INSS expands granting of sick pay without expertise

The INSS (National Institute of Social Security) once again extended the release of sick pay without in-person medical expertise for another 90 days.

To apply for sick pay with medical certificate analysis, the insured must access the website or the Meu INSS app and attach the medical documentation. In addition to the certificate, you must send medical reports, complementary exams, among others.

According to the ordinance published in the Official Gazette of this Thursday (20), the deadline can be extended again “in case of strict public interest need”.

The measure was used at the height of the pandemic to release aid for temporary disability, as sickness aid is called, while the INSS agencies were closed. This type of concession was regulated for 30 days, in July of this year, in places where the wait for the expert examination exceeded one month, and had already been extended for 60 days.

“In all cases, the maximum period that the insured can receive the sickness benefit through analysis of medical documentation is 90 days”, says lawyer Priscila Demetro.

“If the insured person needs more time to rehabilitate himself and return to his work activities, it is recommended that he apply for the benefit of sick leave in the traditional way, which is through face-to-face medical expertise”, says the specialist in social security law. and co-founder at Demetro & Machado Advocacia.

Assistance without expertise is not valid for benefits of an accidental nature, that is, those linked to illness or work-related accident. Those who already have marked expertise can also opt for document analysis.

Medical certificate for assistance without expertise must be legible

The medical certificate must be legible and without erasures and inform: the insured’s full name, the disease that is disabling him, the ICD (International Classification of Diseases), the time he must remain away from work, the date of issuance of the document, the doctor’s stamp and signature.

If the document is missing any of this information, the application will be rejected. “In this case, the insured will have to undergo a medical examination, which will take longer to prove his disability”, says Priscila.

By law, the INSS has up to 45 days to respond to requests for sick pay, according to the agreement reached with the STF (Supreme Federal Court). If the agency takes longer, the worker can go to court. If the answer is no, it is possible to file an administrative appeal with the institute or seek the Judiciary.

HOW IS THE ANALYSIS FOR ASSESSING SICKNESS ASSISTANCE?

The documents sent by the insured are analyzed by INSS medical experts. The objective is to avoid fraud and understand if the time off work is consistent with the disease. If it is necessary to undergo medical expertise, the citizen will be notified and must schedule the expertise within 30 days.

In cases where on-site expertise is indicated, the INSS guarantees that the initial date of the request will be the day on which the citizen sent the documents through My INSS.