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Order Of 19 June 1997 By Which The Royal Decree 575/1997, 18 April, Amending Certain Aspects Of The Management And Control Of The Economic Benefit For Temporary Disability Social Security Develops.

Original Language Title: Orden de 19 de junio de 1997 por la que se desarrolla el Real Decreto 575/1997, de 18 de abril, que modifica determinados aspectos de la gestión y del control de la prestación económica de la Seguridad Social por incapacidad temporal.

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TEXT

Royal Decree 575/1997 of 18 April 1997 amending certain aspects of the management and control of the economic performance of social security for temporary incapacity, has established a regulation which (a) in several areas of the management of the economic benefit indicated, as well as in the establishment of certain controls in the verification of the maintenance of the right to that provision, in order to ensure the effectiveness of the Social security benefits for temporary incapacity and avoidance of use undue protection, when not fraud.

The application of the aforementioned Royal Decree requires, on the one hand, the implementation of different instrumental mechanisms, basically, of the new models of lower and high medical parts, confirmation of the low and high, in the processes of temporary incapacity, following the forecasts contained in the Royal Decree, and the development of certain precepts of the regulatory standard.

In this sense, the final provision of Royal Decree 575/1995 empowers this department to dictate the general provisions that are necessary for the application and development of the forecasts contained in the the one, to whose purpose the content of the project is commented out.

In its virtue, prior to the report of the Ministry of Health and Consumer Affairs and the corresponding organs of the National Health System, I have stated:

CHAPTER I

General rules

Article 1. Medical parts of temporary incapacity.

1. In accordance with the provisions of Article 1 (7) of Royal Decree 575/1997 of 18 April 1997, the models of medical discharge parts are approved, confirmation of the discharge and discharge of temporary incapacity, which are listed as annexes to the present Order.

2. The lower and high parts of the lower, confirmation, will be edited by the National Institute of Social Security and made available to the National Institute of Health and the corresponding Public Health Services.

In the field of professional contingencies, the Mutual and Occupational Accident and Occupational Diseases of Social Security, the medical parts of the lower, the lower and the high, will be edited by the own mutual societies. in accordance with the models referred to in paragraph 1.

CHAPTER II

Issue of medical parts

Section first. Temporary disability arising from common contingencies

Article 2. Medical parts of temporary disability discharge.

1. The medical part of the temporary incapacity shall be issued immediately after the worker's medical examination by the optional person who carries out the medical examination, extending by an exemplary quadriplicate, using the model shown as Annex I.

The original of the medical part of the discharge, in which the diagnosis, the description of the limitation in the functional capacity that motivates the situation of temporary incapacity and the probable duration of the pathological process, shall be directed to the Health Services Inspectorate of the Social Security or equivalent organ of the respective Public Health Service.

2. Issued the medical part of the discharge, will be given to the worker of two copies, one for the interested party and one for the company.

The worker must submit to the company, within three days, from the date of the issue of the part, the copy to it intended. The company shall complete the paragraphs to it concerning, and shall transmit that, duly sealed and signed, within five days of its receipt, to the managing body, using any means that permit to be established the fact of the communication.

If the company had concluded the coverage of the economic performance of temporary incapacity of the workers to its service with a Mutual of Occupational Accidents and Occupational Diseases of Social Security, the copy referred to in the above paragraph, duly completed, shall be forwarded, within the prescribed period, to the respective mutual party.

The referral by the company, to the managing body, of the copy of the medical part of the lower, where the payment of the economic benefit of temporary incapacity, under the cooperation procedure, shall not be compulsory. voluntary, in the terms laid down in paragraph (d) (1) of Article 77 of the recast text of the General Law on Social Security, adopted by Royal Decree-Law 1/1994 of 20 June.

3. When the medical part of the discharge is issued, the Public Health Service concerned shall forward the copy to the managing body or the mutual entity, as appropriate, within the five-day period from the issue of the party. In the copy of the part to the managing body or the mutual entity, the diagnosis, the description of the limitation in functional capacity, which motivates the situation of temporary incapacity, and the likely duration of the process shall be recorded. pathologic.

