who is entitled and how much they receive if they get sick

THE sick pay it is a Social Security compensation for those who cannot work because they are sick.

If you become ill and cannot work, in principle you will not be left without income. It is precisely for this type of situation that the sickness subsidy exists. However, certain conditions must be met in order to be entitled to receive this benefit.

The first, and which applies to all groups that can benefit from this subsidy, concerns the very concept of illness.

That is, Social Security understands that a disease is a morbid and evolutionary situation that incapacitates for work. However, and with some exceptions (which we will explain below), this illness cannot be caused by a professional reason or the responsibility of a third party for which compensation is due. For example, an accident at work or being run over.

So, if you do not meet certain conditions, you may be on sick leave and not receive sickness benefits.

Who is entitled to sickness benefit?

Sickness benefit covers workersincluding those of Domestic Service to make Social Security discounts.

You independent workers (which includes individual entrepreneurs) are also entitled to receive this benefit.

With regard to beneficiaries of voluntary social securitythe sickness subsidy applies to those who work on ships belonging to foreign companies (maritime workers and national watchmen) and to scientific research fellows.

There are also situations in which, even if you are receiving compensation for an accident at work or an occupational disease, you may be entitled to the subsidy. To do so, you will have to be working and making Social Security discounts. In addition, the compensation amount must be less than the sickness allowance.

If you are receiving a pension for an accident at work or an occupational disease, you are also entitled, as long as you are working and making Social Security contributions.

Anyone receiving an indemnity pension or pre-retirement pension is covered by the sickness subsidy, as long as they work and pay contributions.

What are the conditions for accessing the sickness subsidy?

If you are part of one of the groups referred to in the previous point, you will still have to fulfill more conditions to have access to this benefit.

The first is be temporarily disabledwhich has to be certified by the doctor of the competent health service. That is, if you are sick and this does not allow you to work, an SNS doctor must confirm this situation and issue the respective disability certificate.

Another condition is to fulfill the call warranty period. That is, to have, on the start date of the write-off, six months, consecutive or interpolated, of discounts.

If you are self-employed or under the Voluntary Social Security regime, you cannot have Social Security debts.

There is also a third requirement: the professionality index. That is, you must have worked at least 12 days in the first four months of the last six. These 12 days can refer to a single month or be the sum of days you worked during the four months prior to the start of the sick leave.

The answer to this question is yes and no. That is, you can receive sickness subsidy and, at the same time, the Social Insertion Income (RSI) or compensation for disability resulting from an occupational disease and an accident at work. In this case, however, the amount of compensation must be less than the sickness benefit

Pensions within the scope of protection for accidents at work, occupational diseases and others recognized as compensatory are also cumulative with the sickness subsidy.

It can also be accumulated with compensatory payments for holiday and Christmas subsidies. These benefits are awarded by Social Security when, because you are on sick leave, you do not receive these subsidies from your employer.

What installments can you not accumulate?

If you are already receiving a pension (due to disability or old age) you are not entitled to sickness benefit. The same goes for those who receive unemployment benefit or social unemployment benefit.

Subsidies in the context of parenting, benefits from the solidarity subsystem (except the Social Insertion Income) and support subsidy for the main informal caregiver also prevent you from being able to benefit from the sickness subsidy.

See too
Social Assistance for Inclusion: how does it work and who is entitled?

How long is it received?

Except in the case of sick leave, there is a limit to the duration of sick pay. This concession period therefore depends on the type of employment you have:

• Employees, maritime workers and national watchmen who work on ships belonging to foreign companies: up to 1095 days;
• Self-employed (on a green receipt or sole proprietorship); scientific research fellows: up to 365 days;
• Tuberculosis discharge: no time limit.

From what day do you start receiving?

The date on which sickness benefit is awarded also depends on the type of employment you have. Thus, in the case of employees, only the first three days are not paid low. This means that on the fourth day of incapacity they begin to receive.

Self-employed workers must wait 10 days until it starts to be paid, which means that only from the 11th day onwards the write-off starts to count. For example, in a 15-day withdrawal, you only receive four.

