Go to the updated text

RISKS OF WORK Decree 717/96 Give powers to the Superintendence of Labour Risks and the Superintendence of Administration of Pension and Pension Funds to regulate the actions of the Medical Commissions and the Central Medical Commission. Determination of Contingencies and Incapacities. Intervention of the Medical Commissions. Transmit to them. Resources.

Bs. As., 28/6/96

VISTO Law No. 24.557, and

CONSIDERING:

That Act No. 24.557, as an integral rule of the Social Security System, has as its main objective the protection of the worker, against the contingencies provided for therein, first through prevention and second by means of the foreseen benefits and expeditious procedures to achieve them.

That a contingency occurred and in order to achieve the effectiveness of the system advocated by the Law, it is necessary that the benefits be perceived by the worker in a timely time, eliminating or reducing the temporary gap between the time the need and the time in which it is satisfied.

That in the light of the above, it is necessary to establish a way of impeling the procedure for determining the disastrous consequences of a contingency and to protect the worker immediately.

That the employer's complaint is the tool imposed by Law No. 24.557 for the Insurer to learn about the existence of a contingency. Without prejudice to this and in the light of the above paragraphs, it is consistent with the purpose of the norm to establish alternative channels of communication for the purpose of providing greater agility to the system.

Once the procedure is activated, it is reasonable to draw a flexible mechanism, based on the interaction of the parties, that allows a quick resolution alternative to situations where there are no conflicts between them.

It should be noted that the above-mentioned flexibility should be limited to certain situations and within precise parameters that avoid distorting the objectives of the Act.

That the Medical Commissions are the bodies established by the Law to resolve the discrepancies between the insurance company and the survivor or its beneficiaries, and therefore it is appropriate to regulate the carrills that allow a rapid intervention of them.

That the procedure before the Medical Commissions should also address the immediacy in the granting of benefits, and therefore it is considered necessary to establish short periods for the resolution of conflicts between the parties when the delay could cause serious injury to the worker, which does not prevent the establishment of more comprehensive time-frames to resolve the other situations before them.

That the intervention of the Medical Commissions should not imply the abandonment of the conciliatory spirit of the procedure to be standardized, but should instead impregnate them with a mediating attitude, opening the active participation of the parties in the conformation of the resolution. The procedure thus follows the sharp trend of new national legislation.

That the Medical Commissions and the Central Medical Commission are composed of selected human resources with a view to the new functions assigned to them by Law No. 24.557, and taking into account the essentially variable nature of the situation of incapacity to work until the declaration of its definitive character or even the medical discharge, it is prudent and logical that those, as organs of the administration, act and survive on the accelerated, changing and complex pace of the events that demand basic judicial control.

It is necessary, in terms of resources, to reconcile the regime established by Law No. 24.557 with the pre-existing rule of Law No. 24.241, without prejudice to establishing the procedure before the Central Medical Commission in accordance with the legal mandate.

That it is prudent, taking into account the dynamism of the system, to grant powers to the SUPERINTENDANCE OF RISKS OF WORK and to the SUPERINTENDANCE OF ADMINISTRATIVES OF JUBILATIONS AND PENSIONS so that they precisely regulate the actions of the Medical Commissions and the Central Medical Commission in certain aspects, as well as the way to finance their functioning.

That the present is determined by article 99 (2) of the National Constitution and article 21, paragraph (3) of Act No. 24.557.

Therefore,

THE PRESIDENT OF THE ARGENTINA NATION

RIGHT:

CHAPTER I

DETERMINATION OF CONTINGENCES AND INCAPACITIES

Article 1 . The employer is obliged to report to the insurance company, immediately known, any work accident or occupational disease that suffers from its dependents.

The complaint may also be made by the worker himself, his or her beneficiaries or by any person who has been aware of the work accident or professional illness.