4. If the optional person issuing the lower medical part is unable to determine the managing body or partner with whom the undertaking has concerted the coverage of the temporary incapacity, the worker, in the case of closed, shall be given the copy intended for those entities. The worker shall forward the copy to the relevant managing body or partner for any of the following procedures:

By submitting the copy referred to in the company, together with the copy referred to in paragraph 2, so that it is sent, within five days of the filing, to the managing or contributing entity respective.

Well, by referring directly, by the means that it considers to be most appropriate, and that allows to record its receipt, the copy indicated to the respective managing or contributing entity, within five days of the delivery of the mentioned copy by the optional.

The use of the exceptional procedure provided for in this paragraph shall not apply to the confirmation or discharge parts, unless the worker is unable to provide the data relating to the managing body again or contributor.

Article 3. Medical parts for confirmation of the discharge.

1. The medical parts of the confirmation of discharge shall be issued on the fourth day of the start of the temporary incapacity situation and, in turn, as long as the temporary incapacity is maintained, every seven days, counted from the first part of the confirmation.

The confirmation parts shall be issued by the appropriate Health Service optional, on an exemplary fourfold, using the model set out in Annex II.

The original of the medical part of the confirmation of the discharge, in which the diagnosis and the description of the limitation in the functional capacity that motivates, on the date of issue of the part, the continuation in the situation of temporary incapacity, shall be directed to the Inspection of Health Services of the Social Security or equivalent organ of the respective Public Health Service.

2. The medical confirmation of the discharge provided for in paragraph 2 of the previous Article, in respect of the copies to be delivered to the worker, shall be applied to the medical staff, the presentation by the worker in the company of the copy to the worker, and the completion by that of the data relating to it, and its referral to the managing or mutual entity, as appropriate.

When the employment relationship has been extinguished, it shall be for the worker to present directly to the managing or mutual entity, as appropriate, the copy corresponding to the undertaking, within the time limit set for the undertaking.

3. The medical part of the discharge shall be issued by the appropriate Public Health Service to the managing body or to the mutual entity, as appropriate, the copy to which it is intended, within the five-day period, from the date of issue of the part. In the copy to the managing body or the mutual entity, the diagnosis and description of the limitation in the functional capacity, which motivates, on the date of issue of the party, the continuation in the situation of temporary disability, and the likely duration of the pathological process.

4. Where the issue of the third medical part of confirmation of the discharge is appropriate, the optional issuing party shall complete the paragraphs corresponding to the supplementary report, which are set out in the model of the confirmation parts of the discharge. accompanied by Annex II, and in which the ailments suffered by the worker, the prescribed medical treatment, the development of the ailments in the course of the temporary incapacity situation, and the incidence of those on the functional capacity of the person concerned. The likely duration of the process shall also be expressed from the date of issue of the report.

The supplementary medical report, as referred to in the preceding paragraph, must be formalised in successive confirmation parts, every four weeks, from the previous one.

Article 4. High medical parts.

1. The medical part of the discharge in the situation of temporary incapacity shall be issued by the optional Public Health Service, after the medical examination carried out, extending by an exemplary quadriplicate, using the model which is accompanied by Annex I.

The original of the medical part of discharge, in which it must be stated, necessarily, the result and cause that motivates the discharge in the situation of temporary incapacity, will be directed to the Inspection of Health Services of the Safety Social or equivalent organ of the respective Public Health Service.

2. Issued the medical part of discharge, will be given to the worker of two copies, one for the interested party and one for the company.

The medical part of discharge shall be submitted by the worker to the undertaking within 24 hours, and that part, after completion of the corresponding paragraphs, shall forward the copy to the managing body or mutual, as appropriate, within a period of five days from the day of their receipt.

When the employment relationship has been extinguished, it shall be for the worker to present directly to the managing or mutual entity, as appropriate, the copy of the medical part of discharge, within the time limit set for the undertaking.

