Requirements for claiming incapacity for work benefit

The temporary incapacity benefit, which is the payment that a person receives while they are unable to carry out their work duties due to an accident at work or not, or due to an occupational or common illness, is subject to compliance with a series of requirements. On this occasion, our aim is to talk to you about them so that you can better understand whether or not you are in a position to obtain it.

Characteristics of the temporary incapacity benefit

First of all, however, we would like to explain exactly what the elements that characterise temporary incapacity benefit are. 

In this sense, this benefit can be obtained by any worker who is affiliated to the Social Security and who is in a situation of registration or assimilated to registration. Moreover, it may not last more than 365 days, with the exception that medical personnel may foresee discharge within the following 180 days. Therefore, a worker may receive temporary incapacity benefit for a maximum of 545 days. After that time, the affected person will have to return to his or her job or, failing that, receive permanent incapacity pay. 

What are the general requirements for temporary incapacity benefit?

In general terms, current legislation provides for the payment of temporary incapacity benefit to those who have a minimum contribution period of 180 days in the 5 years prior to the causal event. This point refers to a non-occupational accident or, failing that, to a common illness. 

On the other hand, if the sick leave is due to an accident or occupational disease, then the legislation specifies that no minimum contribution period is required. This means that a worker could obtain sick leave for either of these reasons the day after being hired and registered with the Social Security. 

Which institutions are responsible for paying temporary incapacity benefit?

The entity responsible for paying the benefit will depend, fundamentally, on the type of worker who is entitled to it. In this respect, there are three bodies specified by law to carry out the payment:

1. Mutual Social Security Collaborating Mutual Societies. 
2. National Social Security Institute. 
3. Social Marine Institute. 

As soon as it is determined which body is responsible for the payment of the benefit, payment will be made in the manner specified by law. This means that, unless there is a collective agreement that specifies otherwise, the employer will calculate and pay the worker's remuneration from the fourth day of sick leave until the 15th day. From the sixteenth day onwards, it will be the mutual insurance company, the Social Marine Institute or the National Social Security Institute that will do so, regardless of whether the company acts by delegated payment or not.

Formalities required to obtain temporary disability benefit

The Social Security specifies that, depending on the type of worker, the requirements in terms of formalities to be carried out to obtain temporary incapacity benefit are different.

Formalities required to obtain the benefit for workers registered with the General Social Security Scheme

It is probably easiest for those affiliated to the General Social Security Scheme to apply for temporary incapacity benefit. First of all, they must obtain a sick leave certificate. This can only be issued by the primary care or family doctor assigned to the worker at their usual medical centre. Once they have it in their possession, they must present it to the company within the following three working days. 

It should be noted at this point that each time the doctor confirms the worker's sick leave status, the process must be repeated. This means that if, for example, the subject is not in a position to return to work at the time when the period of temporary incapacity determined by the primary care specialist expires, he/she will have to go to the doctor's office again and request a new report. If the specialist gives you a new report, you will have to present it again to your employer. 

For his part, the worker is obliged to inform his employer that he has received the discharge report within 24 hours of receiving it. The company, for its part, must send it, as it did previously with the sick leave reports, to the Social Security and, if applicable, to the corresponding mutual insurance company. 

Procedures for obtaining temporary incapacity benefit for domestic workers

A few years ago, the National Social Security Institute created the Special System for Household Workers, which establishes a different system for obtaining temporary incapacity benefit. 

The process of applying for sick leave must be carried out in the same way as for those affiliated to the General Social Security Scheme. However, from the fourth day until the eighth day, the employer, regardless of whether it is an individual or a company, must pay the amount of the benefit. From the ninth day onwards, these workers are obliged to submit their benefit claim to the National Social Security Institute or, failing that, to the mutual insurance company they have contracted. 

Specifically, the documentation that must be attached to the Application for Temporary Incapacity Benefit for Domestic Employees, which can be downloaded from the INSS website or obtained at any of its affiliated offices, is as follows: 

1. National ID card of the worker requesting the temporary incapacity benefit. 
2. Medical report of sick leave and confirmation, if any. 
3. Certificate completed and signed by the employer requesting payment of the temporary incapacity benefit to the worker from the Social Security. This is also available on the INSS website and at its offices. 

Procedures for obtaining temporary incapacity benefit for self-employed workers

The procedures for the self-employed to access this temporary incapacity benefit also differ from the previous cases. However, as in the case of self-employed workers, the first thing they must do is go to their family doctor to request a sick leave certificate. 

Once they have it, the self-employed must present it to the INSS or, failing that, to the mutual insurance company they chose to cover their contingencies at the time they were registered with the Social Security. In fact, this is where you will have to go to apply for temporary incapacity benefit. If you are not registered with one, you will have to go to a Social Security Attention and Information Centre. 

The documentation that the self-employed must attach is as follows: 

1. Signed and completed application for temporary incapacity benefit. It can be downloaded from the Social Security website, although the mutual insurance companies are obliged to provide it. 
2. NATIONAL ID CARD. 
3. Medical report of sick leave and confirmation, if any. 
4. Receipts for payment of self-employed contributions for the last three months. 
5. Declaration of activity status: here you will have to specify whether you are definitively or temporarily ceasing your activity or, failing that, whether you are leaving it in the hands of another person. 

As you will have been able to see, the requirements for applying for temporary incapacity benefit are few, but the procedures to be carried out, especially in the case of domestic workers and the self-employed, are quite extensive. We hope we have been useful and have answered your questions. If you have any doubts, contact G. Elías y Muñoz Abogados, and our lawyers specialised in labour law will attend to you with the maximum professionalism that this type of case requires.