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Order Ess/1187/2015, 15 June, Which Develops The Royal Decree 625/2014, Of 18 July, Which Regulates Certain Aspects Of The Management And Control Of The Processes For Temporary Disability In The First Three Hundred And Sixty And...

Original Language Title: Orden ESS/1187/2015, de 15 de junio, por la que se desarrolla el Real Decreto 625/2014, de 18 de julio, por el que se regulan determinados aspectos de la gestión y control de los procesos por incapacidad temporal en los primeros trescientos sesenta y...

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Royal Decree 625/2014, of 18 July, which regulates certain aspects of the management and control of processes for temporary incapacity in the first three hundred and sixty-five days of its duration, has come to to establish a new regulation which has an impact on a number of issues in the management of the temporary disability situation. This regulation responds, among other reasons, to certain legal reforms introduced in recent years in the field of temporary incapacity, and to the progress in the means of coordination of actions between the various entities involved in the management.

The modifications introduced by Royal Decree 625/2014 have affected, mainly, the issue of the medical parts of discharge, confirmation and discharge, so that, maintaining the rigor in the observation of the sickness or injuries to the worker and their impact on their ability to carry out the work, they save red tape and adapt the emission of the parts to the estimated duration of each process. To this end, temporary protocols have been established for the medical acts of confirmation of the discharge according to the estimated duration of the process, which will be fixed by the corresponding physician, to his medical criterion, counting to this end. with tables of optimal duration based on the diagnosis, occupation and age of the worker.

Also, Royal Decree 625/2014 improves the mechanisms of communication, coordination and collaboration among the different entities involved in the management of temporary incapacity, as well as the possibilities of control of the the provision, in order to lighten the existing procedures and charges.

The application of the aforementioned royal decree requires, on the one hand, the implementation of different instrumental mechanisms, basically, of the new models of low/high medical parts and confirmation in the processes of temporary incapacity, in accordance with the provisions laid down in that rule and, on the other hand, the necessary development of certain provisions of the regulatory standard. This is the answer to this ministerial order.

In the process of its processing, the order has been submitted to the public authorities involved and the social partners and has also been informed by the Ministry of Health, Social Services and Equality.

The order is issued in accordance with the provisions of Article 5.2.b) of the recast text of the General Law of Social Security, approved by the Royal Legislative Decree 1/1994 of 20 June, and in the final provision seventh of Royal Decree 625/2014, of 18 July.

In its virtue, in use of the powers conferred, I have:

CHAPTER I

General rules

Article 1. Medical parts of temporary incapacity.

In accordance with the provisions of Articles 2 and 5 of Royal Decree 625/2014 of 18 July 2014 governing certain aspects of the management and control of processes for temporary incapacity in the first three hundred Sixty-five days of its duration, the models of the low/high medical parts and the confirmation of the temporary incapacity, which are listed as annexes to this order, are approved.

The workers shall provide the persons who are responsible for the issue of the aforementioned medical parts with the data necessary for their correct completion.

Article 2. Types of temporary disability processes based on their estimated duration.

1. In accordance with Article 2.3 of Royal Decree 625/2014 of 18 July, four types of temporary disability processes are distinguished, depending on their estimated duration:

a) Very short estimated duration process: less than five calendar days.

b) Short estimated duration process: 5 to 30 calendar days.

c) Average estimated duration process: 31 to 60 calendar days.

d) Long estimated duration process: 61 or more calendar days.

2. It is up to the doctor who gives the medical part of the discharge and confirmation to determine, at the time of issue, the estimated duration of the process. The optional may alter that estimated duration at a later time as a result of the modification or update of the diagnosis or health development of the worker. To this end, as provided for in Article 2.4 of Royal Decree 625/2014 of 18 July 2014, it will issue a confirmation part which will contain the new estimated duration and, where appropriate, the framing of the process in a different type than those provided for in the the previous section.

3. For the purpose of assigning the estimated duration to each process, the optional will have tables of optimal duration for the different pathological processes that can generate disabilities, as well as tables on the degree of incidence of them. in the various work activities. These tables will be regularly provided and reviewed by the National Social Security Institute.

CHAPTER II

Expedition of the medical parts of low and confirmation

Article 3. Dispatch of the medical discharge parts.

