Mutual insurance company collaborating with Social Security

What is a mutual insurance company?

Mutual insurance companies originated in the 20th century as employer-run mutual insurance schemes for workplace accidents and were gradually integrated into the Social Security system as collaborating entities. Law 35/2014 modified their legal framework, adopted their current name of mutual insurance companies collaborating with Social Security, strengthened public oversight, and clarified their functions. Their nature is unique: they are private entities, but they manage public Social Security funds; their assets dedicated to collaboration are public; and they are subject to the control of the General Treasury, the General Comptroller’s Office, and the Directorate General for the Organization of Social Security.

Companies’ membership in the mutual insurance company is voluntary, but coverage for occupational accidents and illnesses is mandatory: every company must have its employees covered for work-related accidents and illnesses with a mutual insurance company or the National Social Security Institute. Self-employed workers must also choose a mutual insurance company to manage their occupational accidents and illnesses. The membership agreement is valid for one year and is automatically renewed.

For companies, the mutual insurance company is the daily point of contact in the event of an accident: healthcare, rehabilitation, financial benefits, monitoring of temporary disability, and, where applicable, proposals for discharge, declaration of permanent disability to the National Social Security Institute (INSS), and support for reintegration. In terms of prevention, it carries out advisory and informational activities funded by contributions, manages the incentive system for reducing accident rates (bonuses), and collaborates in accident investigations within its scope of responsibility, without replacing the company’s own occupational health and safety organization.

Main functions

• Occupational contingencies. Healthcare and rehabilitation assistance, financial benefits for temporary incapacity, permanent incapacity, death and survivorship arising from work accidents and occupational diseases, with initial determination of the occupational nature of the contingency.
• Temporary disability due to common contingencies. Management of the financial benefit, with powers of control and monitoring and of proposing discharge to the public health services, when the company has opted for this coverage.
• Other benefits. Risk during pregnancy and breastfeeding, care of minors affected by cancer or other serious illness, and protection for cessation of activity of self-employed workers.
• Prevention funded by contributions. Activities including advising SMEs, dissemination, training and preventive education, and management of incentives for accident reduction, in accordance with the annual authorization of the Ministry.
• Special benefits. Supplementary social assistance through the Special Benefits Commission for injured workers and their families.
• Collaboration with Social Security. Collection of contributions through the Treasury, management of the affected assets, reserves, and participation of employers, workers and the self-employed in its governing and participatory bodies.

Relationship with occupational risk prevention

• It is not a prevention service. Law 35/2014 and subsequent regulations definitively separated mutual insurance companies from external prevention services; the company’s preventive organization remains its own responsibility in accordance with Law 31/1995 and Royal Decree 39/1997.
• Advice. Mutual insurance companies can advise member companies, prioritizing SMEs and those with higher accident rates, and carry out visits and preventive action plans within the framework of authorized programs.
• Incentives. Management of applications for the system of reduction of contributions for professional contingencies to companies that have reduced their accident rate, regulated by Royal Decree 231/2017.
• Accident data. The mutual insurance company has information on accidents and illnesses that allows the company to analyze trends and prioritize measures.
• Reintegration. Readaptation programs and support for returning to work after accidents with lasting effects.

Organizational application: how to manage the relationship with the mutual insurance company

1. Choosing the mutual insurance company by assessing its healthcare network, territorial coverage, temporary disability management services and preventive programs, with consultation with workers’ representatives in accordance with regulations.
2. Formalize the association agreement and, where applicable, the option for coverage of temporary incapacity due to common contingencies.
3. Establish the internal procedure for action in case of accident: assistance at the mutual center, accident report through the Delt@ system within the deadline, internal communication and investigation.
4. Coordinate with the mutual insurance company the management of temporary disability, proposals for discharge and reinstatements, respecting the confidentiality of health data.
5. Take advantage of preventive advice programs and accident information as a complement, never as a substitute, for your own or external prevention service.
6. Request the incentives for accident reduction when the requirements are met, with the preventive documentation that proves the investment and compliance.
7. Maintaining a separation of the functions of the mutual insurance company, the prevention service, and health surveillance within the preventive management system.

Preventive management software allows for the recording of accidents and the linking of mutual insurance company information with internal investigations, action planning, and accident indicators, with traceability for incentive applications.

Limits and common mistakes

1. Believing that the mutual insurance company covers the company’s prevention obligations or acts as an external prevention service.
2. Confusing a mutual insurance company with private insurance: it manages public social security benefits with public rules and controls.
3. Delaying the communication of the accident or the report through Delt@, with sanctioning and management consequences.
4. Do not use the mutual insurance company’s accident data in preventive planning.
5. Requesting the incentive for reducing accidents without meeting the preventive documentary requirements.
6. Neglecting the protection of health data in information exchanges with the mutual insurance company.

The legal framework for mutual insurance companies is found in the General Social Security Law and its collaboration regulations; this document is for informational purposes only.

Regulatory and reference framework

• Royal Legislative Decree 8/2015, General Social Security Law, articles 80 to 102. Legal regime of mutual insurance companies collaborating with Social Security.
• Law 35/2014, of December 26. Modification of the legal regime of mutual insurance companies and new name.
• Royal Decree 1993/1995, of December 7. Regulation on collaboration of mutual insurance companies.
• Royal Decree 231/2017, of March 10. System for reducing contributions for occupational contingencies for companies that have reduced workplace accidents.
• Law 31/1995, of November 8. Preventive organization of the company, distinct from the collaboration of mutual insurance companies.
• Social Security . Official website with information on mutual insurance companies and benefits.

The Ministry of Inclusion, Social Security and Migration publishes annually the resolutions that establish the preventive activities that mutual insurance companies can carry out using contributions.