Art. 2o La The employer ' s complaint must contain at least the data required by the WORKING RISK SUPERINTENDANCE. For the other subjects provided for in article 1 of this Decree, it shall be sufficient that the complaint be in writing and contain a relation of the facts, the identification of the parties and the signature of the complainant. Art. 3o La The complaint will be addressed to the insurance company, but it may be presented to the service provider that the insurance company can do so. Art. 4o . When the complaint is filed directly with the insurance company, it must take the necessary precautions so that the worker immediately receives the benefits in kind.

When the complaint is submitted directly to the service provider, it shall:

(a) To take the necessary precautions for the worker to receive immediate benefits in kind and,

(b) to refer the complaint to the Insurer within the time limit of VEINTICUATRO (24) hours received, so that the complainant accepts or rejects the claim.

Art. 5o . In the circumstances of Article 4 of this Decree, benefits in kind shall be granted to the worker while the claim is not rejected in the terms of the following article. Art. 6th . The insurance company and the service provider authorized under Article 3 of this Decree may not refuse to receive the complaint. In all cases, the Insurer must be issued expressly by accepting or rejecting the claim and promptly notify the worker and employer of the decision.

The silence of the Insurer will be understood as acceptance of the claim that has elapsed TEN (10) days after the complaint has been received. This period shall be suspended in the case of article 10, paragraph 1 (d) of this Decree.

Rejection may be based only on the absence of the employment relationship or on any of the cases referred to in article 6 (a) and (b) of Act No. 24.557.

The Insurer may not reject the claim on the basis of the absence of employment relationship recognized by the employer.

Art. 7o . Accepted the complaint, the Insurer must specify, in the notification provided for in the preceding article, the medical diagnosis, the type of incapacity to work suffered by the worker and, where appropriate, the character and degree, indicating the content and scope of the in-kind benefits to be granted.

The worker shall be obliged to undergo the control of the physician appointed by the Insurer as often as reasonably as required.

Art. 8o . The insurance company, on its own or at the request of the worker, may review the type, character and degree of incapacity determined above, as well as the content and scope of the in-kind benefits, and must notify the worker of the result of the review. Art. 9th . The determination of the existence of a professional disease must be carried out, both by the Insurers and by the medical commissions, in accordance with the Manual of Procedures for the Diagnosis of the Professional Diseases which, to that end, establish the SUPERINTENDANCE OF RISKS OF WORK.

CHAPTER II

INTERVENTION OF THE MEDICAL COMMISSIONS

Art. 10. Las The Medical Commissions should intervene only in the following assumptions:

(1) At the request of the worker:

(a) When the complaint is rejected by the Insurers by denying the existence of the working nature of the accident or the professional character of the disease, or in the cases referred to in section 6 (3) of Law No. 24.557.

(b) When you have divergences with the insurance company in relation to the situation of Early Labour Incapacity (ILT) or Permanent Labour Incapacity (ILP).

(c) When you have divergences with the insurance company regarding the content and scope of the benefits in kind.

(d) When three (3) days after the complaint had passed, the Insurer had not expressly issued accepting or rejecting the claim.

(2) In order to extend the time limit for the provisionality of a Permanent Labour Incapacity (ILP), as set out in Article 9(1) of Law No. 24.557.

(3) In cases where the final character of a Partial Permanent Labour Incapacity (IPP) should be determined, unless the parties had agreed to that character, and the degree of incapacity affecting the worker, to the labour authority authorized to that end by the WORKING RISK SUPERINTENDANCE.

The agreements must be approved by such authority and be adapted to the Incapacity Assessment Table and the Professional Disease List established by Law No. 24.557.

(4) In all cases where the final character of a Total Permanent Labour Incapacity (IPT) should be determined.

(5) In the cases provided for in article 20, paragraph 2, of Act No. 24.557.

Art. 11. Las The Medical Commissions will not follow up on issues relating to the existence of the working relationship, which must be resolved previously by the competent authority.

Differences relating to base income, in determining the amount of allowances, shall be decided by the competent authority, without affecting the worker ' s right to receive such benefits on the basis of the income recognized by the obligation to pay.

