Occupational accident: healthcare and financial assistance

When a worker suffers an injury resulting from their work activity, FREMAP immediately activates health assistance and, if applicable, the financial benefit for occupational contingency. As a Mutual Insurance Company collaborating with Social Security, we guarantee specialized care, efficient management and support throughout the entire process: from the initial assessment and sick leave, to rehabilitation, discharge and supplementary benefits. This page offers essential information for companies, the self-employed, consultancies and workers on how to proceed and what coverage FREMAP provides.

Protection for employed workers and self-employed people

The benefit for occupational contingencies is intended for those who suffer an injury resulting from their work activity. They are protected:

  • Employees included in the General Scheme or special schemes whose company has arranged coverage with FREMAP.
  • Self-employed workers (RETA) associated with FREMAP
  • Economically dependent self-employed workers (TRADE) associated with FREMAP.

This coverage guarantees immediate health care and, in case of sick leave, access to financial benefits or temporary disability allowance.

Conditions for accessing healthcare and temporary disability benefits due to work accidents

1. For employees:

  • That the worker's company has occupational contingency covered by FREMAP.
  • That the event suffered should be considered a work accident.

2. For self-employed workers (RETA):

  • That the self-employed person is associated with FREMAP.
  • Be up to date with Social Security payments.
  • To prove the direct and immediate causal relationship between the professional activity and the injury (there is no automatic presumption as in employed workers).

  • The company must report the accident via DELT@ within a maximum of 5 business days from when it occurred.
  • The worker must go to FREMAP as soon as possible after the accident.

How to act, step by step

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

1

Report the accident. If you are employed, inform your company. If you are self-employed, go directly to FREMAP.

2

Go to a FREMAP care center. We will perform the initial medical assessment, treatment, and follow-up.

3

Administrative processing. The company or the self-employed individual will send the work accident report (DELT@). FREMAP will issue, if applicable, medical leave, confirmation reports and medical discharge.

4

Economic management. If temporary disability benefits are applicable and must be paid in direct payment mode, it will be necessary to submit the corresponding payment request to FREMAP.

5

In case of disagreement with the contingency of a medical leave, you can request the INSS to initiate a contingency determination file.

  • Amount: 75% of the regulatory base for temporary incapacity due to professional contingency from the day after the medical leave, in delegated payment or direct payment modality.
  • Day of discharge: The worker must receive a salary (not a subsidy), so the company must pay it.

What should I do immediately after a workplace accident?

Notify your company and go to a FREMAP center for a medical evaluation. In life-threatening emergencies, go to the nearest medical center.

What if I'm self-employed?

Go directly to a FREMAP center. You must justify the direct and immediate relationship between the injury and your work.

What is the difference between “accident in itinere” and “on a mission”?

  • In itinere: the one suffered on the usual journey between home and work, provided that the requirements of time spent on the journey are met, correct route, suitable means of transport and purpose of the journey to go or return from home to work or vice versa.
  • On a mission: travels entrusted by the company.

Can I receive compensation if I suffer lasting effects from a work-related accident?

Yes, provided that the INSS decides so after the corresponding procedure has been followed.

What happens if the company does not report the accident as soon as possible?

FREMAP will also provide assistance and will request the accident report later.

Can I request a review of the accident rating?

Yeah. You can request the start of a contingency determination procedure before the INSS.

Is it possible to have a work accident while teleworking?

Yes, it is possible. In these cases, the Mutual Insurance Company must analyze all the circumstances involved to determine whether the accident should be classified as work-related or non-work-related, taking into account the special circumstances that occur in this type of work.