Benefit for non-work-related illness and non-work-related accident (ITCC - temporary disability resulting from a non-work-related illness)

When a worker is unable to perform their activity due to a non-work-related illness or a non-work-related accident, FREMAP guarantees a streamlined and secure management of the temporary disability benefit. As a Mutual Society Collaborating with Social Security, we collaborate with the INSS and the Public Health System to ensure the correct medical, administrative and financial processing. On this page you will find what the benefit covers, requirements, necessary documentation and the steps you must follow, whether you are an employee, self-employed worker, company or a labour consultancy.

On this page, we explain, clearly and step by step, who can apply, the requirements and how to process it with FREMAP.

Persons protected by the benefit

Temporary disability benefits due to non-work-related illness or non-work-related accident are aimed at those who are temporarily unable to perform their professional activity and require healthcare. They can access:

Employees and those treated as such under the General Scheme.
Workers in special systems (agriculture, domestic, sea, coal mining).
Self-employed workers (RETA) with non-work-related illnesses and non-work-related accidents covered.
Civil servants and military personnel when the applicable regime refers to the Social Security regime.

The protection covers both spontaneous illnesses and accidents without a work-related connection, provided there is medical leave and the contribution requirements are met. FREMAP acts as the paying entity from the 16th day onwards in processes where direct payment or delegated payment is required.

Conditions for accessing the subsidy

To receive the benefit, the following must be met:

General requirements

Be affiliated and registered, or in a situation treated as such, with the Social Security system.
Being unable to work and receiving healthcare from the Public Health System (PHS).
Have a medical certificate of sick leave issued by the SPS.

Contribution requirement (waiting period)

Non-work-related illness: have contributed for 180 days in the previous 5 years.
Non-work-related accident: does not require a waiting period.
Self-employed workers: same requirements, in addition to being up-to-date with contributions (mechanism for requesting payment if there is debt).

Situations without required waiting period

disabling secondary dysmenorrhea
Termination of pregnancy
Organ or tissue donation

In these SPECIAL SITUATIONS, on the day of sick leave, the employee will receive their salary from the company or will not receive a subsidy (in the case of self-employed worker) and will receive the benefit from the day after the sick leave, in the following situations:

Termination of pregnancy
39th week of pregnancy

However, temporary disability benefits will be received from the day of sick leave in these other situations:

Living organ and tissue donors for transplantation
disabling secondary dysmenorrhea

Documents required according to each case

If there is an employment relationship

The company must submit the financial data via the RED System.

Self-employed workers (RETA)

Statement of activity status (deadline: 15 business days from the date of sick leave).
Proof of being up-to-date with the payment of contributions, if applicable.

In direct payment requests FREMAP

Official request from FREMAP.
Company certificate (when the employment relationship has ended).
Correct bank details for payment.

FREMAP may request additional information to verify the waiting period, contribution or medical situation.

Beginning of the right and key times

Start of the benefit

Days 1–3: without subsidy.
Days 4–15: company pays (employed workers).
From the 16th day: FREMAP pays.
Self-employed workers: subsidy from day 4.

Resolution

FREMAP resolves direct payment requests within a maximum of 30 calendar days from the date the file is complete.

Duration of the TD

Up to 365 days.
Extension of an additional 180 days (max. 545 days).
Up to 730 days delay in qualification (INSS)

Statute of limitations

Five years after taking medical leave.

How to proceed, step by step

The itinerary for the worker is simple if we look at it in phases:

Go to the Public Health System. Obtain the medical certificate of sick leave. The SPS automatically sends the information to the INSS.

Communication to FREMAP and company. The INSS electronically sends the reports to FREMAP. The company communicates economic data through RED.

If you are self-employed, submit your activity declaration within 15 working days.

Review by FREMAP. We will validate: status of discharge, waiting period, contributions, documentation and clinical consistency.

Resolution and notification. FREMAP will recognise or deny the right and will officially inform you.

What is TD for common contingencies?

Temporary disability in which the worker cannot perform their activity due to non-work-related illness or non-work-related accident, receiving healthcare and being unable to work.

How long does the benefit last?

Up to 365 days, extendable by 180 days. It can be extended up to 730 days if the INSS is assessing a permanent disability.

Can I work while on sick leave?

No. It is incompatible and involves suspension of the right.

Can I appeal my medical discharge?

Discharge reports are administrative acts and, as such, can be challenged through this channel and before the social jurisdiction. The Social Jurisdiction Act provides for certain special provisions regarding the challenge of medical discharges (with some unique circumstances when the situation of temporary disability has exceeded 365 days).

In some special cases of discharges issued by the INSS on day 366 of temporary disability, or on the next working day, the beneficiary, within four calendar days, may express their disagreement before the Health Inspectorate.

I am self-employed and I was late in submitting documentation. Do I lose my right?

If more than 3 months pass, payment is only made retroactively for 3 months, except in justified cases.

What happens if the company does not pay the subsidy?

You can request direct payment to FREMAP.