CHAPTER III

TO THE MEDICAL COMMISSIONS

Art. 12. La WORKING RISK SUPERINTENDANCE will establish the necessary requirements for formalizing requests for intervention with the Medical Commissions. The presentation will be made at the headquarters of the Medical Commission or through the postal service provided for this purpose.

The parties shall, in their first submission, constitute a legal domicile where all notifications made by the Medical Commissions shall be valid.

Requests for intervention related to the existence of psychophysical harm or illness or to the type, character and degree of incapacity to work or the content and scope of benefits in kind should be subscribed by appropriate health professionals.

Art. 13. . Received the request for intervention, the Medical Commission will set a hearing within the TEN (10) following days, notifying the interested parties with TRES (3) days in advance of the place, day and time for their realization.

The notification shall contain the substantial data to determine the circumstances underlying the intervention of the Medical Commission, the identification of the requesting party and the employer and the intimation to present the background of the case that the parties have in their possession, subject to the expectation of resolving the matter with the elements in the file.

Art. 14. La The Medical Commission, when its intervention is required to declare the definitive character of an incapacity, must carry out the necessary steps and dictate the Resolution within a period not exceeding the SESENTA (60) days of receipt of the first request.

The same period of SESENTA (60) days will have the Medical Commissions to dictate Resolution on those issues that, for a reason, determine that they do not cause serious injury to the worker.

In other cases, the Resolution shall be issued within the time limit of VEINTE (20) days of receipt of the application.

Art. 15. . In the Resolutions that determine Temporary or Permanent Labour Incapacity, the Medical Commission shall indicate a time limit within which the Insurer shall undertake a further review of the type, character or degree of incapacity granted, and must notify the worker of the result. Art. 16. . The applicant must submit, at the time of the hearing, supplementary studies and any other element specified in the presentation, on which it has been based to request the intervention; likewise, the other parties may present the relevant background.

In the same act, the parties involved may perform their discard. If the Insurer is raiding the worker's claim, the procedure will be suspended.

Art. 17. . The worker will be obliged to undergo medical examinations indicated by the Medical Commission. In the event that it makes it difficult to review or carry out supplementary studies, the Medical Commission will dictate according to the background in its power.

If the worker provides a background for those who are unable to personally attend the summons for a review, the Medical Commission shall designate a medical professional to move to the place where the worker is in order to do so.

Art. 18. . The parties may designate experts on the part to participate in the hearing and in the other proceedings to be carried out. The fees that the same will be paid by the proponents. These professionals will be entitled to be heard by the Medical Commission, to present the studies and diagnoses carried out at their expense, background, reports and a synthesis of their said ones will be dumped in the records to be published, which must be subscribed by them, being responsible for their statements and opinions, but they will not be able to raise any incidences in the processing of the records. Art. 19. . From the action at the hearing, it will be recorded in an Act that will subscribe to all the participants.

The Medical Commission may endorse the agreement reached by the parties or resolve the matter on the basis of the facts and evidence submitted to it and the other evidences and clarifications it may require.

Agreements between parties that are not compatible with the incapacity assessment table and the list of professional diseases established by Act No. 24.557 shall not be approved.

Art. 20. Las The Medical Commissions may indicate the conduct of complementary studies, expert expertise and any other necessary diligence, when the background was not sufficient to issue resolution. These shall be carried out by the Insurers on the assumption that due diligence has not been carried out by them. Otherwise, they shall be financed in accordance with article 51 of Act No. 24,241, replaced by article 50 of Act No. 24,557. They may also request the recruitment of professional services or technical agencies to be issued on areas beyond their professional competence when required by the conflict. They may also require the collaboration of the labour authority to release evidence at the scene.

The powers set forth in this article shall be exercised in accordance with the provisions of the SUPERINTENDANCE OF JUBILATIONS AND PENSIONS FUNDERS and the SUPERINTENDANCE OF RISKS OF WORK jointly.

