Sickness aid is a social security benefit granted to workers who are temporarily unable to carry out their work activities due to an illness or accident.
In this article, we will discuss in detail how sickness benefit works, covering everything from the necessary requirements for granting it to the procedures for requesting and accompanying it.
Requirements for granting sickness benefit
To be entitled to sickness benefit, the worker needs to meet some requirements established by social security legislation.
First, it is necessary that the insured is regularly contributing to Social Security, whether as an employee, individual contributor or optionally insured.
In addition, it is necessary to prove incapacity for work, either through medical expertise carried out by the INSS (National Social Security Institute) or through medical reports and certificates.
The legislation also requires a grace period for granting sickness benefit, that is, a minimum number of monthly contributions to the INSS.
This period varies according to the category of the insured person and the nature of the illness or accident.
Procedures for applying for sickness benefit
To apply for sickness benefit, the insured person must schedule a medical examination with the INSS.
This schedule can be made through the INSS website, the Meu INSS app or by calling 135.
On the day of the expertise, it is important to take all the medical documents that prove the incapacity, such as exams, reports and certificates.
During the medical examination, the expert will assess the health condition of the insured person and verify if he is really incapable of working.
It is important to note that sickness benefit is not granted automatically, and it is necessary to prove incapacity.
Follow-up and duration of sickness benefit
After granting the sickness benefit, the insured person must undergo periodic reassessments to verify whether he/she is still unable to work.
The interval between reassessments varies according to the severity of the illness or accident and the expectation of recovery.
During the period in which he is receiving the sickness benefit, the insured person is entitled to receive a monthly amount corresponding to a percentage of his contribution salary.
This percentage varies according to current legislation, and may be 91% of the contribution salary for most insured persons, or 100% in cases of serious illness or accidents at work.
It is important to mention that the sick pay has a maximum duration established by law.
If the insured person does not recover within the maximum period of leave provided for, the benefit can be converted into disability retirement, if the disability is considered permanent, or the insured person can return to work if he or she fully recovers.
Sickness Benefit Resources and Reviews
If the insured person has his application for sickness benefit denied by the INSS, he has the right to appeal the decision.
For this, it is necessary to file an administrative appeal within the established deadline. The appeal will be analyzed by a resource board from the INSS itself, which will reassess the situation of the insured person.
In addition, it is possible to request a review of the sickness benefit if there is a worsening in the health condition or a change in the circumstances that justified the granting of the benefit.
For this, it is necessary to present new medical documents that prove the need for revision.
Conclusion
Sick pay is a fundamental benefit for workers who are temporarily incapacitated due to an illness or accident.
To guarantee its concession, it is necessary to fulfill the requirements established by the social security legislation, undergo the INSS medical examination and follow the correct procedures.
In addition, it is important to periodically monitor the benefit and be aware of available remedies and revisions should you need to challenge a decision.
