The accident benefit is a compensation benefit provided for in Article 86 of Law No. 8213/1991, paid to the insured person in the General Social Security System (RGPS) who, after enhancing the injury resulting from an accident or illness, begins to present permanent sequelae that partially reduce the ability to work normally.
This benefit does not replace salary and can be obtained with a work bonus.
“In general, accident benefit is a monthly compensation paid when the National Institute of Social Security (INSS) realizes that after an accident or illness there are permanent restrictions on work, even if the person continues to work,” explains Social Security lawyer Robson Gonsalves.
- Exposure to an accident of any kind (work, commuting or non-occupational) or illness with functional repercussions;
- It presents permanent sequelae that cause a partial reduction in the ability to perform usual activities;
- There is a link between the accident/illness and the outcome;
- Injuries were considered to be supported by INSS expertise.
The benefit is not payable to the elective insured and does not apply in cases where the limitation is only temporary, in which case coverage is provided by the temporary disability benefit.
Technical lists of sequelae used in experience
Social security legislation does not provide a closed list of diseases that always lead to the right to receive accident benefit. Article 86 of Law No. 8213/1991 determines the benefit on the basis of the presence of permanent consequences that reduce the ability to work.
Internal INSS rules, such as PRES/INSS Standard Instruction No. 128/2022, specify that the expert use lists of consequences prepared by the Ministry of Labor and Social Security, such as Annex III of the Social Security Regulation (Decree No. 3048/1999), which describes, for example, conditions such as partial loss of limbs, joint insufficiency, decreased vision and hearing loss.
“These technical lists serve as a reference for experience, but the analysis continues on a case-by-case basis. It is clear that the presence of permanent sequelae that have an impact on work is the key point for obtaining assistance in accidents.” Robson GonsalvesSocial Security Lawyer.
Amount and duration of accident assistance
Accident compensation is compensatory in nature and, as a general rule, is equivalent to 50% of the arithmetic average of all contributory salaries since July 1994, calculated on the compensation salary form provided for in Law No. 8213/1991 and subsequent regulations.
Since it does not completely replace work income, the value may be less than the minimum wage. Payment begins as soon as injuries consolidate or the day after benefits cease due to temporary disability, according to an expert’s conclusion, and continues until retirement is granted or until the death of the insured.
Relationship with retirement
The moment the insured begins receiving retirement, the accident benefit ends. However, the date a benefit was granted is usually considered an indicator of permanent statute of limitations, and may be used as evidence in applications for disability benefits or retirement benefits for a person with a disability, depending on the specific case.
“When accident benefits are active, the institute itself has already recognized that there are permanent consequences that have an impact on the business. This record usually has weight in the analysis of other claims related to the disability or the condition of the person with a disability,” notes Robson Gonsalves.
The application for accident compensation is formalized with INSS, generally through the Meu INSS platform or Central 135, with an appointment for a medical examination. In the evaluation, the Institute analyzes the clinical documentation provided, checking whether the injuries have been combined and whether the consequences cause a permanent decrease in the ability to carry out usual activities.
The concession or denial results from this expert report. Robson Gonsalves, a Social Security lawyer, explains that the accident benefit is a compensation benefit paid by the National Social Security Institution along with the salary, that is, the insured can continue working normally: permanent consequences are recognised, but there is no requirement to take time off work to obtain the benefit.
“The accident benefit is a benefit of a compensatory nature that is paid by the National Social Security Institution with salary; in practice, the insured can continue working, because there is no requirement to leave the job to obtain the benefit,” concludes Robson Gonsalves, Social Security lawyer.