Hurt or ill because of work, accident rules and the mutua

Terms used

• Mutua — The mutua is the private body, chosen by your employer, that works with Social Security to cover work accidents and occupational illness.
• INSS — The INSS is the national Social Security institute that manages benefits such as sick leave and pensions.
• Enfermedad profesional — An enfermedad profesional is an illness caused by work and listed on the official table of occupational diseases.
• Determinación de contingencia — The determinación de contingencia is the INSS procedure that decides whether your case is a work accident or ordinary sickness.
• Reclamación previa — The reclamación previa is a written complaint to the INSS that you must file before going to the labour court.

Key rules

• Recording: Make sure your injury or illness is recorded as work-related, not ordinary sickness.
• Deadlines: You have 30 days to file a reclamación previa, and 30 days after its rejection to go to court.
• Emergency: You can use public health care straight away in an emergency, whatever your mutua arrangement.

Work injuries are treated differently from ordinary sickness

If you are hurt or made ill because of your job, your case follows a separate route from ordinary sickness. Your injury or illness must be recorded as work-related. If it is recorded as ordinary sickness, you lose the better terms described below.

What counts as a work accident

A work accident is any bodily injury you suffer because of your work or while doing it for someone else. It also covers:

• accidents on the way to or from work
• accidents during union duties
• illnesses that arise from the work

An injury at your workplace during working time is presumed to be work-related. You are treated as registered with Social Security even if your employer failed to register you.

How the money differs

• The benefit starts the day after the accident. Your employer pays the day of the accident itself.
• The benefit is 75% of your regulatory base from the day after the accident. For ordinary sickness it is 60% from day 4 to 20, then 75% from day 21.
• No minimum contributions are needed for a work accident. Ordinary sickness needs 180 days of contributions in the previous five years.

The mutua

The mutua is the body your employer chooses to cover work accidents and occupational illness. It pays your sick-leave benefit and provides treatment and rehabilitation. Some employers have the INSS cover this instead, so ask which applies to you.

Where a mutua covers your case, its medical services normally treat you, and it may issue your sick leave and your discharge. You still have the right to public health care, and in an emergency you should use it straight away. If you disagree with the mutua's doctors, ask the public health service for a second opinion.

The steps to take right after an accident are in the process below.

Occupational illness

An enfermedad profesional is an illness caused by the substances or activities on an official list. A company doctor, a public health doctor or a mutua doctor issues the medical report. Public health doctors must report suspected cases to the INSS or the mutua, which decides whether the illness counts. You or your employer can also request recognition.

An illness caused by work that is not on the list is treated as a work accident.

If your case is treated as ordinary sickness

You can ask the INSS to start a procedure called determinación de contingencia. You, your employer, the mutua or the health service can start it. The INSS normally issues its decision within 15 days. While it is pending, you are paid as for ordinary sickness.

If you disagree with the decision, file a reclamación previa within 30 days. If that is rejected, you have 30 days to bring a claim in the labour court. Confirm these deadlines and steps with the INSS or a labour lawyer.

The checklist, warnings and questions below cover the rest.

Steps to take after a workplace accident in Spain

After a workplace accident

• Get urgent medical care, and call 112 if the injury is serious: immediately after the accident

• Tell your employer or supervisor, in writing if you can, with the time, place and what happened: right away

• Go to the medical service of your company's mutua (the private body that works with Social Security on work accidents), or to a public hospital in an emergency: as soon as you can after telling your employer

• Collect the medical report and, if you get sick leave, the leave form (parte de baja): at the medical visit

• Keep evidence: witness names, photos, medical reports and copies of every paper: from the first day

• Your employer files the official accident report (parte de accidente de trabajo) electronically through the Delt@ system, which passes the data to the mutua: within 5 working days of the day of the leave if you are on sick leave; in the first 5 working days of the following month if there is no leave

• For a serious or very serious accident, a death, or an accident hurting four or more workers, your employer also notifies the labour authority electronically, with the formal report following: within 24 hours

• Follow the medical check-ups and hand in your leave confirmations: throughout your recovery

• If the case is disputed, take it to the INSS (the national social security institute) or the labour courts: if the mutua or INSS disagrees with you

Checklist

• Ask that your injury or illness is recorded as work-related, not ordinary sickness.

• Find out whether your employer uses a mutua or the INSS directly to cover work accidents and occupational illness.

• Ask the doctor to issue the medical report if you suspect an occupational illness, and ask your employer or the mutua to request recognition.

• Check whether your illness is on the official list of occupational diseases; if it is not but work caused it, ask for it to be treated as a work accident.

• Ask the INSS to start a determinación de contingencia if your case is treated as ordinary sickness.

• File a claim in the labour court (juzgado de lo social) within 30 days of the rejection.

What to watch out for

• Treated as ordinary sickness: If the mutua or INSS treats your injury as ordinary sickness, you get lower benefit and may lose work-accident protection. Meanwhile you are paid as for sickness. Ask the INSS to start a determinación de contingencia as soon as you disagree.

• Missing the 30-day deadlines: The reclamación previa must be filed within 30 days, and the court claim within 30 days of its rejection. Late filing can end your challenge. Note the date of the INSS resolution and file each step well before the deadline.

Frequently asked questions

Does a work accident benefit pay more than ordinary sickness?

Yes, a work accident benefit is 75% of your regulatory base from the day after the accident, while sickness pays 60% from day 4 to 20 and 75% from day 21. Your employer pays the day of the accident itself. You also need no minimum contributions for a work accident, whereas sickness requires 180 days in the previous five years.

Does an accident on the way to work count as a work accident?

Yes, an accident on the way to or from work (in itinere) counts as a work accident, as do accidents during union duties. An injury suffered at the time and place of work is presumed to be work-related.

What can I do if the mutua says my injury is ordinary sickness?

You can ask the INSS to start a procedure called determinación de contingencia, which decides whether the case is work-related. The INSS normally resolves it within 15 days. After that you can file a reclamación previa within 30 days, then go to the labour court (juzgado de lo social) within 30 days of its rejection. Meanwhile you are paid as for ordinary sickness.

Is an illness caused by my job treated as a work accident?

Yes, if the illness is not on the official list of occupational diseases but was caused by work, it is treated as a work accident. Listed illnesses are called enfermedad profesional, and the INSS or mutua decides on the qualification. Your employer or you can also request recognition.