How does Sick Pay work? Learn about the benefit

Learn all about how sickness benefits work. In this article, we'll explain everything: what they are, which illnesses exempt you from the waiting period, and much more!

I bet you've heard the term "Sick Pay" before, right? Everyone has that friend—or even that acquaintance—who needed to apply for benefits due to some illness. 

But do you know how this benefit works in practice and what the benefits are? requirements and rules that the worker must follow to obtain this assistance?

In this text, we will explain a little about how Sick Pay works, who can apply for it, and the conditions of the benefit.

Today's content will be organized into topics, which will cover the following subjects:

• What is Sick Pay?
• What do I need to apply for Sick Pay?
• Illnesses that exempt you from the waiting period when applying for Sickness Benefit?
• Steps to obtain Sickness Benefit
• When does Sick Pay end?
• Conclusion

What is Sick Pay?

Sickness Benefit (or Temporary Disability Benefit) is a social security benefit. Paid by the National Institute of Social Security (INSS), this benefit is intended for people who are unable to perform their daily activities for more than 15 days.

This amount serves as a replacement for the income the worker is unable to earn through work. To receive this benefit, the citizen must prove, through a medical examination, that they are unable to perform their work activities due to their health condition.

What do I need to apply for Sick Pay?

For a citizen to be able to apply for the benefit, they must meet three requirements:

Temporary disability

In this requirement, the worker can request the benefit if he has some type of illness that prevents him from carrying out his remunerative activities normally, in his work environment. 

Insured status

In order to apply for and access the benefit, the citizen must not only be a member of the INSS, but must also be making their monthly contributions to the INSS correctly. 

A 12-month contribution period

To be eligible for this Sickness Benefit, workers must have completed the minimum period of contributions to the INSS (National Institute of Social Security). Only after this 12-month period can they apply for the benefit, if necessary. 

In addition to these requirements, the applicant must prove, through a report issued by the responsible medical expert, the illness/accident that is preventing him/her from carrying out his/her activities normally.

Illnesses that exempt you from the waiting period when applying for Sickness Benefit

As mentioned at the end of the previous topic, there is a waiting period for applying for the benefit. However, some illnesses are considered serious and therefore exempt from this minimum waiting period. These are:

• Active tuberculosis;

• Hansen's disease;
• Ankylosing spondyloarthrosis;
• Mental alienation;
• Malignant neoplasm;
• Acquired Immune Deficiency Syndrome (AIDS);
• Blindness;
• Irreversible and disabling paralysis;
• Severe heart disease;
• Parkinson's disease;
• Severe nephropathy;
• Advanced stage of Paget's disease (osteitis deformans);
• Radiation contamination based on the conclusion of specialized medicine;
• Severe liver disease.

Remember that other diseases may also be included in this list, subject to a specialist's analysis of their severity.

During the pandemic, the number of sickness benefit claims for psychological illnesses—such as schizophrenia, bipolar disorder, and post-traumatic stress disorder—increased by approximately 291,000,000, with depression and anxiety being the main causes. This shows that the effects of social isolation and the COVID-19 pandemic go far beyond the physical.

Steps to obtain Sickness Benefit

For citizens to apply for this benefit, they must go through several steps. To better illustrate, we've listed the steps involved in this process.

When the worker is unable to perform his work, he receives a medical certificate.

If this certificate is older than 15 days and within the 60-day period, the employer must submit a request for an expert assessment to the INSS.

Benefit request

In this first stage, the applicant accesses the My INSS or through the apps, available for Android and iOS. 

Next, log in to the platform and select "Schedule Your Expertise" from the left-hand side menu. If this is your first request, simply click "Schedule New."

To request an extension of the benefit, click on “Schedule Extension”.

After this procedure, the applicant will be able to track 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. At this stage, the applicant must go to the INSS unit selected for the examination.

On the day of the INSS assessment, the worker must appear with their personal documents with photo, CPF number, medical certificate and the exams that prove their incapacity.

Please note that, in specific cases, this medical examination may be carried out at the applicant's home.

Just like in the previous stage, after the examination is carried out, the worker will follow the request and the expert result directly through My INSS through the “Disability Benefit/Claim Result” option.

In addition to these options, workers can contact the INSS by calling 135, one of the INSS's customer service channels. The service is available Monday through Saturday, from 7 a.m. to 10 p.m. 

When does Sick Pay end?

Once their situation improves, the insured will be ready to return to their normal activities. This means that access to assistance is complete.

The INSS must periodically review the benefit. This allows them to determine whether the individual's condition still requires them to receive the benefit. This is the most common approach.

There are also cases where the applicant's disability is recognized as permanent. In this case, the sickness benefit is converted into disability retirement.

Conclusion

Even though it is not in anyone's plans to contract a disease and need to apply for this benefit, it is impossible to predict the future.

Therefore, obtaining this type of knowledge is very useful for all workers to be aware of their rights and how the INSS can support them in certain situations involving labor issues in general.  

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