The additional eleventh provision of the General Law of Social Security authorizes the Mutual Work and Occupational Health Accident Mutuals to manage the coverage provided by the System of Social Security. Social security in the face of the situation of need called temporary incapacity, arising from common contingencies, with respect to the workers at the service of associated enterprises, when they formalize the protection of the contingencies (a) professional training in the same way and opt for the coverage of the economic performance of this situation take effect for the corresponding Mutual. It also authorizes the same entities to be able to manage the coverage of the aforementioned economic benefit in relation to the workers included in the Special Administrative Workers ' Regime, as well as to the self-employed. included in the Special Agrarian Regime, which have chosen to benefit from the coverage of this benefit.

The same legal standard refers to regulatory development the regulation of the legal regime that disciplines the management of this coverage, but without altering the structure of the economic benefit that constitutes its object, since it is (a) the provision in the protective action of the Social Security System, regardless of the entity's management. On the other hand, it orders the establishment of management and control instruments to enable effective action, and also to regulate regulatory development. Finally, it authorizes the Mutual Work and Occupational Diseases of Social Security to establish collaboration agreements with the National Institute of Health or the Health Services of the Autonomous Communities for the effective management of this function.

The regulatory development of the above subjects, in those specific aspects of the management entrusted to the Mutual Working and Occupational Diseases of Social Security, has been used in the Regulation of the Cooperation of the same, subject to this amendment. This Regulation regulates the way in which the persons empowered may establish the obligation to provide for the management by the Mutual Mutual Fund of the economic benefit of temporary incapacity for common contingencies and the scope of the same. It also regulates the financial and accounting arrangements for the activity, establishing the corresponding technical guarantees to ensure compliance with the public obligations assumed, as well as the destination of the economic results obtained. in the development of management. It also regulates the instruments for the control and monitoring of the provision and the cooperation agreements referred to above.

The experience gained in the short period of time since the validity of this regulatory standard has shown that its provisions are insufficient in order to provide the intended purpose, which is an effective management the economic performance of temporary incapacity, nor does it regulate in sufficient detail the content and form of the exercise of the functions corresponding to the management entrusted, which creates legal uncertainty for the entities, beneficiaries and undertakings involved in the provision.

On the other hand, Article 78 of Law 13/1996, of 30 December, of Tax, Administrative and Social Measures, has established new rules aimed at supplementing those contained in the 11th additional provision of the General Law on Social Security, which respects its integrity. The aim is to regulate the aspects of the management of the economic supply in which health management has an impact, in order to make the first one more effective, since this is the sole and final object of all the activities which In the case of temporary incapacity, in accordance with Articles 38 (1) (c) and 129 of the General Law on Social Security, they are covered by the provisions of the General Law on Social Security. It also refers to the regulatory area for the development of its provisions.

To this effect, and without prejudice to the general provisions on the management and control of the provision regardless of which entity it is carried out, it is necessary to regulate those specific aspects of the management developed by these entities, with the consequent modification of the General Regulation on collaboration in the management of the Mutual Work and Occupational Diseases of Social Security.

Thus, this Royal Decree aims to amend the said Regulation in order to comply with the mandate of the legislator expressed in Article 78 of Law 13/1996 and, at the same time, to regulate in greater detail certain activities falling within the scope of the functions conferred on the Mutual Fund by the additional provision of the General Law on Social Security.

In its virtue, on the proposal of the Minister of Labour and Social Affairs, in agreement with the Council of State and after deliberation of the Council of Ministers at its meeting of 18 April 1997,

D I S P O N G O:

Article first.

The General Regulation on collaboration in the management of the Mutual Work and Occupational Diseases of the Occupational Safety Diseases, approved by Royal Decree 1993/1995 of 7 December 1995, is amended in the following cases: terms:

One. New wording is given to Article 37 (3), the terms of which shall be as follows:

" 3. These are the competencies of the Monitoring and Monitoring Committee of each Mutua, the following:

a) To know the criteria of the Mutual Action in the different modalities of collaboration that it has authorized.

b) Participate in the preparation of the preliminary draft budget of the Mutual Fund.

c) Report the annual memory project, prior to its referral to the General Board.

d) Having prior knowledge of the Director-Manager's nomination proposals.

e) Having knowledge and being informed of the management carried out by the Entity in the different modalities of collaboration that has been authorized.

f) To propose any measures deemed necessary for the best fulfilment of the aims of the Mutual Fund in the areas of management authorised, in the framework of the general objectives of Social Security.

g) In general, to be able to request how much generic information is needed regarding the management carried out by the Entity in the different modalities of collaboration that it has authorized. "

Two. 1. Article 71 (1) is reworded, the terms of which shall be as follows:

" 1. The Mutual Insurance and Social Security Accidents Mutuals shall assume the coverage of the economic benefit due to temporary incapacity arising from common contingencies, in favour of the workers employed by their employees. (a) to the extent to which they have exercised this option with the same scope as the social security management bodies, subject to the rules governing the provision of the social security scheme in which they are registered and with the Details of the details of this Regulation. '

