COMMENCEMENT AND TERMINATION OF THE RIGHT TO BENEFITS - IMPORTANCE OF THE DISCHARGE MOMENT
Convergent Social Protection Scheme

» The right to protection is initiated, in the case of:

- Accident at work – on the date in which the accident took place, if it is qualified as being of work

- Occupational disease – on the date of presumptive diagnosis, save if the National Centre for the Protection Against Occupational Risks confirms that the disease is related to a previous date

» The medical certificate of “discharge” – determines the termination of the right to benefits of:

- Medical, drug, nursing, transport and stay assistance, exclusively for the access to these types of assistance

- Occupational reintegration for partial, temporary disablement for work – work compatible with remaining capabilities

- Compensation during all periods of temporary, absolute or partial disablement for work

» After the “discharge” the right to the following benefits is maintained:

- Prostheses and orthotics, their renewal, repair and maintenance

- Occupational reintegration, according to remaining capabilities arising from permanent disablement

- transportes e estada necessários para as prestações a que há direito

- Transport and stay necessary for the benefits to which gives right

- Benefits for permanent disablement

The termination of the employment legal relationship, regardless of the respective cause, including the reason for retirement, does not entail the termination of the right to benefits, if the discharge still has not been certified, as well those which are maintained besides this one

» Calculation and duration of benefits

» The amounts of the benefits correspond to the reimbursement of expenses actually incurred or to the direct payment of same, if the treatments and means used meet requirements provided for in the law

» Compensation is paid in full, including supplements on which fall contributions for the Convergent Social Protection Scheme or Social Security General Scheme, as appropriate, during the absences to work or its performance under conditions of timetable or performance of tasks or functions different from those usually performed, justified by medical prescription, while the convergence with the Social Security General Scheme is not carried out

» The grant is ensured during the time necessary to the recovery of health or other acts necessary (travels, for example) to the grant or maintenance of various benefits that there will be

» However, in any case shall not be used benefits schemes of Public Employees Healthcare System (ADSE), either in the scope of an agreement regime with ADSE with healthcare providers or outside such agreement, under penalty of loss of the right to reimbursement of expenses incurred

» Who grants benefits and respective request

» The grant of benefits due for temporary disablement for work, including the respective charges, namely with treatments of injuries or illness and remaining rights provided for in the law, with exception of those arising from permanent disablement or death, is of the responsibility of the employer entity at the service of which the accident at work has taken place or the occupational disease has been contracted

» The benefits for permanent disablement and death, the allowance for assistance to a third person, if the injured or sick person is retired, as well as the expenses related to travels and stay, medical boards and other acts necessary to the confirmation of the right to these benefits are granted and paid by the Public Employee Special Pension Scheme (CGA)

» The funeral expenses and death allowance fall upon the employer entity at the service of which the accident at work has taken place or the occupational disease has been contracted, in cases in which the death of the injured or sick person occurs in the situation of activity. In cases in which the death is verified in the retirement situation, the grant and payment of those benefits is of the responsibility of the CGA

» The grant of all benefits shall be requested from the employer entity in charge or from CGA, where appropriate

» In the case of transfer of the responsibility by accidents at work to the insurance company, exceptionally authorized, it is this one the competent entity to grant all benefits applicable, either for temporary disablement, for permanent disablement or death

» Articulation of benefits and of benefits with work

» The death grant, provided for in this regime, is cumulated with death allowance, within the scope of death eventuality, only in the part in which the latter exceeds the former

» The pension for death is not cumulated with the pension granted for exceptional and relevant services provided to the country or with other destined to compensate the same damages

» The pension for death may be cumulated with survivor’s pension, provided for in the eventuality of death, only in the part in which the latter exceeds the former

» Compensation for work actually performed or due in the case of temporary disablement for work, either for reason of disease or resulting from accident at work or of occupational disease, is cumulated with pensions for permanent disablement arising from those occupational risks, as well as other pensions of a compensation character

» It is not cumulated with compensation resulting from the fulfilment of professional activity the pension for absolute permanent disablement for any work of any kind whatever and the pension for absolute permanent disablement for the usual work, provided that in this case, it deals with the same professional activity or of activity subject to the same risk of the occupational disease in relation to which is pensioner