3. If the medical part of the discharge is issued, the corresponding Public Health Service shall transmit to the managing body or the mutual entity, as appropriate, the copy to it intended, within the five-day period, from the issue of the party. Such copy shall necessarily include the result and the cause of the discharge in the situation of temporary incapacity.

Article 5. Special rules applicable to self-employed persons and to members of the Special Regime of Home Employees.

1. In the case of temporary incapacity for self-employed persons, as well as members of the Special Scheme of Home Employees, it shall be for the parties concerned to forward the copy of the medical staff to the managing body. low, low or high confirmation, using the copy intended for the company.

The remission of the indicated parts shall be made no later than five days after the date of the issue of the item.

2. Selfemployed persons who have concluded the economic benefit with a mutual accident of work and occupational diseases of social security shall forward the copy referred to in the preceding paragraph to the mutual benefit corresponding.

Section 2. Temporary incapacity arising from professional contingencies

Article 6. Medical parts of temporary disability leave.

1. The medical part of a temporary disability shall be issued immediately after the worker's medical examination by the person who makes it, extending by an exemplary fourfold, using the model shown as Annex III.

The original of the medical part of the discharge, in which the diagnosis, the description of the limitation in the functional capacity that motivates the situation of temporary incapacity and the probable duration of the pathological process, shall be directed to the Health Services Inspectorate of the Social Security or equivalent organ of the respective Public Health Service.

2. Issued the medical part of the discharge, will be given to the worker of two copies, one for the interested party and one for the company.

The worker must submit to the company, within three days, from the date of the issue of the part, the copy to it intended. The company shall complete the paragraphs to it concerning, and shall transmit that, duly sealed and signed, within five days of its receipt, to the managing body, using any means that permit to be established the fact of the communication.

3. When the medical part of the discharge is issued, the corresponding Public Health Service shall transmit to the managing body the copy to which it is intended, within the five-day period, from the issue of the party. In the copy of the part to the managing body, the diagnosis, the description of the limitation in the functional capacity which motivates the situation of temporary incapacity and the likely duration of the process shall be recorded. pathologic.

Article 7. Medical parts for confirmation of the discharge.

1. The medical parts for confirmation of the discharge shall be issued within seven calendar days following the start of the incapacity and, successively, every seven days, starting from the first part of the confirmation, extending by an exemplary fourfold, using the model shown as Annex IV.

The original of the medical part of the confirmation of the discharge, in which the diagnosis and the description of the limitation in the functional capacity that motivates, on the date of issue of the part, the continuation in the situation of temporary incapacity and the likely duration of the pathological process, will be directed to the Health Services Inspectorate of the Social Security or equivalent organ of the respective Public Health Service.

2. It shall apply to the medical parts of confirmation of the discharge provided for in paragraph 2 of the preceding Article, in respect of copies to be delivered to the worker, the presentation by the worker in the company of the copy to it intended, as well as the completion by that of the data relating to it, and its referral to the managing body.

When the employment relationship has been extinguished, it shall be for the worker to present the copy for the undertaking directly to the managing body within the time limit set for the undertaking.

3. The medical part of the confirmation of the discharge, by the Public Health Service concerned, shall be transmitted to the managing body, the copy to it intended, within the period of five days, from the dispatch of the part. In any event, the copy of the party to the managing body must include, necessarily, the diagnosis and description of the limitation in the functional capacity which motivates, on the date of issue of the party, the continuation in the temporary disability status.

4. Where the issue of the third medical part of confirmation of the discharge is appropriate, the optional person issuing it shall complete the paragraphs corresponding to the supplementary report, which appear in the accompanying confirmation part model as Annex IV, and in which the ailments suffered by the worker are collected, the treatment prescribed, the evolution of the ailments in the course of the temporary incapacity situation, as well as the incidence of those on the functional capacity from the interested party The likely duration of the process shall also be expressed from the date of issue of the report.