2. The first subparagraph of Article 71 (2) is reworded, the terms of which shall be as follows:

" 2. The financing of the functions and activities attributed to the Mutuas under the provisions of the preceding paragraph shall be made by the delivery to them, through the General Treasury of the Social Security, of the fraction of the quota which determine the Ministry of Labour and Social Affairs. The contributions received by the Mutuas for this purpose shall not apply to them as laid down in the second section of Chapter III of the General Regulation on the listing and settlement of other social security rights, approved by Royal Decree 2064/1995 of 22 December 1995 on the contribution to the maintenance of the common and social services of Social Security. "

Three. Article 73 shall be deleted, passing the articles listed below, with the following numbering:

Article 74 becomes Article 73; Article 74 of Article 76 becomes Article 75; Article 77 becomes Article 76; Article 77 shall become Article 76; Article 78 shall become Article 77; Article 79 shall become Article 77. Article 78; Article 80 shall become Article 79.

Four. The third subparagraph of Article 73 (3) of the numbering set out in the preceding paragraph is reworded, the terms of which shall be as follows:

" Similarly, when the reserve for the stabilization of temporary incapacity for common contingencies is provided at its maximum level, the positive results resulting from this management will be allocated to the the provision and reserves provided for in Article 65 of this Regulation, provided that they have not been able to be covered to the maximum extent by the application of the results produced in the management of professional contingencies. The excess resulting from the application of the same, if applicable, as set out above, shall be distributed as follows:

(a) 90 per 100 shall be used for the purposes provided for in Article 91.1 of the General Law on Social Security, and shall be entered in the General Treasury of Social Security within the time limit set in the first paragraph of the Article 66.1 of this Regulation.

(b) 10 per 100 shall be used to provide the voluntary reserves of the entity referred to in Article 66.3 of this Regulation or, in the absence of such reserves, for the purpose specified in the preceding paragraph. "

Five. Article 76 (2) of the numbering provided for in paragraph 3 of this Article, as referred to in paragraph 3, is deleted, and the terms of paragraph 2 shall be as follows:

" 2. The Mutual Insurance and Occupational Diseases of the Occupational Safety and Health Insurance Workers ' Association shall be required to cover the benefit of the benefit of the self-employed persons who are in temporary incapacity for work. with the same scope as social security management entities, subject to the rules governing the provision of the social security scheme in which they are registered and with the particularities set out in this Regulation.

The financing of the functions and activities attributed to the Mutuas pursuant to the provisions of the preceding paragraph shall be made by the delivery to them, through the General Treasury of the Social Security, of the Part of the quota to be determined by the Ministry of Labour and Social Affairs, which shall not apply to it in the second section of Chapter III of the General Regulation on the listing and settlement of other security rights Social, approved by Royal Decree 2064/1995 of 22 December 1995, in respect of the contribution to the support for the common and social services of social security. "

Six. Article 78 of the numbering set out in paragraph 3 of this Article is reworded, the terms of which shall be as follows:

" Article 78. Obligations of employees.

1. The worker shall comply with the obligations relating to the listing, documentation, information and other similar obligations arising from the applicable social security scheme, as well as from the provisions of this Regulation and other provisions of this Regulation. application.

2. In addition, the Working Party and the Occupational Diseases of the Social Security Mutuals shall require the employees of their own account to adhere to the declaration referred to in the supplementary provision of Royal Decree 2319/1993. December 29, in the same way, within the same time limits and with the effects established for its presentation to the National Institute of Social Security. "

Article 2.

A new Chapter IV is added to Title II of the General Regulation on cooperation in the management of the Mutual Work and Occupational Diseases of Occupational Safety and Occupational Diseases, approved by Royal Decree 1993/1995, of 7 June 1995. December, the terms of which will be as follows:

" CHAPTER IV

Rules common to Chapters II and III

Article 80. Content of the management.

1. The Mutual Insurance and Occupational Diseases of Occupational Safety and Occupational Diseases shall grant the economic benefit due to temporary incapacity arising from common contingencies in the amount and other conditions resulting from the applicable rules the social security scheme in which the employees of the associated undertakings who had exercised this option or those who had made their accession were subject to the social security scheme and shall dispense with the benefit in the same way as the Social Security Management Entities.

The management includes the function of the declaration of the right to the allowance, after examination of the concurrency of the facts that constitute the legal situation of temporary incapacity and of the requirements that condition the birth of the rights, as well as the functions of refusal, suspension, cancellation or termination of the right. In addition, the Mutual Fund shall bear the cost of the temporary incapacity allowance, the cost of the administrative management carried out in respect of these benefits and the monitoring and monitoring of the economic performance and the situation of the temporary incapacity, as well as that of the actions referred to in Article 82 and the agreements and concerts referred to in Article 83.

