Occupational disease: diagnosis, protection and benefits

A work-related illness is one contracted as a result of work carried out in the activities specified in the table of work-related illnesses (Annex 1 of Royal Decree 1299/2006) and caused by exposure to the agents or substances indicated in that table for each work-related illness. As a Mutual Society collaborating with Social Security, FREMAP guarantees healthcare, specialised clinical follow-up and access to the economic benefits derived from this contingency that may apply.

The diagnosis of a work-related illness may be certain or under observation. During the observation period, employees will also be entitled to the benefits that correspond to them as a result of occupational contingencies; without prejudice to the fact that once this period has ended, it may be closed by our doctors finally determining a different contingency (such as common illness or work accident).

Furthermore, when we are the mutual insurance company that assumes the protection of occupational contingencies, we will be obliged to prepare and process the work-related illness report electronically, through the CEPROSS computer application; without prejudice to the duty of companies or self-employed workers to provide us with the information required for the preparation of said report.

In any case, the classification of diseases as work-related corresponds to the respective managing entity, without prejudice to their processing as such by FREMAP.

Therefore, when we proceed to close a work-related illness case in CEPROSS as a common illness or work accident, we must send the file to the National Institute of Social Security (INSS), so that it has sufficient information and can, if necessary, determine the cause of the contingency.

Protection for workers exposed to occupational risks

The benefit for work-related illness is intended for:

Employees included in the General Scheme or in special schemes (Agricultural, Maritime, Domestic) when their company has arranged coverage with FREMAP.
Self-employed workers (RETA) affiliated with FREMAP who have incorporated coverage for professional contingencies—an essential requirement.
Furthermore, those workers who, even if they have ceased providing services or carrying out the activity that determines their inclusion in said Social Security Scheme, are not registered or in any other situation equivalent to it, after having provided services in jobs that offered a risk of work-related illness, will continue to be included in the scope of the Social Security Scheme in which they were registered, but in a situation equivalent to registration in the same, even if they have ceased providing services or carrying out the activity that determines registration in said Scheme, for the sole purpose of allowing the National Social Security Institute (INSS) to declare permanent disability due to said contingency.

Conditions necessary to access the work-related illness

For the recognition of a work-related illness by FREMAP, all the elements of the legal concept must be met (articles 157 and 316 TRLGSS and RD 1299/2006) and the rest of the legal requirements.

1. Illnesses included in the official list (Annex 1)

Only the diseases listed in Annex 1 are work-related illnesses, and the burden of proof, where applicable, lies with whoever intends to deny their status as such.

2. Activity likely to cause it

In principle, one of the jobs or activities expressly listed in the table must have been carried out. However, it is an open table or list. Therefore, when fully justified and proven, it could be extended to other professions not included, but with similar requirements and exposed to the same causative agents.

3. Exposure to the causative agent

It must be proven that the person has been exposed to the agents or substances described as causing the problem in the table. The exposure must be proven, among other means of evidence and when necessary, primarily by:

Risk assessments,
Prevention service reports,
Hygiene studies,
Detailed work history.
Technical reports
Safety data sheets for the products used
Measurements
Minimum exposure intensity.
Minimum exposure time
Environmental exposure limit values (EELs)
Biological markers (biological exposure limit values, BLVs)
Determining the exposure
Personal Protective Equipment

4. Legal presumption

The listed illnesses generate a presumption of work-related causality, although it admits evidence to the contrary from whoever intends to deny such consideration.

Since the jurisprudence of the Supreme Court has indicated that, unlike work accidents, in respect of which "proof of the causal link between injury and work" is necessary for the qualification of a work-related illness, such proof is not required of the worker in any case in the listed work-related illnesses.

What is needed to diagnose, communicate, and process a work-related illness

The required documentation may vary depending on the illness, but FREMAP may request:

1. Clinical documentation

Medical reports and diagnostic tests.
Results of specific tests (audiometry, allergies, respiratory studies, dermatology, imaging, etc.).
Non-work-related factors

2. Work and preventive documentation

Determining the exposure
Occupational health and safety assessment.
Report on tasks and biomechanical requirements.
Hygiene studies (noise, silica, chemical agents, biological agents, etc.).
Prevention service reports.

3. Official communication

FREMAP is responsible for preparing and processing the CEPROSS electronic report, both with and without sick leave, and during observation periods.