The supplementary medical report, as referred to in the previous paragraph, must be formalised in successive parts of the confirmation of the discharge, every four weeks, from the previous one.

Article 8. High medical parts.

1. The medical part of the discharge in the situation of temporary incapacity shall be issued by the optional Public Health Service, after the medical examination carried out, extending by four-fold, using the model which is accompanied by Annex III.

The original of the medical part of discharge, in which it must be stated, necessarily, the result and cause that motivates the discharge in the situation of temporary incapacity, will be directed to the Inspection of Health Services of the Safety Social or similar organ of the respective Public Health Service.

2. Issued the medical part of discharge, will be given to the worker of two copies, one for the interested party and one for the company.

The medical part of the discharge shall be submitted by the worker to the undertaking, within 24 hours of the following, and the latter, after completing the corresponding paragraphs, shall forward the copy to the managing body, within five days from the date of their receipt.

When the employment relationship has been extinguished, it shall be for the worker to present directly to the managing body, the copy of the medical part of discharge, within the time limit set for the undertaking.

3. If the medical part of the discharge is issued, the corresponding Public Health Service shall transmit to the managing body the copy to it intended, within a period of five days, from the dispatch of the party. In such a copy of the party to the managing body, the result and the cause of the discharge in the situation of temporary incapacity must necessarily be recorded.

Article 9. Special rules in the processes of temporary incapacity of the self-employed.

In the processes of temporary incapacity for self-employed persons included in the Special Agricultural and Workers ' Schemes, it will be for the parties concerned to forward the copy to the managing body. of the medical, low or discharge medical parts, using the copy intended for the company to do so.

The remission of the indicated parts shall be made no later than five days after the date of the issue of the item.

Article 10. Dispatch of medical parts of low or high level by the Mutual Work and Occupational Accident Mutuals of Social Security.

1. In accordance with the provisions of Article 1 (6) of Royal Decree 575/1997 of 18 April 1997, where the cause of the medical discharge derives from an accident at work or a occupational disease, and affects workers of undertakings which have (a) the protection of such contingencies with a mutual accident of work and occupational diseases of social security, or to self-employed persons who, in turn, have concluded with a mutual benefit the coverage of the disability temporary, derived from professional contingencies, the medical parts of the lower, the confirmation of the discharge or (a) a higher level of education, and, where appropriate, supplementary medical reports, will be directly formalised by the medical services of the Occupational Accident and Social Security Accidents Mutua, without the need for such reports to be sent copies of the medical parts to the Health Services Inspectorate of the Social Security or similar body of the relevant Public Health Service, or to the managing body.

2. Workers shall provide the mutual information necessary to carry out the correct completion of the said medical parts.

CHAPTER III

Control of the temporary disability situation

Article 11. Control by the Health Service inspection services.

1. On a quarterly basis, from the start of the temporary incapacity situation, the Health Services Inspectorate of the Social Security or equivalent body of the respective Public Health Service shall issue a medical report for the control of the incapacity. in which all the extremes which, in the case of a medical judgment, justify the need to maintain the temporary incapacity process.

2. The following medical inspection reports shall be transmitted within 10 days of their dispatch by the Health Service to the managing or mutual entity, as appropriate.

3. In the cases referred to in Article 10, the medical inspection report shall be carried out directly by the medical services of the mutual authority.

Article 12. Extension of temporary incapacity.

1. In cases of temporary incapacity, in order to allow the receipt of the relevant economic benefit to be extended once, for the twelve months, the receipt of the discharge may be carried out in the respective part of the confirmation of the discharge. corresponding medical report, describing the following aspects:

(a) The ailments suffered by the person concerned.

b) The limitations of the functional capacity of that.

c) The medical presumption that the data subject, within the following six months, may be discharged for cure.

2. The medical report referred to in the preceding paragraph shall be completed by the corresponding optional on the confirmation part of the discharge immediately preceding the one in which the twelve months of the stay of the person concerned is fulfilled. temporary disability status.

