When a person becomes ill or suffers an accident that prevents them from working, the INSS offers certain benefits to guarantee a minimum of financial security during this period. These are the so-called disability benefits: sickness benefit, disability pension and accident benefit.
Although they are benefits related to health and incapacity for work, in practice they each have their own requirements and objectives. Below, we explain each of them in simple language, to clarify the most common doubts.
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SICKNESS BENEFIT
What it is
Sickness benefit, also known as temporary incapacity benefit, is a benefit paid to INSS insured people who are unable to work or perform their usual activities for a certain period of time due to illness or accident.
Example: Maria, a sales clerk, was diagnosed with a herniated disc and had to take time off work for an operation and physiotherapy treatment. Because of the operation, she was unable to work for 45 days and received sick pay during her recovery.
When it can be requested
It can only be requested when the incapacity exceeds 15 consecutive days, and must be proven by a medical examination carried out by the INSS itself.
Who pays
In the case of people who have a formal contract, the first 15 days of absence are paid for by the company. From the 16th day onwards, payment becomes the responsibility of the INSS. For self-employed workers, individual contributors or the unemployed, the INSS pays the benefit from the start of the incapacity until medical discharge.
How it works
Sickness benefit acts as a wage replacement during the period in which the person is unable to work. In addition, the time spent receiving the benefit can also count as contribution time for retirement, if the receipt of sickness benefit is interspersed with contributions before and after the benefit.
The amount of sickness benefit corresponds to 91% of the average of the contribution salaries paid since July 1994 (when the Real Plan was created). The benefit is only paid for the duration of the incapacity. It can be terminated if the insured person is found to be fit in the review examinations, if they fail to attend the review examinations, or if they return to work while still receiving the benefit, since, as a rule, those who are unable to work cannot engage in paid activities.
And when we talk about “paid activity”, this isn't just restricted to the insured person who has a formal contract, but also to the MEI who pays the DAS, the Simples Nacional entrepreneur, the self-employed person who pays the INSS via the little form, etc.
Before having their benefits terminated, insured people can be referred to a professional rehabilitation program, especially when they are still able to work, but can no longer perform the same job they did before they went on sick leave. In this case, rehabilitation aims to prepare them to take on a new job that is compatible with their new health condition.
Requirements
In order to qualify for sickness benefit, you must meet the requirements:
- Insured status at the time of onset of incapacity
- At least 12 monthly contributions to the INSS (this is the so-called grace period)
The waiting period is not required in cases of accidents of any kind, occupational diseases or some serious illnesses, such as malignant neoplasms (cancer), active tuberculosis, multiple sclerosis, Parkinson's disease, among others.
If the incapacity is caused by an illness or injury that already existed before the person became insured, they are not entitled to sickness benefit, because the incapacity cannot be pre-existing. The exception is when, after the person starts contributing, the illness worsens or evolves, and its aggravation leads to an inability to work. In these cases, even if it is an old illness, the INSS can grant the benefit because of the worsening.
Important documents
- Identification document and CPF;
- Work permit or tax card;
- Certificates, exams and medical reports proving incapacity.
How to apply
The request can be made via the Meu INSS app, by telephone on 135 or in person at a branch, by appointment.
Types of sick pay
There are two types of sick pay:
Social security (or ordinary) sick pay: is the benefit paid when the illness or accident suffered is not work-related. These are the main characteristics of ordinary sick pay:
- You must have completed the minimum waiting period of 12 months;
- Time off work does not create stability, meaning that the worker can be dismissed when they return to work;
- The employer has no obligation to pay the FGTS during leave;
- No CAT is issued.
Accident sick pay: is the benefit in the event of an accident at work, professional illness or occupational disease. Its main characteristics are:
- There is no minimum waiting period;
- The leave of absence generates stability for 12 months after the insured person returns to work;
- During the leave of absence, the employer must continue to pay the FGTS;
- The issuance of a CAT is mandatory.
| SOCIAL SECURITY SICK PAY (ORDINARY) | ACCIDENT SICK PAY | |
| Type of disability | Total and temporary, unrelated to work | Total and temporary, due to accident, occupational or professional disease |
| Requirements | Insured status at the time of incapacity + minimum waiting period of 12 months | Insured status at the time of incapacity, no waiting period required |
| Who is entitled | All types of insured | All types of insured |
| Benefit amount | 91% of the average contribution salary | 91% of the average contribution salary |
| How long is it paid for | For as long as the disability lasts | For as long as the disability lasts |
| When it closes | Medical discharge, recovery or return to work | Medical discharge, recovery or return to work |
| You can keep working | No, under penalty of cancellation | No, under penalty of cancellation |
| Stability after return | No | Yes, for 12 months |
| FGTS collection | No | Yes |
| Issuing CATs | No | Yes, mandatory issue |
| Counts towards contribution time (retirement) | Yes | Yes |
ACCIDENT AID
What it is
Accident benefit is a compensation benefit paid to insured people who, after suffering an accident of any kind, are left with permanent sequelae that reduce their ability to do the work they were doing before.
In other words, even after clinical recovery, if there is a partial and definitive reduction in working capacity, the worker is entitled to accident benefit as a form of compensation.
