Government expands the INSS’s fine-tooth comb and opens the way for assistance without expertise

Insureds who receive accident aid may have the benefit reviewed and canceled in the INSS’s fine-tooth comb. The novelty is part of MP (Provisional Measure) 1113, published in an extra edition this Wednesday (20).

The MP also paves the way for the resumption of granting aid for temporary incapacity (formerly sick pay) without medical expertise from the INSS – the benefit is released after the worker presents a medical certificate or report. This model, which has already been used in 2020 and 2021 because of service restrictions during the pandemic, still depends on details that must be presented by the MTP (Ministry of Labor and Welfare).

To be converted into law, the MP needs to be approved in 120 days in the House and Senate, where it can undergo changes. The final text will still need to be sanctioned by President Jair Bolsonaro (PL).

Review of accident aid in the fine-tooth comb

The accident allowance is due to the insured person who suffers an accident and has permanent sequelae that reduce his ability to work, which can also occur due to occupational diseases. The benefit works as a kind of indemnity, as it does not prevent the person from continuing to work — unlike retirement due to permanent disability (former disability retirement). This is the case, for example, of workers who, after leaving the company, can no longer work in the same role, but are still able to work in another area of ​​the company.

Social security lawyer Rômulo Saraiva, a columnist for Sheetstates that the accident benefit used to have a permanent character and its payment was interrupted only with the death or retirement of the beneficiary.

With the new MP, this type of assistance can be reviewed in the Special Program for the Analysis of Benefits with Evidence of Irregularity, known as the INSS’s fine-tooth comb.

Adriane Bramante, president of the IBDP (Brazilian Institute of Social Security Law), states that, probably, all insured persons who receive accident assistance will be called to undergo an expert examination, in order to analyze whether the worker continues with the partial disability that motivated the benefit.

The text published this Wednesday also amends the fine-tooth comb law, to add that the analysis of evidence of irregularity can be carried out during the concession, in the appeal phase or in the review of the INSS benefit.

The insured may appeal the assessment result within 30 days. The appeal must be submitted to the Social Security Secretariat of the Ministry of Labor and Social Security and will be judged by members of the federal medical expert career.

According to Francisco Alves, president of the ANMP (National Association of Expert Physicians), the fine-tooth comb is not done by the INSS. Alves says that the category, which is on strike, is against carrying out a review of benefits “at this moment that the country is experiencing”.

According to the Ministry of Labor and Welfare, the MP includes accident assistance among the benefits that can undergo periodic review, through medical examination of the expertise. The body says that an act must establish the criteria and dates for the summons.

Sickness aid can be granted again without expertise

In 2020 and 2021, because of the pandemic, the INSS adopted the so-called documentary expertise for the granting of the temporary disability benefit (disease aid). In some cases, the insured could receive the benefit without going through an in-person medical examination, after sending certificates, exams and medical reports. The benefit released was an advance, in the amount of the minimum wage. Subsequently, if it is proven that the insured was entitled to a higher amount, the insured would receive the difference.

In Bramante’s opinion, the experience of document analysis during the pandemic was positive. “It worked very well. In case of doubt, the insured could go through the on-site forensic examination afterwards”, he says.

MP 1113 opens up this possibility again, but leaves the details open. The regulation should take place through an act of the Minister of Labor and Social Security, a position currently held by José Carlos Oliveira.

The president of ANMP considers that the measure is an attempt to make the expert activity precarious, because it puts administrative servers to analyze medical documents.

“During the pandemic, with the agencies closed, it was an exceptional measure to prevent serious harm to the citizen, and there was a period limit of 30 days. Now there is no longer this justification, there is no longer a closed agency”, says the medical expert.

Francisco Alves also states that document expertise increases the risk of fraud and exposes the insured to a breach of medical confidentiality, as administrative servers do not respond to medical advice.

“If the government believes that it will reduce the queue with this, on the contrary, it will create a greater demand from people who now think they can get a benefit without having to go through the expert”, says Alves.