Which question it resolves
The procedure determines the contingency underlying temporary incapacity and other related matters, such as whether it constitutes a relapse or which entity is responsible for benefits. It is not a general investigation of fault or an automatic finding of employer non-compliance.
Nor does it replace the clinical decision on a person’s health. A diagnosis describes a health problem; classifying its origin requires applying Social Security categories and requirements to the established facts.
Who can initiate it
It may be initiated once the medical sick-leave certificate has been issued, through the legally provided routes. These include an application by the worker or their representative and initiation by the INSS on its own authority. The regulation also provides for initiatives by authorised bodies and entities.
Use the official channel and appropriate form. Check that the procedure concerns determination of contingency: it is not the same as requesting a review of a fitness-for-work discharge, claiming a different benefit or reporting an accident.
Prepare an understandable application
The documentation should connect the incapacity episode with the proposed cause. It may include medical reports, test results and relevant employment documentation. A clear chronology helps distinguish dates of exposure, onset of the problem, consultations and sick leave.
As a practical approach, identify actual tasks, the circumstances of the event and documents supporting each statement. Avoid accumulating irrelevant information or presenting technical conclusions without supporting data. Retain proof of submission and subsequent communications.
Reports, representations and the decision
The INSS notifies initiation and requests background information under the procedure. Specific time limits apply to providing documentation and making representations. The incapacity assessment team issues a mandatory report before the provincial directorate makes its decision.
The maximum decision period of fifteen working days runs from submission of documentation or expiry of the set time limits, not automatically from the initial application. Read notifications in full: their instructions identify the action and deadline applying at each stage.
Effects and preventive action
The decision may lead to adjustments in benefits and responsibility for them. Review or appeal routes must be examined in light of the decision and applicable procedure; a generic deadline should not be applied to every communication.
Prevention has its own purpose. Where there are indications of work-related harm, risks and measures should be examined without waiting for an administrative dispute to end. The company receives the information needed to act, without indiscriminate access to the person’s medical history.
Hypothetical example: organising the background information
A person considers that sick leave processed as non-occupational is related to a workplace exposure. They prepare a chronology, provide reports and request a determination through the official channel. They subsequently respond to the request received, keeping a copy of their submission.
In parallel, the prevention service reviews exposure conditions and proposes measures where appropriate. The preventive review does not predetermine the administrative outcome, and the existence of proceedings does not justify delaying necessary protection.