The waiting period is even longer for beneficiaries of the voluntary social insurance scheme: they are 30 days.

The exceptions

There are, however, situations in which sickness benefit is paid on the very first day. This is the case of hospitalization or outpatient surgery, as long as they occur in SNS or private hospitals.

Tuberculosis infection is another case where there is no waiting period.

The waiting period also ceases to exist when the illness that started during the period in which the parental benefit was granted goes beyond this period.

Can sickness benefit be suspended?

Yes, there may be a suspension. For example, if obligations are not fulfilled such as staying at home or carrying out medical examinations for which you have been summoned.

If you are receiving benefits in the context of parenting, you will also stop receiving sickness benefit.

The benefit is also suspended if, after evaluation by the Disability Verification Committee, it considers that there are no longer any reasons for the reduction.

When do you lose entitlement to sickness benefit?

Cessation occurs when the period of leave defined in the Certificate of Temporary Disability (CIT) ends, when you return to work or when, after evaluation by the competent health services or the reassessment committee, it is verified that the disability no longer exists.

But be aware that termination may occur for other reasons. If you are summoned for a medical examination and do not appear or if you do not duly justify your absence from home, you may lose your entitlement to the subsidy.

In the case of self-employed workers or beneficiaries of the optional registration scheme, the benefit may be cut if debts to Social Security are not settled within the three months following the month of suspension.

HOW MUCH DO YOU RECEIVE?

The sickness subsidy amount is a daily subsidy amount, which is calculated by applying a percentage to the reference salary.

This percentage varies depending on the duration and nature of the illness, as you can see in the table below. The longer the downtime, the greater the amount to be received.

And if you have tuberculosis?

This disease is another exception. The percentage of the reference remuneration is higher and increases if you have more dependent family members:

• 80% of the reference remuneration if you have up to two dependent family members;
• 100% of the reference remuneration if you have more than two dependent family members.

increase sick pay

When the subsidy corresponds to 55% or 60% of the reference remuneration, there may be an increase of 5% to these percentages. Thus, in a decrease of up to 30 days, the value becomes 60%; in a duration between 31 and 90 days becomes 65%.

For this to happen, it is necessary that:

• The reference remuneration is equal to or less than 500 euros;
• The household has three or more descendants aged up to 16 years old or up to 24 years old if they receive family allowance;
• There are, in the household, descendants with bonus for disability of the Family Allowance for Children and Young People.

What are the limits?

As with other social benefits, there are minimum and maximum limits to the amounts to be received by those on sick leave. So, the lowest amount is 4.80 euros per daywhich corresponds to 30% of the daily value of the IAS or the reference remuneration, if this is lower than that minimum limit.

The maximum value corresponds to the net value of this remuneration.

What are the obligations of those receiving the subsidy?

Whoever receives the sickness subsidy has to fulfill certain obligations, under penalty of, as we have seen, suffering penalties such as the suspension or cessation of support.

One of these obligations just leave the house for medical treatments or, if the doctor authorizes it, from 11 am to 3 pm and from 6 pm to 9 pm. You must also attend the medical examinations to be summoned by the Disability Verification Service (SVI).

Another obligation is to inform Social Security, within five working days, if you are receiving pre-retirement, pensions or compensation for an accident at work.

It must also communicate, within that period, the identification of the person responsible and the amount of the compensation, if there is provisional payment of the subsidy due to an accident at work or third party liability.

If you change address, if you work, even if you are not paid or if you are arrested, you must also inform this entity. The same should be done if any situation arises that implies that you lose the right to this subsidy.

What to do to get?

In fact, in principle you do not have to do anything. The Temporary Disability Certificate is sent electronically by health services to Social Security. This entity checks the conditions and, if they are fulfilled, makes the payment.

If the certificate is passed manually, the beneficiary will have to send, in the 5 business daysa copy of this document to the Social Security service in your area of ​​residence.

Whether the CIT is electronic or manual, you will receive a certified copy to deliver to the employer and thus justify the absence.

Article originally published in July 2019. Last updated in January 2023.