1. The medical part of the temporary incapacity, whatever the determining contingency, shall be issued immediately after the medical examination of the worker, by the public health service provider, using the model as shown in Annex I.

In the event that the medical discharge derives from an accident at work or from a professional illness, the coverage of which corresponds to a mutual partner with the Social Security, in future mutual, will be the physician of the medical service of the mutual one who, immediately after the medical examination of the worker, issues the medical part of the discharge using the model listed as Annex I.

2. Where the optional public health service or the mutual authority considers that this is a very short process of estimated duration, it shall issue the part of the discharge and discharge in the same medical act. To this end, it shall use a single item according to the model set out in Annex I, stating, together with the data relating to the discharge, the identification of the discharge and the date of the discharge, which may coincide with the day of the discharge or be included in the of the following three calendar days.

However, the worker may request that a medical examination be carried out on the day that has been set as a discharge date, and the optional, if he considers that the worker has not recovered his or her work capacity, may to modify the duration of the process initially estimated, by issuing, for the purpose, a confirmation part of the discharge in the form provided for in Article 4. In this first part of the confirmation, which will leave the discharge in the lower part without effect, the diagnosis, the estimated new duration and the type of process as laid down in Article 2.1, as well as the date of the following, shall be indicated. medical review.

3. Where the optional public health or mutual service considers that it is a process of short, medium or long estimated duration, it shall enter the date of the next scheduled medical review at the lower part of the process, which shall in no case be the case, shall exceed in more than seven calendar days the date of the medical discharge, in the case of processes of short or medium estimated duration, or of fourteen calendar days for processes of long estimated duration.

On the date of the first medical review, the discharge part or, if applicable, the discharge, the first part of the confirmation shall be extended, as indicated in the following article.

Article 4. Issue of the confirmation parts of the discharge.

1. The confirmation parts shall be issued by the relevant public health service provider, or by the mutual authority where the temporary incapacity derives from a professional contingency covered by it, using the model shown as Annex II.

2. Confirmation parts will be issued based on the estimated duration of the process, according to the following rules:

(a) In processes of very short estimated duration, the issuance of confirmation parts shall not proceed, without prejudice to the provisions of the second paragraph of Article 3.2.

(b) Short estimated duration processes: the first confirmation part shall be issued within a maximum period of seven calendar days from the date of the medical discharge. The second and successive parts of confirmation shall be issued every fourteen calendar days, at most.

(c) Average estimated duration processes: the first confirmation part shall be issued within a maximum period of seven calendar days from the date of the medical discharge. The second and successive parts of confirmation shall be issued every twenty-eight calendar days, at most.

(d) Long estimated duration processes: the first confirmation part shall be issued within a maximum period of fourteen calendar days from the date of the medical discharge. The second and successive parts of confirmation shall be issued every thirty-five calendar days, at most.

In any case, regardless of the estimated duration of the process, the physician will issue the medical discharge for healing or improvement that allows for the usual work, when considering that the worker has recovered their work capacity, or on the basis of a proposal for permanent incapacity, or at the start of a maternity situation.

If the worker does not go to the medical checkup provided for in the parts of the discharge and confirmation, the medical discharge may be issued for failure to appear.

Produced a modification or update of the diagnosis or a variation of the estimated duration according to the health evolution of the worker, a confirmation part will be issued in which the diagnosis will be recorded updated, the new estimated duration and the date of the next revision. Subsequent confirmation parts will be issued based on the new estimated duration.

3. Where a worker in temporary incapacity is receiving health care in a public health service other than that which has been provided by him, that circumstance shall be reflected in the confirmation part immediately. above, by completing the appropriate section. This shall also indicate the date on which the following medical review will be carried out by the new public health service.

4. The optional public health service or the mutual optional if it is a professional contingency in charge of the same, when it issues the last part of confirmation before the exhaustion of the 365 calendar days, will communicate the worker in the act of medical recognition who, after the expiry of that period, the control of the process shall be hereinafter referred to as the National Institute of Social Security under the terms laid down in Article 128.1 (a) of the Law General of Social Security, informing him that he will not issue more confirmation parts. This is without prejudice to the continued provision of health care by the public health service or the mutual service to the public.

To this end, in that part of the confirmation, the optional, instead of the date of the next medical review, will fill in the section corresponding to the pass to control by the National Institute of Social Security, pointing out the day of compliance with the 365 calendar days of temporary incapacity.

