Prestaciones contributivas – Incapacidad Temporal

La prestación económica por incapacidad temporal trata de cubrir la falta de ingresos que se produce cuando el trabajador, debido a una enfermedad o accidente, está imposibilitado temporalmente para trabajar y precisa asistencia sanitaria de la Seguridad Social. Se concede a los trabajadores incapacitados temporalmente para trabajar, debido a una enfermedad común o profesional, o a un accidente, sea o no de trabajo, mientras reciba asistencia sanitaria de la Seguridad Social, y durante los períodos de observación por enfermedad profesional en los que sea necesario solicitar la baja.

Los requisitos para tener derecho a esta prestación son:

  • Estar en alta en la Seguridad Social, o en situación asimilada.
  • Tener cubierto un período de cotización de 180 días en los 5 años anteriores, si el origen es una enfermedad común. Si se debe a un accidente o a una enfermedad profesional, no se requiere período previo de cotización.

La cuantía del subsidio depende de la base reguladora y del origen de la incapacidad:

  • Si se debe a enfermedad común o accidente no laboral, es el 60% de la base reguladora entre el cuarto y el vigésimo día; y el 75% a partir del vigésimo primero.
  • Si el origen es una enfermedad profesional o un accidente de trabajo, es el 75% de la base reguladora desde el día siguiente al de la baja.
  • Cuando el trabajador agote el período máximo de duración de la Incapacidad Temporal, y hasta el momento de la calificación de Invalidez Permanente, continúa cobrando el importe de las prestaciones que le correspondan.
  • Si una vez reconocida la Incapacidad Permanente, el importe de esta fuera superior al que venía percibiendo, se retrotraerá su abono al momento que haya agotado la Incapacidad Temporal, percibiendo la diferencia.
  • En caso de accidente de trabajo y enfermedad profesional se cobra el 75% desde el día en que se produce el accidente.

Para calcular la base reguladora hay que tener en cuenta el origen de la incapacidad:

  • Si se debe a enfermedad común o accidente no laboral, es el cociente de dividir la base de cotización por contingencias comunes del trabajador del mes anterior a la fecha de baja, por el número de días a que corresponde dicha cotización.
  • En caso de accidente de trabajo o enfermedad profesional, es el cociente de dividir la base de cotización por contingencias profesionales del trabajador del mes anterior a la fecha de la baja, por el número de días a que corresponde dicha cotización, tomando como cotización por horas extraordinarias el promedio de las efectuadas por este concepto en los 12 meses anteriores al suceso.

El reconocimiento del derecho y el pago del subsidio corresponde al INSS, o a la Mutua de Accidentes de Trabajo y Enfermedades Profesionales, según la opción que el empresario hubiere adoptado para la cobertura de esta contingencia, y a las empresas autorizadas a colaborar voluntariamente en el Régimen General cuando derive de las contingencias a que afecte su colaboración.

El pago lo efectúa la empresa por delegación, y corre a cargo de quien haya reconocido el derecho. En caso de enfermedad común o accidente no laboral, el subsidio se abonará a partir del decimosexto día de baja en el trabajo, estando a cargo del empresario el abono de la prestación al trabajador desde los días cuarto al decimoquinto, ambos inclusive.

En caso de incumplimiento de la obligación de pago por el empresario, extinción del contrato de trabajo, alta médica con propuesta de invalidez permanente, y otros supuestos, el INSS o la Entidad Colaboradora deben efectuar el pago directamente.

El subsidio por Incapacidad Temporal, como consecuencia de una enfermedad común o profesional, o de un accidente, puede cobrarse como máximo 12 meses, prorrogables por otros 6, cuando se presuma que en ese tiempo el trabajador puede recibir el alta médica por curación. Los períodos de observación por enfermedad profesional durarán un máximo de 6 meses, prorrogables por otros 6 más.

Cuando la situación se extinga por haber transcurrido el plazo máximo establecido de 18 meses, la inspección sanitaria del respectivo Servicio Público de Salud formulará la correspondiente alta médica por curación, o alta médica por agotamiento de la incapacidad temporal. Esta última deberá justificarse en virtud de las secuelas o reducciones anatómicas o funcionales graves del trabajador, de las cuales se deduzca razonablemente la posible existencia de una situación de incapacidad permanente, o por la necesidad de que aquél continúe con el tratamiento médico prescrito.

Los efectos de la situación de Incapacidad Temporal se prorrogarán:

  • Por un plazo máximo de 3 meses, para examinar el estado del incapacitado a efectos de su calificación en el grado que corresponda, como inválido permanente, cuando la situación se extinga por el transcurso del plazo máximo.
  • Hasta un máximo de 30 meses, contados desde la fecha en que se haya iniciado la incapacidad temporal, cuando continúe a su extinción la necesidad de tratamiento médico, y la situación clínica del interesado hiciera aconsejable demorar la citada calificación, lo cual demandará, como requisito previo, el oportuno dictamen de los servicios médicos del INSS, en el que expresamente se señale la conveniencia de no proceder de inmediato a la calificación de la incapacidad permanente, atendida la situación clínica del interesado y la necesidad de continuar con el tratamiento médico.

Durante estos períodos de prórroga de los efectos de la situación de Incapacidad Temporal, no existe la obligación de cotizar.

Se pierde el derecho a cobrar el subsidio por incapacidad temporal si el beneficiario ha obrado fraudulentamente para obtenerlo o conservarlo, y cuando trabaja por cuenta propia o ajena.

El proceso para llegar a obtener el subsidio se inicia con el parte de baja, en el que deberá constar el diagnóstico, la descripción de la limitación en la capacidad funcional, y la duración probable. Este certificado debe ser entregado en la empresa en un plazo máximo de 3 días.

Los partes de confirmación de la baja se extenderán al cuarto día del inicio de la situación de incapacidad, y sucesivamente cada siete días naturales.

Trimestralmente, a contar desde el inicio de la baja, la inspección médica expedirá un informe de control de la incapacidad, en el que debera pronunciarse sobre todos los extremos que justifiquen, desde el punto de vista médico, la necesidad de mantener el proceso de incapacidad del trabajador.

Los partes de alta médica se extenderán, tras el reconocimiento del trabajador, por el correspondiente facultativo, y debe ser presentado por el trabajador en la empresa en un plazo de 24 horas.

Si durante el período de baja se produjese la finalización del contrato, el trabajador estará obligado a presentar al INSS o a la Mutua, según corresponda, los partes de confirmación de baja y alta.

Cómo se calcula la base regulador

  • Si el origen es una enfermedad común o un accidente no laboral, la base reguladora será el cociente de dividir la base de cotización por contingencias comunes del trabajador del mes anterior a la fecha de baja, por el número de días a que corresponde dicha cotización.
  • Si se debe a un accidente de trabajo o enfermedad profesional, será el cociente de dividir la base de cotización por contingencias profesionales del trabajador del mes anterior a la fecha de la baja, por el número de días a que corresponda dicha cotización, tomando como cotización por horas extraordinarias el promedio de las efectuadas por este concepto en los 12 meses anteriores al suceso.

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