MEDICAL LEAVE OF ABSENCE AND INDUSTRIAL INJURY: MANAGEMENT AND PROCESSING

 

Article 5 of Royal Decree Law 6/2020 of 10th March adopting certain urgent measures in the economic field and for the protection of public health introduced that, in order to protect public health, periods of isolation or infection of workers caused by the health crisis resulting from the COVID19 shall be considered as an exceptional situation assimilated to an accident at work.

The main difference in the treatment of temporary incapacity derived from the COVID19 and its usual treatment lies in the economic benefit. Workers will receive the economic benefit that would correspond to the professional contingency referred to.

The economic benefit for an accident at work is determined according to the Regulatory Base, which is the result of dividing the amount of the worker’s contribution base in the month prior to the date of commencement of the incapacity by the number of days to which said contribution refers (this divisor will be specifically: 30, if the worker has a monthly salary; 30, 31 or 28, 29 if he has a daily salary).

However, if the worker joins the company in the same month in which the incapacity begins, the contribution base for that month will be taken for the Regulatory Base, divided by the days actually contributed. Also, the days effectively contributed will be taken as a divisor, when the worker has not remained in the company during the entire previous calendar month.

In the case of an accident at work or occupational disease, the Regulatory Base is obtained by adding two summonses:

– The contribution base for professional contingencies of the previous month, without overtime, divided by the number of days to which said contribution corresponds.

– The contribution base for overtime of the previous calendar year, divided by 365 days, unless the seniority in the company is lower, in which case, the number of days of work in the company will be expressed, excluding those of the month of termination.

In the case of workers hired on a part-time basis, the Regulatory Base will be the result of dividing the sum of the accredited part-time contribution bases since the last work registration, with a maximum of three months immediately prior to that of the causal event, by the number of calendar days included in said period.

The amount of the economic benefit for temporary incapacity derived from an accident at work will be paid by the companies as a delegated payment, that is, the company pays it through the salary receipts, deducting such amounts from the Social Security payments to be made the month following the accrual of the contributions. Workers are paid 75% of the regulatory base from the day after the doctor issues the corresponding medical leave.

The duration of this exceptional benefit will be determined by the length of the sick leave and the corresponding registration. The benefit may also be paid to employees or self-employed workers who are registered with any of the social security systems on the date of the event.

Under normal conditions, the maximum duration will be three hundred and sixty-five days, which can be extended for another one hundred and eighty days when it is presumed that the worker can be discharged from the hospital on medical grounds. For the determination of the maximum period, relapses shall be counted, as well as periods of observation. A relapse in the same process shall be deemed to have occurred when a new medical discharge for the same or similar pathology occurs within one hundred and eighty calendar days following the date of effect of the previous medical discharge or of the resolution denying permanent disability.

No waiting period is required during the health crisis situation. The date of the causal event will be the date on which the isolation or illness of the worker is agreed, without prejudice to the fact that the discharge report is issued after that date.

The date of the causal event shall be the date on which the isolation or illness of the worker is agreed, without prejudice to the fact that the sick leave is issued after that date.

PROCESSING DIFFICULTIES

These days the medical services of the public health services live in an exceptional situation that does not allow normal functioning, or what we consider normal. During the duration of the health crisis, the doctors are at the disposal of the Health Authorities to attend to the emergencies they are assigned, as well as the services that are prioritized according to how the events develop.

It is advisable for workers affected by COVID19 or isolated due to their risk situation to call the health centre telephone number on their health card. They will put you in touch with your family doctor who will issue the medical leave document for professional contingencies.

The family doctor will attend to you, either on the spot or by returning the call, and will assess the situation, according to which he or she will issue the corresponding medical leave.

The medical report of cancellation, confirmation or discharge may be sent by e-mail, or if the doctor considers it appropriate, an authorised person (never the patient) will go to the corresponding health centre to collect it.

MANAGEMENT BY COMPANIES

The physicians of the Public Health Service to which the worker is assigned shall be responsible for issuing the corresponding discharge, confirmation and registration reports. Even if the initial reports (those issued before the health crisis) were issued as a common illness, they will have the economic and performance effects that occupational accidents and illnesses have.

The companies must communicate through the RED/SILTRA system the medical reports issued by the doctors, which the workers will send to the company by the means they consider appropriate. For this purpose, the companies will send an FDI file through the SILTRA system or will communicate it online. They must contain all the data required for this purpose by the system and which contain the medical reports.

It should be taken into account that, if the service is working normally, at the moment in which the medical reports of illness or accident are processed, the National Institute of Social Security will send the companies a communication or alert about the process of temporary incapacity that has begun, which is called the FIE file.

The reports issued by the primary care physician will be sent that same day to the INSS who, after verifying the diagnoses, will convert the contingency to an accident at work, so that in the social security settlement the associated benefit will be that of a Temporary Incapacity derived from an accident at work. Companies must prepare their wage receipts as if the worker were on leave for temporary disability derived from an accident at work.

It will also be possible to consult the contingency related to the process of temporary incapacity by requesting a Contribution Data Report from the system for the worker whose medical report has been processed by the doctor.

Once the temporary incapacity has been processed in the system, the Management Entity will have proof of the delegated payment and the companies will be able to make the corresponding deductions in the contribution files that will be generated the following month.

It should be remembered that under no circumstances is it required to process any DELTA (Electronic Declaration of Injured Workers) part and that the mutual insurance companies for accidents at work and occupational illnesses will not issue any medical report related to the COVID19.