The initial communication of the report must be carried out within ten working days following the date on which the diagnosis of work-related illness occurred.

In any case, all the data must be transmitted within a maximum period of five working days following the initial communication, for which purpose the company or self-employed worker must send the information requested by FREMAP so that it can comply with the above deadlines.

The completion or CLOSURE of the process will be communicated within five business days following the event that motivates said completion. In this communication, without prejudice to its initial diagnosis as an observation period for work-related illnesses, FREMAP will report the contingency with which it finally closes the process (work-related illness, common illness or work accident), without prejudice to its subsequent qualification – when appropriate – by the INSS.

Healthcare, monitoring and financial protection:

1. Healthcare

Specialised medical care in FREMAP centres.
Diagnostic tests, treatments and rehabilitation.
Prescription of medications and therapies.
Referral to specialised units (e.g., Work-related Illness Unit of the FREMAP Majadahonda Hospital).

2. Financial benefit for temporary disability due to work-related illness

75% of the regulatory base from the day after the sick leave. This is also true during the observation period for work-related illnesses that require medical leave.
The company pays for the day of sick leave (for employees).

3. Permanent disability benefits to continue practising the usual profession derived from work-related illness

When assessing and deciding on a possible permanent disability resulting from a work-related illness, it must be taken into account that the concept of USUAL PROFESSION is not defined based on the specific job position that was performed, nor according to the formal delimitation of the professional group, but according to the scope of functions to which the type of work that is carried out or can be carried out within functional mobility refers.

Therefore, there is a bonus in the employer's social security contribution for a change of job position due to a work-related illness, provided that all the requirements for this are met. This aid seeks to encourage, when necessary, the relocation of the worker to a position compatible with their health. It is applicable when the worker, as a result of that work-related illness, must change positions, either within the same company or to a different one where they can continue to perform their duties without exposure to risk.

How to proceed, step by step

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

Consult with your company or prevention service. If you are an employee, report your symptoms and exposure.

Go to a FREMAP healthcare centre. The professionals will assess whether it could be a work-related illness and will open, if appropriate, an observation period. Even when doctors of the National Health System, in the course of their professional activities, become aware of the existence of a disease included in Annex 1 that could be classified as work-related, they will communicate it for the appropriate purposes, through the competent body of each autonomous community and of the cities with Statute of Autonomy, to the managing entity, for the purposes of classification foreseen and, where appropriate, to the mutual society that assumes the protection of occupational contingencies so that it may initiate the study that corresponds in each case. The same communication must be made by the medical professionals of the prevention service, where applicable.

FREMAP carries out the study, the request for preventive reports, the risk assessment, the hygiene studies and the clinical tests.

CEPROSS processing. Electronic report prepared by FREMAP.

Resolution and closure of the observation period. Certainty diagnosis → Work-related illness. Work-related illness does not apply → common illness or work accident (if there is an exclusive causal relationship).

Work-related illness is primarily regulated through:

Possible reference GUIDES to help healthcare professionals identify and, where appropriate, report and classify a work-related illness:

What is the difference between a work-related illness and a common illness

The work-related illness is listed in Annex 1 of RD 1299/2006 and is presumed to be work-related when all requirements are met.

Can a work-related illness be recognised even if my profession is not listed in the chart?

Yes. The list is open to activities. The important thing is to demonstrate exposure to the agent.

What happens if there is doubt between work-related illness, work accident or common illness?

In any case, whenever necessary, the classification of illnesses as work-related corresponds to the respective managing entity, without prejudice to their processing as such by FREMAP.

The managing entity is also responsible for determining the occupational nature of the illness in respect of workers who are not in a situation of discharge.

Can work-related illnesses appear years after leaving the position?

Yes. Many work-related illnesses have long latency (asbestos, silica, noise…).

For this purpose, the maximum latency period and the minimum induction period are also assessed.

What if I'm self-employed?

You are entitled to it if you have occupational contingency coverage and prove exposure to the elements and substances and in the activities specified in the list of work-related illnesses (Annex 1 of Royal Decree 1299/2006).

Is the work-related illness always communicated through CEPROSS?

Yes. Since 2007, FREMAP has been responsible for issuing the electronic report.

I am a company, can I obtain a bonus?

Yes, in cases where, due to a work-related illness, there is a change of post within the same company or the worker takes up a post in another company that is compatible with their condition.

Access the Royal Decree 1/2023