INSS starts using artificial intelligence to detect fraud in sickness benefit certificates

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Dataprev’s robot will scan medical certificates sent over the internet. In 2023, almost half of the documents issued were not accepted by the INSS. INSS will use artificial intelligence against fraud in sickness benefits The INSS begins this Monday (15) to use artificial intelligence (AI) to detect fraud in medical certificates to obtain sickness benefit, currently called temporary incapacity benefit. This benefit is granted when the worker needs to be away from work for more than 15 days due to illness. To obtain it, you must present a certificate or undergo a medical examination (understand below). Starting this Monday, a robot developed by Dataprev will scan medical certificates sent over the internet, via the Atestmed platform. This system replaces expert medical care with document analysis, in cases where the benefit lasts up to 180 days. Now, the analysis carried out by artificial intelligence will cross-reference data such as the doctor’s name, signature and CRM on the certificate, in addition to identifying the address from which the file was sent. In 2023, more than 1.6 million requests reached the INSS via Atestmed, but almost half (46%) were not accepted because they did not comply with the institute’s rules. According to the agency, some information was missing from the certificate or some data raised doubts, which is why the workers were sent for examination. Both those who forge and those who use a false document can be sentenced to up to 5 years in prison. Furthermore, the INSS beneficiary who purchased the certificate will have to return the money received and may be fired for just cause. 📃 RULES FOR CERTIFICATES – Certificates must be issued by doctors registered with the Regional Council of Medicine (CRM) and cannot have any erasures. They also need to: specify the time away needed for the patient to recover; establish the diagnosis when expressly authorized by the patient; record data in a legible manner; identify the issuer through signature and stamp or registration number in the CRM; bring the corresponding International Classification of Diseases (ICD) number, in the case of Atestmed. A medical certificate can be considered false, according to the INSS, when: it is drawn up by a person who does not have the qualification to issue the document; its content is not true, even if signed by a qualified professional; it is proven that the document has been tampered with; although the certificate is legitimate. Herniated disc and low back pain lead causes of absence from work in Brazil When can a worker be removed from work due to illness? In order for an employee to be removed from work due to illness, he or she must receive a medical certificate with a request for leave. What generates the right to benefit is the inability to carry out your professional activity as a result of the illness, says lawyer Carla Benedetti, master in social security law. From this point on, “the first 15 days of leave will be paid for by the company and, after that, the responsibility is transferred to the INSS”, explains Larissa Maschio Escuder, coordinator of the labor area at Jorge Advogados. The INSS will then submit the employee to a medical examination to assess the necessary time off and whether he or she is entitled to sickness benefit. In cases where the benefit lasts up to 180 days, it is not necessary to carry out an examination. And, if the worker has a work-related illness, the company needs to issue a Work Accident Report (CAT) so that he or she can obtain accident benefit, a modality that guarantees stability for 12 months after discharge. Who is entitled to INSS sickness benefit? Anyone who is insured is entitled to sickness benefit, including CLT employees, self-employed people, entrepreneurs, voluntary workers or individual taxpayers. “And if the person is unemployed, they have a grace period of 12 months, in the case of an accident at work, to claim the benefit while still insured”, points out Marcelo Martins, member of the OAB-SP Labor Advocacy Commission. “Sickness benefit is calculated according to the simple average of the employee’s highest contribution wages to the INSS”, explains Rodrigo Mattos Sérvulo de Faria, labor lawyer at Almeida Advogados. What rights do employees with burnout, depression or another work-related illness have? See more about worker rights: Paid and unpaid leave from work: see what they are and understand the rules New equal pay law: find out the main points Find out how many vacation days can be deducted due to unjustified absences

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