Who acknowledges the incapacities above 540 days?
The Ministry of Health and Social Protection issued Decree 1333 of 2018 on July 27, 2018 and modified the regime of periodic reviews of incapacities for general illness of common origin by EPSs (Health Promoting Companies) in Colombia and the time of definitive qualification. Here are the main aspects:
- How will the control of workers’ incapacities be carried out?
- In accordance with Decree 1333 of 2018, through a periodic review of the incapacity. The Health Promotion Agencies (EPS) and other Entities Responsible to Compensate (EOC in Spanish) must carry out periodic reviews of incapacities due to general illnesses of common origin, in which they must implement a comprehensive plan of treatment, monitoring and evaluation of the rehabilitation process, which could allow to evaluate every sixty (60) calendar days the progress of the recovery of your work capacity.
- In whose head will be the recognition and payment of incapacities greater than 540 days?
- EPSs and other EOCs must recognize and pay for disabilities greater than 540 days, restarting the payment as of day 541, in the following cases:
- When there is a favorable concept of rehabilitation issued by the attending physician, in which it is required to continue medical treatment.
- When the patient has not recovered during the illness or injury that caused the incapacity due to a general illness of common origin, having followed the protocols, care guides and the recommendations of the attending physician.
- When new situations that extend the recovery time of the patient have occurred due to concomitant diseases.
- What happens if the concept of rehabilitation is unfavorable?
- When the EPS issues an unfavorable rehabilitation concept, the “incapacity” qualification process will begin.
- The norm does not establish who has the obligation to assume the payments during the incapacity qualification process as of day 540; however, since it is not expressly defined, in our opinion the affiliate’s Pension Fund Administrator should be responsible.
- Can I deduct the value of incapacities due to general illness, maternity and paternity leave from health contributions?
- No, since the date of entry into force of the master accounts for collection (year 2011), the contributors and independent workers must contribute independently to the Health System to the recognition of incapacity assistance or maternity or paternity leave.
- To avoid the creation of an additional economic burden on the employer, the Decree establishes periods of recognition of these benefits (incapacity assistance and licenses), namely: 5 working days from the date on which the economic benefit is recognized, payment that will be made directly or through electronic transfer.
- What happens if the member seeks to defraud the system of incapacitating indefinitely, abusing their right?
- The Decree indicates some behaviors considered as “situations of abuse of rights by contributors”. When there is abuse of the right, the case will be brought to the knowledge of the EPS or EOC, and in more serious cases, of the Office of the Attorney General of the Nation providing the corresponding evidence. Additionally, when it is determined that any of the causes of abuse of the right was established, there will be a suspension or non-recognition of the incapacity payment due to general illness.
By: María Angélica Pulido
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