The public health service will communicate the date of exhaustion of 365 days immediately to the National Social Security Institute immediately to its compliance and, in any case, no later than the first working day. next.

5. In the processes in which the subsidy is in charge of a mutual, whatever the contingency of which they derive, the National Institute of Social Security will communicate to it, immediately, that the process has reached the 330 calendar days the duration according to the data in the databases of the system, indicating that from the exhaustion of 365 days, the managing body shall exercise the powers that correspond to it in accordance with Article 128.1.a) of the recast text the General Law of Social Security, approved by the Royal Legislative Decree 1/1994 of 20 June.

Dealing with processes derived from professional contingency, the mutual, once received the indicated communication and before the temporary incapacity reaches the 345 calendar days of duration, will be able to do to the National Institute of Social security a reasoned proposal for action in one of the senses referred to in the second paragraph of Article 128.1.a. Such a proposal will not be binding on the National Social Security Institute.

This Institute will give express resolution in the exercise of these powers, whatever the contingency.

Article 5. Supplementary reports.

In the processes of temporary incapacity of estimated duration of more than 30 calendar days, the management of which corresponds to the public health service, whatever the contingency of the result, the second part of the confirmation of the A supplementary medical report shall be completed and updated by the optional person issuing the confirmation part, in accordance with the terms and conditions laid down in Article 4.1 of Royal Decree 625/2014. with the content referred to in that Article.

CHAPTER III

High-medical declaration in temporary disability processes

Article 6. Dispatch of medical parts of discharge by the public health service provider or the public service provider.

1. The medical part of discharge shall be issued by the optional public health service, or by the other party if the process derives from professional contingency covered by it, after the worker's recognition, using the model that is accompanied by Annex I.

2. The medical discharge shall determine the termination of the temporary incapacity and the subsequent allowance on the day of issue, without prejudice to the continued provision of care by the relevant health services to the worker. health that advises your status.

Article 7. Dispatch of senior doctors by medical inspectors of public health services.

The medical inspectors of the respective public health service who, in accordance with the provisions of Article 5 of Royal Decree 625/2014, issue medical discharge, shall use the model Annex I. The processing of the discharge, of which two copies are to be delivered to the worker, shall be as provided for in Chapter IV of this order.

Article 8. Dispatch of senior doctors by medical inspectors attached to the National Institute of Social Security and Social Institute of the Navy.

1. Medical inspectors of the National Institute of Social Security or the Social Institute of the Navy, which, as provided for in Article 5 of Royal Decree 625/2014, issue medical discharge, shall use the model shown in Annex I. The processing of the part of the discharge, of which two copies shall be delivered to the worker, shall be as provided for in Articles 10, 11, 12 and 13 of this order.

The National Institute of Social Security or the Social Institute of the Navy, as appropriate, shall promptly transfer the part of the party immediately and, in any event, on the first working day following that of that issue, to the public health service, for their knowledge, and to the mutual when, in the case of common contingencies, the coverage of the economic benefit corresponds to it.

2. In cases where the mutuals formulate the National Institute of Social Security or the Social Institute of the Navy for discharge, as provided for in Article 6.3 of Royal Decree 625/2014, they shall do so by means of telematics. The managing body shall decide within the four-day period laid down in that Article.

If the managing body considers that the request by the mutual authority does not proceed, it shall communicate it to the other party by telematic, immediately and, in any event, on the first working day following the date on which the request was made. decision.

If the managing body considers that the request by the mutual authority is high, it shall issue the relevant party, as referred to in paragraph 1 of this Article. The processing and communication of the said part shall also be carried out in accordance with paragraph 1.

3. Where in a process of temporary incapacity the medical part of discharge by the National Institute of Social Security or, where appropriate, by the Social Institute of the Navy has been issued, through the medical inspectors attached to those entities, They shall be the only competent authority to issue through such inspectors a new discharge for the same or similar pathology, during the one hundred and eighty calendar days following the date on which the discharge was issued, using the model of the Annex I. Such casualties shall be communicated to the Public Health Service as well as to the mutual one where appropriate the coverage of the economic performance. In such cases, the control of the situation will be carried out, from that moment, directly by the National Institute of Social Security or the Social Institute of the Navy, without the issue of the issue of confirmation parts.

