ATT ASSESSORS Insurance and services Balaguer Lleida

Modifications in the management and control of processes due to temporary incapacity

Modifications in the management and control of IT processes


Royal Decree 625/2014, of July 18, regulating certain aspects of the management and control of processes for temporary disability in the first 365 days.

Scope of application
During the first 365 days, the IT processes, regardless of the determining contingency, will be applied, which are those that are included in any of the regimes that make up the Social Security system to carry out a work or activity For someone else's or your own.

They are excluded: the special regimes of the Armed Forces, civil servants of the State Administration and of personnel at the service of the Justice Administration.

Medical statements of low and low confirmation in the IT processes.
The public health service or the mutual society must send the personal data of the worker through the telematic route to the INSS and, in addition, the compulsory information of the unpaid statement regarding the date of the loss, to the contingent contingent, to the code Of the diagnosis, the national worker's employment code, the estimated duration of the process and, where appropriate, the clarification that the process is relapsed from a previous one, as well as, in this case, the date of termination of the process That originates Also, indicate the date on which the following medical examination will be carried out.

The doctors will be available:

- Tables of optimum duration typified by the different pathological processes susceptible to generate incapacities

- Tables on the degree of incidence of those processes in the different work activities.

The statements of cancellation and confirmation of the loss will be extended based on the period of time that the doctor who issues them estimates. For these purposes, four groups of processes are established:

- In the processes of an estimated duration of less than 5 calendar days, the doctor of the public health service, or of the mutual society, will issue the statement of absence and the discharge of the same in the same medical act.

- In the processes of estimated duration of 5 to 30 calendar days. After the first confirmation statement, successive ones, when necessary, will not be able to be issued with a difference of more than 14 natural days together.

- In the processes of estimated duration of 31 to 60 calendar days. After the first confirmation notice, the successors, when necessary, can not be issued with a difference of more than 28 natural days together.

- In the processes of estimated duration of 61 or more calendar days. After the first confirmation statement, successive ones, when necessary, will not be able to be issued with a difference of more than 35 natural days together.

Whenever a modification or update of the diagnosis occurs, a confirmation statement will be issued that will collect the estimated duration of the doctor who issues it.

The medical reports of IT will be made in accordance with a model that allows their computerized management, which will include an identifying code of the health center issuing them.

The FIRST TD of RD 625/2014 establishes that while not approved the new models will remain valid those currently in force, which will be processed in accordance with the previous regulations.

Rules regarding determination of IT contingency.
The disused public service, the Social Marine Institute or the mutual funds, who have issued the notice of termination, may instigate, reasonably, before the INSS the revision of the initial consideration of the contingency, by means of the procedure regulated in the Article 6 of Royal Decree 1430/2009, regarding the provision of temporary disability.

Proposals for medical discharge formulated by mutual companies in the processes derived from common contingencies.

In the IT processes derived from common contingencies that the coverage corresponds to a mutual, when this, in view of the medical reports on the cancellation or confirmation of termination, of the complementary reports or of the control and follow-up actions that it develops, Consider that the worker may not be prevented from work, he may make, through the doctors attached to it, motivated proposals for medical discharge, which will accompany the reports and tests that, if applicable, have been carried out, Addressed to the medical inspection units of the public health service, who will immediately send them to the doctors or medical services that correspond to the issuance of the medical reports of the process that they will have to pronounce either confirming medical discharge, or accepting the proposal, through The issuance of the corresponding part of medical discharge.

Mutuals will communicate simultaneously to the affected worker, for their knowledge, that the proposal for registration has been sent.
In the event that the loss is confirmed, the medical inspection will transfer the report together with the action carried out within a maximum period of 5 days from the receipt of the proposal for registration. Second TD: "During the first 6 months of the entry into force of this RD, the 5-day period is 11 days."

In the event that the medical inspection of the corresponding public health service does not receive a reply from medical practitioners or medical services, or in case of disagreement with it, they may agree to medical discharge, effective and immediate. In any case, the inspection must inform the mutual member, within 5 days after the date of receipt of the proposal for registration, the action carried out together with the reports that the doctor has submitted. Second TD: "During the first 6 months of the entry into force of this RD, the 5-day period is 11 days."

When the proposed affiliation by a mutual society is not resolved and notified within a period of 5 days, the mutual society may request affiliation to the INSS or, where appropriate, the ISM, in accordance with the competencies Envisaged in the fifty-second DA of the LGSS. The managing entity must resolve within a period of 4 days after the reception. Second DT: "During the first 6 months of the entry into force of this RD, the term of 5 and 4 days will be 11 and 8."

Processing of medical reports and medical discharge by the INSS or, where appropriate, the Social Marine Institute.

The public health service or, in the case of the mutual society, will send the medical, low, confirmation and discharge reports to the National Institute of Social Security, by telematic way, immediately and, in any case, in the The first working day following that of its expedition.

Companies are obligated to refer to the INSS, in an immediate way and, in any case, within a maximum period of 3 business days from the receipt of the statement submitted by the worker, through the RED system, the reports Medical Officers, confirmation of the loss and discharge submitted by the workers, filled in with the corresponding data to the company.
Failure to comply with said obligation may constitute, as the case may be, an offense against those set forth in the art. 21.6 of the TRLISOS (RD Leg 5/2000).
The non-referral of the medical reports to the INSS may result in the Ministry of Employment and Social Security, at the proposal of the managing entity or the mutual society, to suspend the mandatory collaboration of the company In the delegated payment of the economic benefits for temporary incapacity. The agreed suspension must be transferred to the TGSS, as well as to the managing or mutual entity.

