INSS returns to release aid without expertise; see rules – 07/22/2023 – Market

The INSS (National Social Security Institute) once again granted sickness benefit – now called temporary incapacity aid – without the need for medical expertise. The measure integrates the program to face the queue of social security benefits.

The concession will be made through documental analysis, including the medical certificate, according to the ordinance published this Friday (21). The INSS queue today has 1.794 million policyholders waiting to be granted a social security benefit.

To speed up the analyses, the government published a provisional measure in which it establishes the granting of bonuses of R$ 68 and R$ 75 to administrative servants and experts. The bonus program, however, displeased the professionals.

How will the granting of sickness aid without expertise

According to the ordinance, policyholders can apply for sickness aid through document analysis, sending the medical certificate through the application or website Meu INSS. It is also possible to make the request through the Telephone Center 135. In this case, it will be necessary to send the medical certificate by email or delivering it to a Social Security agency.

Aid without expertise was even granted during the coronavirus pandemic, in 2020 and 2021, and then between July and December 2022. The concession was stopped in recent months, after the ordinance edited by the Bolsonaro government asked for validity.

The benefit will be granted for a period of up to 180 days, interspersed or not. Insured persons who suffer an accident at work will have to present the CAT (Communication of Accident at Work) to the INSS, otherwise, they will have to schedule a medical examination.

The medical or dental certificate must be on paper without erasures, and contain the following information:

• Full name
• Date of issue (which cannot be equal to or greater than 90 days from the date of submission of the application
• Diagnosis in full or ICD code (International Classification of Diseases)
• Signature of the professional, which can be electronic and must respect the rules in force
• Identification of the doctor, with name and registration with the class council (Regional Council of Medicine or Regional Council of Dentistry), with the Ministry of Health (Registration of the Ministry of Health), or stamp
• Start date of rest or withdrawal from usual activities
• Time required for recovery, preferably in days (this date may be an estimate)

Insureds who have not yet gone through the expertise can make a new claim

Lawyer Adriane Bramante, president of the IBDP (Brazilian Institute of Social Security Law), says that the insured person with expertise scheduled with a period of more than 30 days for trying assistance without expertise, if he meets the rules.

“The insured needs to pay attention to the requirements demanded in the medical report, because if one of them is missing, the request may be rejected and the new request can only be made after 15 days”, he says.

For Adriane, granting aid without the need for an in-person medical examination is an alternative to the current INSS crisis, with a long queue.

Lawyer Priscila Arraes Reino, from Arraes e Centeno, also sees it favorably, but believes that the limitations of the ordinance may hinder the granting of the benefit. “The government is trying to reduce the queue, but it will be complicated, because of the requirement of joining the CAT issued by the employer. And we know that the employer almost does not issue”, she says.

Servers and experts criticize government bonus program

INSS administrative servants and medical experts can now join the Social Security Queue Confrontation Program, which will pay bonuses for productivity. The measure, however, is criticized by representatives of professionals.

According to the INSS, those who meet the requirements can now register for the program through the task manager. The MP with the bonus was published last Tuesday, but the regulation came out only this Friday. The program encompasses benefits not granted in the last 45 days —in the case of expertise, it is 30 days— and lasts for nine months, which can be extended for another three.

According to the regulation, civil servants who carry out the analysis of requests for benefits outside office hours may receive up to R$ 10,064 extra, if they meet the monthly goal of extraordinary analysis.

The SINSSP (Union of Social Service Workers in the State of São Paulo) issued a note taking a position against the program. For the union, the program alone will not have the desired effect.

In the case of the bonus, the union claims that the requirement of meeting 30% more in the daily target mischaracterizes the program. “It’s a disaster. If the target of 4.27 a day corresponds to eight hours of work, the 30% more demanded is unpaid overtime”, he says.

Medical experts call the measures a “career attack.” “How do you want to reduce the queue with a bonus program that reduces the value of each expertise by half and limits operational capacity only to weekends and holidays, periods when Dataprev usually performs maintenance on its systems?”, says Francisco Eduardo Cardoso Alves, vice president of ANMP (National Association of Medical Experts).

According to him, the expert who agrees to participate will “pay to work”. The category is also against granting aid through documentary expertise, without face-to-face examination. “Because of this, adherence to the new program will be minimal.”