INSS failure denies sick insured assistance; institute says problem has been solved

A failure in the synchronization of two systems used in the INSS (National Social Security Institute) forensic examinations resulted in the denial of sickness benefits that had been approved by doctors, according to the ANMP (National Association of Federal Medical Experts) .

In a letter sent on Wednesday (12) to the Minister Onyx Lorenzoni, of Labor and Welfare, the entity says that thousands of policyholders were automatically and unduly denied their disability benefits.

The INSS says it has identified an instability in the automatic granting of disability benefits, together with Dataprev (a data processing company), which would have already corrected the problem. The failure, according to the institute, resulted in the reprocessing of 6,173 orders on January 8 and 9.

The error, according to the ANMP, would be occurring in the integration of data between the system used in the investigation, the Sabi (Disability Benefits Administration System), and the Cnis (National Registry of Social Information), which is the basic file of the INSS, where the worker’s employment ties, contributions and eventual absences are recorded.

All starting skill dice are rolled into Sabi, which is linked to Cnis. Failure to communicate between the two bases would be leading to denials, even when the expert considered that the insured was entitled to the benefit.

The medical experts state, in the document sent to the government, that in addition to the automatic rejection, the system used to release the information collected by the professional from the medical reports and the expert consultation is not allowing the characterization of the type of benefit.

This block prevents the doctor from informing, for example, if that disability benefit is of an occupational nature, that is, if it originates from an accident or illness at work. For this classification, the expert must include the ICD (international classification of diseases) and the Cnae (classification of economic activities) in the system.

“It is unacceptable that a serious mistake like this remains in force and continues to harm policyholders and put servers at risk, as they become the target of citizens’ indignation even without having given rise to the rejection”, says the association, in a note.

Lawyer Priscila Arraes Centeno says the problem is very similar to what happened in April of last year, after a systems update. At the time, about 650,000 requests went unanswered because the INSS system accused data errors or the lack of some information.

“The system accuses information divergence. To grant the benefit, the system needs to check the insured person’s lack and quality [número mínimo de contribuições para ter a cobertura previdenciária]. In this error, even with the incapacity recognized by the expert, the benefit is not granted”, he says.

In 2021, it was necessary to adopt a procedure called post-expertise adjustment, through which the insured, after consultation to assess disability, accessed the system and corrected any errors in the registration.

The entity that represents the doctors says that the mistake made the expertise innocuous, “which represents an unequivocal waste of public funds.”

For those who recently underwent expertise at the INSS, lawyer Priscila Centeno recommends paying attention to the rejection notice, which provides information that the worker should be aware of. If the denial is for administrative reasons, such as the lack of quality of insured, this will be informed in the report of the result of the expertise.

Another important data is the type of benefit. A b-31 is a common sickness benefit, a b-91 is an accidental sickness benefit, when the leave is related to the work performed by the insured. If, in the opinion of the insured, his benefit did not come out with the correct code, the ideal is to enter with a review.

In the request for reassessment, which is made on the INSS website or on the institute’s application, lawyer Priscila Centeno also recommends that the insured person include the CID of their disease, information that must be included in the medical certificate, and the Cnae of the company where they work. .

You can consult this code from the company’s CNPJ on the Federal Revenue website.

In the note published on its website on Wednesday, the ANMP says that it will also send official letters to the MPF (Federal Public Prosecutor’s Office), the TCU (Union Court of Auditors) and the CGU (Comptroller General of the Union) so that “acts of interference practiced by the former president of the INSS, who was unable to correct this systemic error during the period he was in charge of the autarchy.”