3. In the cases referred to in Article 10, the medical report referred to in paragraph 1 shall be carried out directly by the medical services of the mutual authority.

Article 13. Requirements for workers for medical recognition.

1. The managing body or the mutual entity, in the latter case, in respect of processes arising from common contingencies, may provide that workers who are in a situation of temporary incapacity, be recognised by the medical services attached to them.

The provisions of the foregoing paragraph are without prejudice to the powers that correspond to the mutual in the processes of temporary incapacity arising from professional contingencies, and which affect the employed persons or on their own account, which have formalised the coverage of the temporary incapacity, arising from the contingencies referred to.

2. Medical examinations and other evidence of incapacity shall be based on the data underlying the parts of the discharge or confirmation of the discharge or the supplementary medical reports provided for in the Articles as well as in subsequent examinations and medical opinions carried out.

To this end, when the worker is called to a medical examination by the medical services of the managing body or collaborator, he will provide the clinical history of his or her being provided by the corresponding person. Health Service. In any case, the medical services of the managing or contributing entity may have access to the clinical documentation necessary for the purpose of controlling the processes of temporary incapacity.

3. In accordance with the provisions of Articles 3 and 6 of Royal Decree 575/1997, medical examinations shall be carried out in accordance with, in any case, the right to privacy and the dignity of workers, as well as to ensure the confidentiality of the information concerning its health status, the provisions of paragraphs 3 and 4 of Article 3 of the said Royal Decree being applied.

4. The unfounded refusal to submit to medical examinations shall give rise to the issue of the proposal for a medical discharge, in accordance with the terms set out in the following Article.

Article 14. Declaration of medical discharge on the proposal of the medical services of the managing body or of the mutual entity.

1. The managing body or the mutual entity, in the latter case, in respect of situations of temporary incapacity arising from common contingencies, where, in the light of the medical conditions of discharge or confirmation of discharge, the supplementary reports and, singularly, of the medical examinations carried out for this purpose, consider that the worker may not be prevented from work, may, through the medical services attached to one or the other, formulate reasoned proposals for medical discharge.

2. The proposals for medical discharge will be made, through the Health Services Inspection Units of the Social Security or similar organ of the corresponding Public Health Service, to the doctors who have issued the lower or lower parts of the health services. confirmation of the discharge, which must be given within 10 days from the date on which the proposal has been made available to the said Inspection Unit, either confirming the medical discharge or admitting the Proposal for discharge, through the issue of the relevant medical part of discharge.

In the event that the discharge is confirmed, any medical care or control that is deemed necessary must be reported, communicating it to the managing or mutual entity.

3. The Health Services Inspectorate of the Social Security or similar body of the respective Public Health Service, where the said doctors shall not, expressly and within the period specified in the previous paragraph, give their opinion on the proposals for discharge, or when they disagree with the statement made, may, within the period of 15 days, be counted from the next to the one in which the discharge proposal is made available, agree the discharge, communicating the action made to the managing body or to the mutual entity that had formulated the proposal.

As provided for in the preceding paragraph, it is without prejudice to the powers of the Health Services Inspectorate of the Social Security or equivalent body of the respective Health Service to agree the medical discharge, mediated or not proposed by the medical services of the managing or mutual entity.

Additional disposition first. Complementary medical reports and control reports.

1. The supplementary medical reports, which must accompany the third part of the confirmation of the discharge, as well as the successive parts of confirmation, every four weeks from the previous one, as referred to in Articles 3 (4) and 7, paragraph 4, shall apply to processes of temporary incapacity which are in progress at the date of entry into force of this Order.

To this end, the first supplementary report shall be made with the third confirmation part corresponding to the entry into force of this Order.

2. Similarly, the control report to be carried out by the Health Services Inspectorate of the Social Security or similar body of the respective Public Health Service, as referred to in Article 11, shall apply to the incapacity processes. temporary that are in progress on the date of entry into force of this Order.

