INSS modifies the analysis of new claims for benefits

The INSS modifies the analysis of new claims for benefits One of the measures includes only the analysis of medical certificates and reports on the granting of sickness benefits.

An interim measure published on April 20 brings changes to the analysis and granting of benefits by the National Institute of Social Security (INSS).

One of the measures includes only the analysis of documents, on the basis of certificates and medical reports, for the granting of aid for temporary incapacity (sickness benefit). On the other hand, the granting of assistance in the event of an accident now requires periodic examination by means of an expert medical examination.

See below the changes made by Interim Measure 1.113.

The federal government announces changes in the rules for granting sickness assistance; see more

One of the measures dispenses with the issue of a conclusive opinion from the federal medical expert for requests for assistance for temporary incapacity (former sickness benefit).

The concession can be simplified, including the analysis of documents, based on medical certificates and reports submitted by workers. This model was used in 2020 and 2021 due to pandemic restrictions. More details will soon be defined in new regulations, according to the Ministry of Labor and Social Security.

Another change was the inclusion of accident assistance (given judicially or administratively) in the list of benefits that can be reviewed periodically by means of an expert medical examination.

Insured persons who benefit from assistance in the event of an accident will also be required, under penalty of suspension of their benefits, to submit to a medical examination at the expense of Social Security, to undergo professional rehabilitation or treatment.

In this way, assistance in the event of an accident begins to receive the same treatment as that already granted to assistance for temporary incapacity (sickness benefit) and retirement for permanent incapacity (invalidity pension).

Accident benefit is due to the insured who suffers an accident or contracts an illness resulting in partial and permanent sequelae that reduce the ability to work – in this case the insured can return to work, even with reduced ability .

An accident that leaves a driver paraplegic or an employee who contracts an MSD, for example, may entitle you to accident assistance.

The insured person continues to receive the salary normally with this aid, the benefit having a compensatory nature. The benefit ends in the event of the death or retirement of the insured, and with the new rule, it can also be discontinued depending on the analysis of the expertise and the outcome of the vocational rehabilitation and treatment process.

Resources

The interim measure also changes the flow of administrative resources in cases where the insured does not agree with the medical expertise.

Thus, when the request for appeal includes elements related to medical expertise, it will be analyzed directly by the Under-Secretary for Federal Medical Expertise, i.e. by an authority higher than that which carried out the the initial expertise.

According to the government, the change should optimize the performance of the Social Security Resource Council – a collegiate body that judges administrative appeals by insured persons against INSS decisions.

Currently, these resources go first to the board, which always seeks advice from the superintendency.

By transmitting the appeal directly to the technical body specializing in the matter, the government believes that there will be more agility in the judgment of appeals, since the processes analyzed by the council will be simplified.

In 2020, of the 992,000 appeals decided by the Social Security Appeals Board, around half were for temporary disability benefits, according to the government.

Tips for medical experts

The MP also institutes the payment of extraordinary duties to expert doctors, under the disability benefit review program, to reduce the containment of processes that depend on the expert medical examination of social security benefits and assistance.

Payment for extraordinary tasks will be due to experts who perform examinations beyond the ordinary target, in social security service units with high demand for expert medical care, with an appointment duration exceeding the legal limit .

Employees who analyze the initial application and review of benefits with the legal deadline for completion already expired will also receive extraordinary tasks.

For each extraordinary expertise, R$61.72 will be paid and, for each analyzed case, the amount will be R$57.50.

According to the Under-Secretary for Federal Medical Expertise, more than 800,000 medical expertise appointments will be able to benefit from this extraordinary service.

Attempts to shorten the application queue

At the end of March, the INSS published a new regulation to guide the work of civil servants in the analysis of requests for benefits, resources and reviews, with the aim of reducing the waiting list of insured persons to analyze their requests and recognize their rights to social security. .

In January, the average time to get benefits was 94 days – the highest since April 2021, when it was 102 days. In Tocantins, however, this period reaches 155 days. In Sergipe and Pará, the 143.

In January, 1,763,859 benefit claims were being processed. In March, that number fell to 1.6 million.

To reduce the stock, the INSS informs that it is working on several fronts:

  • Training for servers
  • Extension and improvement of the technological park, with the acquisition of approximately 18,000 new computers for teleworking servers and the renovation of computers and networks in INSS units
  • Improved work systems for process automation
  • Reopening of INSS agencies for a scheduled face-to-face service
  • Reorganization of the hierarchical and functional structure
  • Investment in security of access to company systems, aimed at protecting servers and preventing fraud
  • Technical cooperation agreements with companies, associations, unions and municipalities, to expand access to social security services and accelerate analysis
  • Partnerships with other government agencies and entities for data cross-referencing and information sharing
  • Social education to citizens through the School of Social Welfare
  • Simplification and organization of social security legislation (new Normative Instruction)
  • Improvement of service channels for the population, either remotely, such as telephone number 135 and Meu INSS (website and app), or in person, at INSS branches and on PrevBarco
  • Request to hire new civil servants – The INSS is awaiting authorization from the Ministry of the Economy to apply for a competition of 7,575 vacancies, including 6,004 for social security technicians and 1,571 for security analysts social.
  • New financial bonus to incentivize increased in-stock process analysis – Source: G1





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