides for the maintenance of the employment contract for at least 12 months after the aid is granted.

When accessing this link, you can understand more about the difference between the types of aid.

Questions about the benefit

Initially, it is interesting to clarify details about the benefit value.

In general, the insured receives a monthly income of 91% of the benefit salary, which is equal to the simple arithmetic average of the highest contribution salaries corresponding to 80% of the contribution period (base calculation period – PBC).

On the other hand, it is also worth noting that it is not possible to accumulate sickness benefit with another retirement, such as maternity pay.

Therefore, it is possible for a Brazilian to have only one benefit.

How do I check the progress of the review?

You need to access the INSS app and in the applications section, click on “sickness benefit review with medical document”.

After clicking on this task, you will be able to check the status.

How does sickness benefit work in 2021?

This is a benefit available to people who suffer from some type of illness or have suffered an accident that makes it impossible for them to carry out their work.

If the request is made for health reasons, it is important to have medical documentation proving the illness on hand.

Thus, Social Security grants the benefit as a social security or accident benefit.

In general, the most common thing is for the individual to receive the sickness benefit due to accidents at work or when they contract an illness that requires isolation, requiring absence for more than 15 days.

And what are the rules for the year 2021?

Due to the pandemic caused by the Coronavirus, on March 31, the Institute published some rules for requesting the benefit without needing to undergo an in-person medical examination, being valid only for simple cases.

It is also a valid measure for those who have the procedure scheduled for a period longer than 60 days.

In fact, we must include those who were unable to schedule an appointment due to the closure of agencies.

As a result, you will only need to submit medical reports through the digital environment.

The certificate must contain the following items:

The estimated date of onset of disease symptoms, signature and identification of the professional, with CRM or RMS registration, the CID, legible writing and without erasures.

It is also important to include the ideal time for rest.

In this sense, it is necessary to present the documentation through the INSS Digital portal

Here, you can understand more details.

Original documents and forms required to apply for the sickness benefit

• CPF number;
• Identification document with a photo that allows your recognition;
• Contribution slips, work card or any other document proving payment to the INSS;
• Report an accident at work (CAT), if applicable; 
• Medical documents proving treatment of the disease, such as exams, certificates, and reports, although not mandatory;
• Declaration signed by the employer and indicating the date of the employee's last day of work (must be printed);

Finally, be aware that in the case of a special insured person, that is, a fisherman, farmer or rural worker, it is important to present documents that prove the situation.

An example of a document would be a lease agreement, indicating that a certain landowner has transferred his rural property so that a third party can exploit it.

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