Art. 21. Las The resolutions of the Medical Commissions should be notified to all interested parties within the time limit of CINCO (5) days of issuance. Art. 22. . The WORKING RISK SUPERINTENDANCE is empowered to impose additional contributions to the Assurers to finance the expenses that demand the functioning of the Medical Commissions when their opinions are modified by them at the request of the worker, or when they unjustly request their intervention, without prejudice to the penalties that they may correspond to the application of article 32 of Law No. 24.557.

CHAPTER IV

RESOURCES TO THE MEDICAL COMMISSIONS

Art. 23. . Only those Resolutions of the Medical Commissions that cannot be revised in accordance with article 22 of Law No. 24.557 will be appealed. Art. 24. Las The resolutions of the Medical Commissions will be appealed by the worker and the insurance companies. Art. 25. . Determining the definitive character of a Total Permanent Labour Incapacity (IPT), shall be resorted to in accordance with the procedure set out in article 49, paragraph 3 - Law No. 24,241, by the persons mentioned in that Law and in the preceding article. Art. 26. Los The resources will be filed in writing with the Medical Commission that issued the Resolution, within the TEN (10) days after the notification. Art. 27. Las The Medical Commissions should elevate the proceedings to the Central Medical Commission within the SETENTA and DOS (72) hours counted from the expiry of the deadline to appeal.

The Provincial Medical Commissions shall elevate the proceedings to the competent Federal Court when the worker has filed an appeal and also opted in this regard, attracting in his case the remedies filed by the Insurer.

Where the assumption of article 25 of the present Decree or in any remedy of the parties is made for the determination of a definitive Permanent Labour Incapacity (IPT), the provisions of the preceding paragraph shall not be applicable, and the proceedings must be brought to the Central Medical Commission in accordance with the procedure established by Act No. 24,241.

Art. 28. . Only evidentiary measures that had been denied in the previous instance can be offered. Art. 29. El The resource will be granted in relation to devolutionary effect. Art. 30. La The Central Medical Commission will notify the parties of the receipt of the file. The applicant will express his or her grievances within the time limit of CINCO (5) days.

The expression of grievances will be transferred to those interested for the period of CINCO (5) days.

Art. 31. La The expression of grievances must contain the concrete and reasoned critique of the Resolution of the Medical Commission that the appealer considers wrong. It will not be sufficient to refer to previous submissions and may base their claims on facts not alleged in the previous instance. Art. 32. . Once the resource has been answered or the deadline for doing so, the Central Medical Commission will carry out the process by ordering, if it deems appropriate, the necessary tests by setting a maximum time limit for its production of CUARENTA (40) days, which can be extended to SESENTA (60) days when the circumstances so require. It will then issue Final Resolution within a maximum period of TREINTA (30) days. Art. 33. . THE SUPERINTENDANCE OF JUBILATIONS AND PENSIONS FUNDERS and the SUPERINTENDANCE OF RISKS OF WORK are empowered to jointly designate medical professionals to perform the functions of Technical Secretaries of the Central Medical Commission, with the scope and modalities that they establish. Art. 34. . Completion of the evidentiary process, the parties who believe it appropriate may claim, for which purpose the proceedings will be at their disposal for consultation within a common time of CINCO (5) days. The Central Medical Commission will issue a technical resolution based on a period not exceeding TREINTA (30) days. Art. 35. La The SUPERINTENDANCE OF RISKS OF WORK will be responsible for dictating the complementary rules for the procedure set out in this Decree. Art. 36. . The SUPERINTENDANCE OF JUBILATIONS AND PENSIONS FUNDERS and the WORKING RISK SUPERINTENDANCE will jointly establish the tariff regime of the Medical Commissions and the Central Medical Commission according to the average cost of each file, which will be calculated taking into account the fixed and variable costs.

They will also be able to equip the Medical Commissions and the Central Medical Commission with technical, national or regional commissions to conduct opinions on matters other than the professional competence of their members.

Art. 37. Las The rules of this Decree established for the insurance companies shall apply to employers who are included within the insurance system. Art. 38. . Communicate, publish, give to the National Directorate of the Official Register and archvese. . MENEM. . Jorge A. Rodriguez. . José A. Caro Figueroa.