CHAPTER IV

Common rules on handling low/high medical parts and confirmation

Article 9. Referral of low/high medical parts and confirmation, by public health services and mutuals.

The public health service or the mutual service, depending on who has issued it, will forward the low/high part and confirmation to the National Social Security Institute, by means of telematics, immediately and, in any case, on the first working day following that of dispatch.

Exceptionally, when the physician does not have the means indicated, the actions will be carried out through the medical parts on paper. However, in such cases, the data relating to those parts must be transmitted by the National Institute of Social Security to the National Institute of Social Security by the public health service or by the mutual service within two working days of its issue.

Article 10. Delivery of the part to the worker and presentation in the company of the copy intended for it.

1. The optional public health service or the mutual member issuing the lower/high medical part and confirmation shall provide the worker with two copies of the same, one for the person concerned and one for the company.

2. The worker is required to submit to the company the copy of the parts of the discharge and confirmation intended for it within three days from the date of issue.

You are also required to submit to the company the copy intended for it from the discharge part within 24 hours of your issue.

Similarly, in the very short estimated duration processes, the worker will submit to the company the copy of the low/high part intended for it within 24 hours of the date of discharge. Exceptionally, if the doctor issues the first part of the confirmation because he considers that the worker has not recovered his or her work capacity, as provided for in the second paragraph of Article 3.2., the worker will present it to the company within 24 hours of their dispatch, together with the initial low part.

However, if the employment relationship ends during the temporary incapacity situation, from that moment the worker will have to present the copy of the confirmation and discharge parts to the company, to the entity the management or mutual fund covering the economic performance of temporary incapacity, within the same time limits as in the preceding paragraph.

Article 11. Processing by the employer.

1. The company shall enter in the copy of the part of the lower part delivered by the worker the price data relating to it, for the purposes of determining the basis of the economic performance for temporary incapacity. It shall also record the key to the national occupation code, the code of the province of the health centre in which the medical part has been issued and the generic data to be established for identification purposes of the process and the undertaking, defined through the Electronic Data Remission (RED) system.

2. The company has the obligation to transmit to the National Institute of Social Security, the part of the discharge, confirmation or discharge to the same by the worker, after completing the sections to it concerning, through the RED system, with immediate character and, in any case, within the maximum period of three working days from its receipt. This obligation corresponds to undertakings even if they have assumed the payment, in their capacity, of the economic benefit of temporary incapacity, on a voluntary basis, in the terms of Article 77,1 (a) and (d) of the General Law of the European Union. Social Security.

The obligation to present copies of the medical parts, by the RED system, will also reach the groups of companies and the collegiate professionals who, by agreement or representation of the company, come presenting or present such medical parts and are or are authorised for the use of such a system.

3. Access to the consultation, processing and exploitation of the data contained in the copy of the parties referred to in this Article may only be carried out by the National Social Security Institute and, where appropriate, the Social Institute of the Navy or the corresponding mutual. Also, access to the consultation of the data contained in the copy of the submitted parts may be carried out by the General Treasury of the Social Security exclusively in relation to those aspects that determine the conditions of quotation specific to workers in the situation of medical leave.

In any case, the transmission, cession, treatment and exploitation of the data collected in the copies of the medical parts, submitted in accordance with the provisions of this article, are subject to the provisions of the Organic Law. 15/1999, of 13 December, Protection of Personal Data.

4. The telematic presentation of copies of the medical parts indicated shall determine that the copies must not be presented on paper.

Models of copies of paper-based medical parts must be retained by the companies for a period of four years, counted from the date of the telematic submission of the same.

Article 12. Special rules applicable to certain workers.

In the processes of temporary incapacity in which the direct payment of the subsidy by the managing or contributing entity proceeds, it shall be for the parties concerned to submit to the same the lower/high or confirmation medical parties, using the copy intended for the company.

The submission of the indicated parts shall be made at the latest within the time limits specified in Article 10.2.

Article 13. Processing by the National Social Security Institute.

The National Institute of Social Security will give the procedure that corresponds to the medical parts of discharge and confirmation intended for the same. In the case of processes derived from a common contingency, the National Social Security Institute shall transmit to the Social Institute of the Navy, or to the corresponding one, immediately and in any event on the first working day following that of its receipt, low/high medical parts and confirmation of workers in respect of those covering the economic benefit due to temporary incapacity arising from the contingency.

