Occupational disease: diagnosis, protection and benefits

Occupational disease (OD) is that contracted as a result of work carried out in the activities specified in the table of OD (annex 1 of RD 1299/2006) and that is caused by the action of the elements or substances indicated in said table for each occupational disease. As a Mutual Insurance Company collaborating with Social Security, FREMAP guarantees healthcare, specialized clinical follow-up and access to the economic benefits derived from this contingency that may apply.

The diagnosis of EP 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 occupational disease 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 occupational corresponds to the respective managing entity, without prejudice to their processing as such by FREMAP.

Therefore, when we proceed to close an occupational disease 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 occupational 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 occupational disease, 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 INSS to declare permanent incapacity due to said contingency.

Conditions necessary to access the EP

For the recognition of an occupational disease by FREMAP, all the elements of the legal concept must be met (arts. 157 and 316 TRLGSS and RD 1299/2006) and the rest of the legal requirements.

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

Only the diseases listed in Annex 1 are EP, 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,
Reports from the Prevention Service,
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)
Determination of exposure
Personal Protective Equipment

4. Legal presumption

The listed diseases 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 an occupational disease, such proof is not required of the worker in any case in the listed occupational diseases.

What is needed to diagnose, communicate, and process an EP

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. Labor and preventive documentation

Determination of exposure
Occupational risk assessment of the company.
Report on tasks and biomechanical requirements.
Hygiene studies (noise, silica, chemical agents, biological agents…).
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 EP 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 occupational disease, FREMAP will report the contingency with which it finally closes the process (occupational disease, common illness or work accident), without prejudice to its subsequent qualification – when appropriate – by the INSS.

Healthcare, monitoring and financial protection:

1. Healthcare

Specialized medical care in FREMAP centers.
Diagnostic tests, treatments and rehabilitation.
Prescription of medications and therapies.
Referral to specialized units (p. e.g., Occupational Diseases Unit of the FREMAP Majadahonda Hospital).

2. Financial benefit for temporary incapacity due to occupational disease

75% of the regulatory base from the day after the decrease. Even during the observation period for EP that requires medical leave.
The company pays for the day of sick leave (employees).

3. Permanent disability benefits to continue practicing the usual profession derived from EP

When assessing and deciding on a possible permanent disability resulting from an occupational disease, 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 an occupational disease, 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 occupational disease, must change positions, either within the same company or to a different one where he can continue to perform his duties without exposure to risk.

How to act, 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 care center. The professionals will assess whether it could be a PD and will open, if appropriate, a period of observation. 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 occupational, 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 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 part prepared by FREMAP.

Resolution and closure of the observation period. Certainty diagnosis → PD. EP does not apply → common illness or AT (if there is an exclusive causal relationship).

Occupational disease is primarily regulated through:

Possible reference GUIDES to help healthcare professionals identify and, where appropriate, report and classify an EP:

What is the difference between an occupational disease and a common work-related illness?

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

Can an EP be recognized even if my profession is not listed in the chart?

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

What happens if there is doubt between occupational disease, work accident or common illness?

In any case, when necessary, the classification of diseases as occupational 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 disease in respect of workers who are not in a situation of discharge.

Can EPs appear years after leaving the position?

Yeah. Many EPs 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 occupational diseases (Annex 1 of Royal Decree 1299/2006).

Is the EP always communicated through CEPROSS?

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

I am a company, can I get any bonus?

Yes, in those cases where, due to occupational disease, there is a change of job position in the same company or the performance, in a different company, of a job compatible with the condition of the worker.

Access Royal Decree Law 1/2023