Final provisions
Regulations on the cooperation of mutual companies (RD 1993/1995 modification)
New Art 16.2 Documentation and claims books
The beneficiaries may submit claims to the management and guardianship body of the mutual societies, dependent on the Ministry of Employment and Social Security, due to deficiencies in the management developed by the entities.
The mutual companies will have in all their centers, regardless of the services that they lodge, of the books of claims
The company will send the claims to the Directorate General for Social Security Management within a maximum period of 10 days after the presentation.
Likewise, interested parties may make their complaints to the aforementioned Directorate-General, through the Internet (Social Security Electronic headquarters), as well as through the means set out in art .38 of Law 30/1992.
The third DA of RD 625/2014 establishes that in the term of 3 months from the entry into force the actions to comply with what is established in article 16.2 of the Regulation on collaboration (RDO 1993/1995) that empowers the They are interested in making their complaints through the electronic headquarters of the Secretary of State for Social Security.

Economic benefits of the Social Security system for maternity, paternity, risk during pregnancy (Modification RD 295/2009)

• Requirement to be aware of the payment of fees for recognition of the right to maternity allowance, paternity allowance and subsidy for risk during pregnancy for self-employed workers, in the case of workers who Be responsible for the contribution income (art.3.8, art.23.6 and 41.2):
In order to recognize the right to the subsidy, the contributions corresponding to the month of the causative event and the two months prior to that, the income still does not appear in the Social Security information systems, are considered to be admitted. In these cases, the management entity will carry out the necessary checks to verify the timely and effective entry of these quotes. If not, the immediate suspension of the provision and repayment of the amounts unduly received will be proceeded.

The provisions of the preceding paragraph are applicable provided that the worker certifies the minimum contribution period required, without comparing the period of up to three months referred to in the same. If you do not prove the minimum contribution period required, you must justify the payment of the corresponding contributions that do not yet appear in the Social Security information systems.

Documents that must accompany the maternity benefit application in the case of maternity or multiple births and paternity benefit:

Delete section c) of article 14.2.1 and paragraph 3 of article 30.2 referring to "certification of contributions to the Social Security of the last or last companies or accreditation of the contribution with the Receipts from the payment of installments, if the causer is the party liable for the deposit, when necessary to prove the minimum contribution period, to determine the amount of the benefit or the requirement to be aware of the payment of The quotas. "

• Maternity Report (Article 13.1)
The maternity report will certify the probable date of birth (early resting) or the death of the child, after maternity leave for at least 180 days. In the other cases, the report will not be required.


Modification RD 1430/2009 regulatory development Law 40/2007, on measures in the field of Social Security, in relation to the provision of IT

• Extension deadlines of the administrative procedure for the review of senior medical personnel issued by the collaborating entity in IT processes for occupational contingencies before the end of the 12 months (art.4.2, 4.4 and 4.5)

The interested party may request the revision of the medical discharge issued by the collaborating entity referred to in the previous section, within the term of the 10 working days following the notification (before 4 calendar days).

Beginning of the special review procedure: the mutual will have a term of 4 business days (before 2) to provide the antecedents related to the IT process in question and report on the causes that motivated the issue of discharge Medical

Application for medical discharge derived from common-high medical contingency prior professional IT process: the interested party will have 10 business days (before 4 calendar days) to request a special review procedure.

• New Article 6. Administrative procedure to determine the contingency that caused the IT processes.

You can start, as of the date of issuance of the medical discharge notice:

A) Ex officio
B) At the request of the worker or his legal representative.
C) At the request of the mutual societies of occupational accidents and occupational diseases of the Social Security or of the collaborating companies, in those matters that directly affect them.

Preceptive report of the disability assessment team

• New Article 7. Prolongation of IT effects and depletion of the same in the cases of art.121.bis.2 second paragraph (extinction subsidy for IT 545 days-delay to qualify as IP)

The prolongation of the effects of temporary incapacity, in the cases contained in the second paragraph of article 131 bis.2, of the LGSS, will require that the competent body to evaluate, describe and review the situation of temporary incapacity determine the convenience Of not proceeding immediately to the qualification of permanent disability, given the clinical situation of the interested party and their work capacity.
The provincial director of the managing entity, at the proposal of the competent bodies to evaluate, rate and review the situation of work incapacity and prior hearing of the mutual society for a maximum period of seven business days, with respect to the processes corresponding to workers protected by the The same will dictate an express resolution, if necessary, the qualification, which may not exceed seven hundred and thirty calendar days following the date on which the temporary disability has begun.

When an administrative resolution is issued by the provincial director of the National Institute of Social Security or of the Social Marine Institute, pursuant to the provisions of the previous section, the managing entities will send to companies, by telematic means, the Result of the aforementioned resolution.
First DT: "While the remission to companies, through the computer system, of the results of the resolutions indicated in article 7.2 of Royal Decree 1430/2009, of September 11, is not implemented, the content of those is They can be progressed through email, without prejudice to subsequent communication on another support.

Modification RD 1630/2011 that regulates the provision of healthcare and recovery services for mutual companies

Modifies article 10 on the approval of the collaboration instruments with the public health administrations and with the Social Security management entities: approval of the DG of Social Security Regulation prior to its subscription, as well as its modifications Or rescissions

Access to clinical documentation by doctors of the Social Marine Institute.

Entry into force

September 1, 2014