Example: John, a bricklayer, had an accident and fractured his wrist. After treatment, he returned to work, but lost some of the mobility and strength in his hand, which prevented him from fully performing his duties. In this case, he is entitled to accident benefit because his functional capacity has been permanently reduced.
Who is entitled
This benefit is restricted to certain categories of compulsory insured persons. They are only entitled:
- Urban or rural employee;
- Freelance workers;
- Domestic employee;
- Special insured.
Therefore, voluntary insured persons and individual contributors are not entitled to accident aid.
Benefit amount
This benefit does not replace salary and can be received even if the insured person continues to work, unlike sickness benefit and disability pension. In addition, the receipt of accident benefit does not count as contribution time for retirement.
The amount corresponds to 50% of the benefit salary and is paid until the insured person retires or dies.
Important documents
- Identification document and CPF;
- Communication of Accident at Work (CAT), if applicable;
- Medical certificates, exams and reports.
How to apply
Accident benefit should start to be paid the day after sickness benefit ends. However, the INSS doesn't always pay it spontaneously and automatically, precisely because it's not always that the medical examiner finds a permanent reduction in working capacity (even if there is one). It is very common for this benefit to be granted only when requested through legal action.
| Type of disability | Partial and permanent reduction in working capacity |
| Who is entitled | Insured employee (urban or rural), self-employed worker, domestic worker, special insured person |
| Requirements | Insured status at the time of incapacity, no waiting period required |
| Benefit amount | 50% of benefit salary |
| How long is it paid for | Until the insured's retirement or death |
| Can you continue working? | Yes |
| Counts towards contribution time (retirement) | No |
DISABILITY PENSION
What it is
A disability pension, or permanent disability allowance, is a benefit granted to an individual who is totally and permanently unable to work or resume their normal activities. Furthermore, this incapacity cannot be rehabilitated.
Example: Carlos, a bus driver, was diagnosed with a progressive neurological disease that totally impaired his movements and reflexes. After a medical assessment, it was found that he could no longer perform his profession or be rehabilitated for another activity. For this reason, the INSS granted him a disability pension, guaranteeing him a permanent income.
Requirements
In order to claim the benefit from the INSS, you need to:
- Have at least a 12-month waiting period, except in the case of an accident or serious illness as provided for by law;
- Maintain insured status at the time of incapacity;
- Proof of incapacity by medical examination.
How it works
Incapacity must be established by a medical expert. The medical expert must establish that the worker can no longer undergo professional rehabilitation and needs to be removed from his or her activities permanently.
The INSS can summon a disability pensioner for a review every two years to see if they are still totally incapacitated or if they are able to return to work. If the new examination verifies their capacity, the benefit will be terminated.
However, there are two exceptions to the review examination: pensioners over the age of 60, or at least 55 and with more than 15 years' benefit are exempt from new examinations.
Like sickness benefit, disability pension is intended to replace the salary of an individual who is no longer able to work. For this reason, invalidity pensioners cannot engage in any paid activity, at the risk of their benefit being terminated if the INSS finds that they have returned to work.
Benefit amount
General rule: 60% of the average of all contribution salaries + 2% for each year over 20 years (men) or 15 years (women);
If due to an accident at work, occupational or professional illness: 100% of the average salary;
An additional 25% may be added if the insured person needs permanent help from another person.
Important documents
- Identification document and CPF;
- Work permit or tax card;
- Examinations, certificates and medical reports proving permanent incapacity.
How to apply
The request is made via Meu INSS, telephone 135 or in person at a branch.
| Type of disability | Total and permanent, with no possibility of rehabilitation |
| Who is entitled | All types of insured |
| Requirements | Insured status at the time of incapacity + minimum waiting period of 12 months |
| Benefit amount | REGRA GERAL: 60% da média + 2% a mais ao que exceder 20 anos (homem) ou 15 anos (mulher) de tempo ACIDENTE, DOENÇA OCUPACIONAL OU PROFISSIONAL: 100% da média de salários + Adicional 25% em caso de precisar de assistência permanente |
| How long is it paid for | As a rule, it can be terminated in the event of an expert finding that the person is fit to work |
| Can you continue working? | No, under penalty of cancellation |
POSSIBILITY OF LEGALIZATION
It is common for the INSS to deny disability benefits even when there is a right to them, or to terminate payments incorrectly. In these cases, it is possible to go to court. A social security lawyer can help you correctly identify the type of benefit you are entitled to, gather the necessary documents and ensure that your rights are respected in both administrative and judicial proceedings.
In moments of vulnerability, having professional support makes all the difference.
CONCLUSIONS
Although all these benefits are related to the worker's health, it is essential to understand the differences between them in order to know which is the most appropriate for each situation. While sickness benefit is temporary and requires time off work, accident benefit can be paid even if the worker is still working. Disability retirement, on the other hand, requires permanent incapacity and no possibility of rehabilitation. All benefits have their own rules for being granted and can be cut if the INSS considers that the insured person has recovered their working capacity or if they fail to comply with legal requirements, such as attending medical examinations.