For this purpose and if the temporary incapacity process has already exceeded the three months, the first control report shall be carried out upon completion of the following monthly allowance, from the date of the start of the incapacity situation temporary. When the first control report is issued, the successive reports shall be made from the date of issue of the first report to three months.

3. In the case of temporary incapacity proceedings which are in force on the date of entry into force of this Order, which have not exceeded 12 months, it is essential that the receipt of the temporary disability allowance be extended. issue of the report referred to in Article 12.

Additional provision second. Exhaustion of temporary incapacity for the duration of the maximum period and extension of its effects.

1. When the situation of temporary incapacity is extinguished, for the course of the eighteen months, the Health Services Inspectorate of the Social Security or similar body of the corresponding Health Service shall formulate the corresponding discharge for the cure or discharge from exhaustion of the maximum period of temporary incapacity.

In the event that the exhaustion is high, this end must be justified by virtue of the consequences or serious anatomical or functional reductions of the worker, of which the possible situation is reasonably deducted constitutive of a permanent disability, or the need for the worker to continue with the prescribed medical treatment.

2. The extension of the effects of the temporary incapacity, in the cases referred to in the second subparagraph of Article 131a (2) of the General Law on Social Security, shall necessarily require the appropriate opinion of the medical services. of the National Institute for Social Security, in which the advisability of not proceeding immediately to the immediate qualification of permanent invalidity, attended to the clinical situation of the person concerned and the need to continue with the prescribed medical treatment.

Single transient arrangement. Use of new models of low parts, confirmation of low and high temporary incapacity.

1. As long as the new models of low and high medical parts, approved by this Order, are not made available to the Public Health Services, they may continue to be used provisionally with prior to the date, the copy shall be sent to the National Institute for Social Security to the Mutual Insurance Fund for Occupational Accidents and Occupational Diseases of the Social Security concerned, where the latter is the entity responsible for the payment of the benefit.

Likewise, as long as they have not been edited by mutual associations, in the field of their competences, the parties mentioned in the preceding paragraph, in accordance with the above models, may continue to use the models provisionally in

2. For the purposes referred to in the first provision, as long as they are not available to the corresponding Public Health Services, or are not edited by the mutuals, the corresponding medical parts for confirmation of the discharge, adapted to the models set out in Annexes II and III respectively to this Order, the supplementary medical reports referred to in Articles 3 (4) and 7 (4) and the medical reports for the purposes of the extension of temporary incapacity, as referred to in Article 12, shall be extended in accordance with the models they have established or can establish the Public Health Services or the mutuals.

Single repeal provision. Rules to be repealed.

Any provisions of equal or lower rank shall be repealed as opposed to this Order and in particular:

Article 17 and paragraphs 3, 4 and 5 of Article 20 of the Order of 13 October 1967 laying down rules for the application and development of benefits for temporary incapacity for work in the scheme General of Social Security.

Articles 4, 5 and 8 of the Order of 6 April 1983 laying down rules for the control of the situation of temporary incapacity for work in the social security system.

Final disposition first. Application and development powers.

By the Secretary of State for Social Security, prior to the report of the General Secretariat for Health Assistance and the Health Ministry of the Autonomous Communities with full health care, the provisions of a general nature that are necessary for the implementation and development of the provisions of this Order.

Final disposition second. Entry into force.

This Order shall enter into force on the day following that of its publication in the "Official State Gazette".

Madrid, June 19, 1997.

BOCANEGRA SANDS

Excmo. Mr. Secretary of State for Social Security.

ATTACHMENTS

Annex I: Low/high medical parts of temporary incapacity, derived from common contingencies.

Annex II: Medical parts for confirmation of the discharge, arising from common contingencies.

Annex III: Low/high medical parts of temporary incapacity, resulting from accident at work and occupational disease.

Annex IV: Medical parts for confirmation of the discharge, arising from accidents at work and occupational disease.

ANNEX I

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ANNEX II

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ANNEX III

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ANNEX IV

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