Benefit for common illness and non-work-related accidents (ITCC)

When a worker is unable to perform their activity due to a common illness or a non-work-related accident, FREMAP guarantees the agile and secure management of the temporary disability benefit. As a Mutual Insurance Company 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, a company or a labor consultancy.

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

Persons protected by the benefit

Temporary disability benefits due to common illness or non-work-related accidents 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 common contingencies covered.
Civil servants and military personnel when the application regime refers to the Social Security system.

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 onwards in processes where direct payment or delegated payment is required.

Conditions for accessing the subsidy

To receive the benefit, the following conditions must be met:

General requirements

Being registered or in a similar situation with Social Security.
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)

Common disease: have contributed for 180 days in the previous 5 years.
Non-work-related accident: It does not require a lack.
Self-employed workers: same requirements, in addition to being up to date with payments (payment invitation mechanism if there is debt).

Situations without required deficiency

disabling dysmenorrhea secondary
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 the self-employed) 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 dysmenorrhea secondary

Documents required depending on each case

In all ITCC processes

Sick leave report, confirmation reports and medical discharge report.
Identification document (DNI/NIE/passport).

If there is an employment relationship

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

Self-employed workers (RETA)

Declaration of activity status (deadline: 15 business days from the date of termination).
Proof of being up to date with the payment of fees, if applicable.

In FREMAP direct payment requests

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 lack, quote or medical situation.

Beginning of law and key times

Start of the coverage

Days 1–3: without subsidy.
Days 4–15: The company pays (employees).
From the 16th: 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 IT

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 act, 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 the RED.

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

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

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

What is IT for common contingencies?

Temporary incapacity in which the worker cannot perform his activity due to common illness or non-work accident, receiving health care 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 implies 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 Law provides for certain special provisions regarding the challenge of medical discharges (with some unique features when the situation of temporary incapacity has exceeded 365 days).

In some special cases of discharges issued by the INSS on day 366 of temporary incapacity, or on the next working day, the beneficiary, within four calendar days, could express their disagreement to the medical inspection.

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.