2. Acts declaring the right to an economic benefit or refusing, suspending, restricting, cancelling or extinguishing the right shall be reasoned and shall be formalised in writing, subject to the effectiveness of the acts of the notification to beneficiaries, as well as to the employers of those beneficiaries who maintain a working relationship, without prejudice to Article 81.

By way of derogation from the foregoing paragraph, issued by the medical discharge, the right to the allowance shall be deemed to be extinguished with effect from the day following that of its issue, unless that date is a public holiday or a public holiday, in which The right will be maintained in such days.

3. Mutuals may call for action by the Health Services Inspectorate of Social Security under the terms recognised by the companies in the Order of the Ministry of Labour of 21 March 1974. They may also bring to the attention of that Inspectorate any fact that they have made manifest in the development of their functions of collaboration for the adoption by the same of the actions or measures corresponding to the scope of their material competences.

4. In addition, where due to concurrent circumstances in a company, the Ministry of Labour and Social Affairs, at the request of the Ministry of Labour and Social Affairs, is considered to be a non-member for the best control of temporary incapacity processes. The Member State concerned may agree to suspend the compulsory cooperation referred to in Article 77 of the General Law on Social Security. The suspension shall be lifted if the reasons for the suspension have disappeared. From the suspension, as well as from its lifting, the General Treasury of Social Security will be transferred to the appropriate effects.

Article 81. Acts of initial determination of the allowance and provisional payments.

1. The amounts collected by the worker in respect of temporary incapacity benefit shall be of a provisional nature within two months from the date on which the payment was made and the final payment was made at the end of the period. (a) the final date for the application of the Agreement, except in the case where the Mutua, prior to its completion, adopts the agreement for recognition of the right referred to in paragraph 3 of this Article. During the same period of time, the Mutual Fund may issue acts whereby the amount of the subsidy is determined initially and on a provisional basis.

2. During the period referred to in the preceding paragraph, the Mutual Working Party and the Occupational Diseases of Social Security may review their acts of initial determination of the allowance and regularise the whole or part of the allowance. the amount of the economic benefits which have been paid on a provisional basis, which shall be effected by means of a reasoned agreement. The arrangements for regularisation and for the review of provisional claims shall be reasoned and shall be notified to the persons referred to in Article 80 (2) of this Regulation.

3. The final determination of the amount of the subsidy shall be made by means of the act of declaration of the right referred to in Article 80 (2) of this Regulation or by the period referred to in paragraph 1 above.

Article 82. Emergency health actions of the Mutuas.

When, more than 15 days after the absence of work, the incapacity situation is prolonged as a result of the delay in the practice of diagnostic tests or in the application of medical treatment or Surgical procedures prescribed by the Health Service concerned, the medical services of the Mutuae may carry out such tests or treatments, with the prior informed consent of the worker and the conformity of the health authority of the Corresponding Health Service, once the adequacy and quality of the same and in the the terms and conditions laid down in the agreements and conventions referred to in Article 83.2.

Article 83. Cooperation and coordination.

1. In the field of cooperation and coordination between the Mutual Working and Occupational Diseases of the Occupational Safety and Occupational Diseases, the National Institute of Health and the Health Services of the Autonomous Communities, the Mutuas will be able to carry out the complementary examinations, medical tests, reports, treatments and surgical interventions which are of interest to them, as well as the actions referred to in Article 82.

2. The relevant agreements and conventions shall set out the economic compensation to be met by the Public Health Service concerned as a consideration for the services performed by the Mutuas, as well as the form and conditions in which the compensation will be satisfied.

Such agreements and agreements must be submitted in advance to the approval of the Ministry of Labour and Social Affairs.

Article 84. Recovery of amounts unduly received.

The Mutual Economic and Social Security Accidents of Accidents and Diseases shall communicate to the General Treasury of the Social Security their agreements and the judicial decisions declaring the existence of amounts unduly paid for by temporary incapacity for economic benefits managed by them, so that they are required to be reimbursed in accordance with the rules laid down in Royal Decree 1637/1995 of 6 October 1995. The proceeds to be obtained shall be transferred by the General Treasury from the Social Security to the corresponding Mutual Fund. "

Article 3.

The references to the Ministry of Labor and Social Security and the General Secretariat for Social Security, contained in the General Regulation on collaboration in the management of the Mutual Work and Disease Accidents Social Security professionals, approved by Royal Decree 1993/1995, of 7 December, will be understood, respectively, to the Ministry of Labour and Social Affairs and to the Secretariat of State of Social Security.

Single repeal provision.

As many provisions of equal or lower rank are repealed, they oppose the provisions of this Royal Decree.

Single end disposition.

This Royal Decree shall enter into force on the first day of the second month following that of its publication in the "Official Gazette of the State".

Given in Madrid to April 18, 1997.

JOHN CARLOS R.

The Minister of Labour and Social Affairs,

JAVIER ARENAS BOCANEGRA