Can the mutual insurance company call me while I am on sick leave?

According to Spanish law, mutual insurance companies are responsible for sick leave due to accidents or occupational diseases. Likewise, the Social Security is responsible for temporary incapacity due to common contingencies. So how is it possible that some workers receive calls from the mutual insurance companies when they are on sick leave due to a common illness? Here we are going to explain it to you.

I am on sick leave from the Social Security and the mutual insurance company has called me, why?

Companies have the right to contract the services of mutual insurance companies for common contingencies, provided that workers' representatives (if there are any) are consulted and employees are notified in writing. If they do so, these entities will be responsible for paying the worker's temporary incapacity during the period of sick leave due to illness or non-occupational accident, not the Social Security.

When can the mutual insurance company call you while you are on sick leave?

However, the main reason why workers are surprised when they receive a call from their employer's mutual insurance company is that, as it is a common contingency, it is the Social Security primary care doctor who must certify the problem and sign the sick leave report.

Once the worker sends this document to his employer, the latter forwards it to the mutual insurance company, which has these obligations:

• Recognise the right to receive the temporary incapacity benefit: once it has received the report, the mutual insurance company will check that the worker meets the requirements and will determine the amount to be paid.
• Pay the amount of the monthly sick leave payments for common contingencies.

But, in addition, the mutual insurance companies are free to carry out ‘control and follow-up actions’ if they deem it appropriate. This is the real reason why you may be called in by the mutual insurance company if you are on social security sick leave, even though it may seem strange to you.

During these evaluations, the health staff of the mutual insurance company will study your case and determine whether the cause that led to the temporary incapacity for common contingencies persists.

Can the mutual insurance company register you if you are on social security leave?

No, it cannot, despite what we have just said. What it can do is send a ‘reasoned proposal for discharge’ to the Medical Inspectorate if it considers that you have recovered and your primary care doctor has not concluded the period of temporary incapacity. This is the body that will decide in this case.

I am on sick leave due to depression and the mutual insurance company has called me, am I obliged to go?

It doesn't matter if you are on sick leave for this reason or for any other. If the mutual insurance company is responsible for paying for your temporary incapacity and contacts you to go to any of its centres so that one of its specialists can study your case, you are obliged to go, unless you have a justified cause.

If you do not attend the appointment and have not presented adequate justification, the mutual insurance company can cut off payment of the temporary incapacity benefit for common contingencies after a period of 10 days has elapsed.

Will the mutual insurance company provide you with health care?

It depends on the case. In this type of situation, the mutual insurance company has the right to offer you health care if it deems it appropriate. For example, in the form of diagnostic tests, rehabilitation sessions with specialists or therapeutic treatment of any kind. But it is not obliged, just as you are not obliged, to accept them if you do not consider them appropriate. You will also have to seek the consent of your social security doctor.

Can I ask the mutual insurance company for copies of medical reports?

Yes, you can request a copy of any medical reports that the mutual insurance company's specialists make about you and your condition and it is obliged to give them to you, as well as to include them in your medical records as a patient. However, this requirement is not reciprocal.

What do we mean by this? Quite simply: the mutual insurance company cannot ask you for medical reports that you have received from the social security. If you want to get them for any reason, you will have to request them from this public body, justifying why you need them.

However, it is generally sufficient to justify this request by claiming that your doctors need them ‘to carry out their duties’, so it is normal for the Social Security to give them to you.

Does the mutual insurance company inform the employer of my illness?

No, as this would violate the data protection rights of the employee who is on sick leave for common contingencies. In the event that the company makes a request in this respect, it is essential that the mutual insurance company asks for the employee's consent, and the employee is free to give or refuse it.

If you are asked and you say yes, you should also be aware that the mutual insurance company can only inform the company about those aspects that affect your ability to carry out your duties in the workplace. They can also give some indication of the estimated recovery time, but nothing more.

If the mutual insurance company calls you, you have to go even if you are on sick leave from the Social Security.

At this point, we think we have made it quite clear what the obligations of the mutual insurance companies are in the event that they are responsible for paying benefits for common contingencies. Similarly, we have also specified your rights as a worker in this type of situation.

But what happens if the mutual insurance company exceeds its duties? In that case, you have the right to challenge their decision, for which you will need the support of a legal expert. We have a large team of employment lawyers in Madrid capable of defending your interests in this type of situation. Contact us if you need to and find out for yourself.