INSS creates review for sick-leave benefits denied without a medical exam and changes rule after two refusals
Ordinance published this Friday (6) gives claimants ten days to request a new assessment of medical documents before appealing the decision
Translated from the Portuguese original by the Panorama newsroom. Read in Portuguese
Summary written by the Panorama newsroom from the sources listed below. Facts are attributed to the original publications.
Brazil's Social Security Ministry and the National Social Security Institute (INSS) have changed the rules for the temporary incapacity benefit, formerly known as sick-leave pay (auxílio-doença), in cases where the claim is assessed only on the basis of medical documents, without an in-person medical exam. The joint ordinance was published in the Official Gazette this Friday (6) and is already in effect, g1 reported.
The main change is a review step. Anyone whose benefit is denied by a technical opinion in the document review may request a new assessment within ten days of being notified of the decision, including by attaching new medical or dental documents. The review will be handled by the Federal Medical Examination service. If the claimant chooses to appeal directly within that window, they lose the right to the review; for those who request it, the appeal deadline only starts after the response to the new request.
The rule also provides that, after two consecutive denials in the document review, subsequent claims must be sent for a medical examination, in person or via telemedicine. This requirement applies until a benefit is granted through an examination. The new rules apply to denials communicated from this Friday on.
The document review is carried out through Atestmed, a system in which workers submit medical certificates and test results via the Meu INSS website or app. This year, the government extended the maximum leave granted this way from 60 to up to 90 days, a measure that, according to the government, aimed to reduce demand for in-person medical exams and shorten the INSS queue; in September, the rule was extended for another 365 days.
According to g1, the changes to Atestmed follow demands from the Federal Court of Accounts (TCU), which in November 2025 ordered measures to reduce the risk of fraud in the system, such as mechanisms to verify the authenticity of medical certificates.