CHAPTER V

Control of the temporary disability situation

Article 14. Control by the medical inspection services of the public health service.

1. In the case of processes whose management corresponds to the public health service, on a quarterly basis, from the start of the temporary incapacity situation, the Health Services Inspectorate of the Social Security or equivalent organ of the respective public health service, or the primary care physician under his supervision, shall issue a medical report for the control of the incapacity in which all the extremes which, in the medical judgment, justify the need to maintain the process of temporary disability.

2. The public health services shall, within five working days of their issuance, make those medical reports available for inspection at the disposal of the medical inspectors attached to the National Social Security Institute or the Social Institute of the Navy, or the physicians ' faculty in respect of the common contingency processes for which they are covered by the coverage. The same obligation shall exist in respect of the supplementary medical reports and their updates referred to in Article 5, and the medical tests performed throughout the process.

Additional disposition first. Physicians and medical inspectors from the Social Institute of the Navy.

The references made in this order to the medical practitioners of the public health service, as well as to the medical inspectors of the public health service, shall be construed as medical inspectors or medical inspectors. of the Social Institute of the Navy in those cases where the latter exercise the same functions, because the transfer of healthcare competence to an autonomous community has not occurred.

Additional provision second. Temporary disability allowance during partial retirement.

The temporary disability allowance, whatever the contingency of which it derives, caused by a worker in a partial retirement situation, shall be paid in direct payment, in any case and for the duration of the (a) the competent authority of the managing body or the relevant partner, without operating the compulsory collaboration scheme referred to in Article 16.1. (b) and (c) of the Order of 25 November 1966 on the cooperation of undertakings in the management of the General System of Social Security.

The managing or contributing entity shall inform the undertaking of the commencement of the payment of the subsidy to the direct payment scheme, as well as its completion.

Additional provision third. National Institute for Health Management.

The references to the public health services that are contained in this order must also be understood as being carried out by the National Institute of Health Management, the managing body of the Social Security, to whom the management is responsible. of health benefits in the areas of the cities of Ceuta and Melilla.

Single transient arrangement. Processes in progress.

New models of medical parts will be used in temporary disability processes that are in progress on the date of entry into force of this order and have not exceeded 365 days.

However, in respect of the indicated processes, these models and the supplementary reports shall be issued with the periodicity and with respect to the mandatory data required by the previous regulations.

The rules set in this order as well as the new models of low/high parts and confirmation of the discharge will apply to the periods of relapse in temporary disability processes initiated prior to the date of entry into force of the order, where the new medical discharge is issued after that date.

The transmission of the parts and data corresponding to the processes referred to above shall be carried out in accordance with the provisions of this order from its entry into force.

Single repeal provision. Rules to be repealed.

As many provisions of equal or lower rank are repealed, the Order of 6 April 1983 laying down rules for the control of the situation of incapacity for work is hereby repealed. The Order of 19 June 1997, for which the Royal Decree 575/1997 of 18 April 1997 and Order TAS/399/2004 of 12 February 2004, on the presentation of information by the parties to the information provided by the Court of Justice of the European Communities Low, low, and high health care providers for temporary disability processes.

Final disposition first. Competence title.

This order is issued in accordance with the provisions of Article 149.1.17. of the Spanish Constitution which attributes exclusive competence to the State in matters of the economic regime of social security.

Final disposition second. Amendment of the Order of 13 October 1967 laying down rules for the application and development of the temporary incapacity for work in the General Social Security Scheme.

Article 9 (2) of the Order of 13 October 1967 laying down rules for the application and development of the provision of temporary incapacity for work in the General System of Social Security is hereby established. drafted in the following terms:

"In the event that the worker is discharged without permanent incapacity, he will be entitled to receive the allowance corresponding to the day of discharge."

Final disposition third. Enforcement powers.

The Secretary of State for Social Security is empowered to make the necessary provisions for the application of this order.

Final disposition fourth. Entry into force.

This order shall enter into force on the first day of the sixth calendar month following that of its publication in the "Official State Gazette".

Madrid, June 15, 2015. -Minister of Employment and Social Security, Fatima Banez García.

ANNEX I

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ANNEX II

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