Sickness Benefit: Who Can Apply and How It Works

THE sickness benefit, an essential benefit of Brazilian Social Security, is a tool to protect workers facing moments of vulnerability.

However, understanding who is entitled and how this mechanism works requires clarity, as the topic involves legal, medical and administrative nuances.

Therefore, this text explores, in an intelligent and accessible way, the eligibility criteria, the application process, and the impacts of this benefit on the lives of Brazilians.

Thus, bringing practical examples, relevant data and an engaging approach.

1. What is Sick Pay and Why Does It Exist?

First of all, it is essential to understand the purpose of sickness benefit.

This is a social security benefit paid by the INSS (National Social Security Institute) to workers who, for health reasons, are temporarily unable to carry out their work activities.

Unlike retirement, it is temporary, acting as a bridge so that the insured can recover without losing their source of income.

Thus, the benefit reflects the social security system’s commitment to the dignity of workers.

Imagine a gear in a machine: if one part fails, the entire system can stop.

Likewise, illness or injury can interrupt a person's productive capacity.

THE sickness benefit, in this sense, acts as a social lubricant, allowing the worker to “stop” to restore himself without collapsing financially.

However, the benefit is not automatic.

It requires the insured to prove their condition through a medical examination and meet specific requirements, which brings us to the next point.

Interestingly, the sickness benefit also has a broader economic impact.

By ensuring that workers are not forced to work while sick, the system reduces the risk of worsening health conditions.

In this sense, this could generate even greater costs for the State and for companies.

Furthermore, the benefit helps maintain families' financial stability, preventing a temporary illness from turning into a permanent crisis.

But who, after all, can access this support?

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2. Who is entitled to sickness benefit?

Now that we know what the sickness benefit, it's time to clarify who can request it.

Firstly, the benefit is intended for INSS policyholders.

In other words, those who contribute to Social Security, whether they are formally employed, self-employed, individual contributors, or even special insured individuals, such as family farmers.

However, simply being a member of the INSS isn't enough. There are strict criteria that must be met.

One of the central requirements is the lack, which corresponds to the minimum number of monthly contributions required before incapacity.

For the sickness benefit, the law determines, as a rule, 12 contributions.

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However, there are exceptions: in cases of serious illnesses, such as cancer or tuberculosis, or accidents of any nature, the waiting period may be waived.

Furthermore, the incapacity must be temporary and proven by a medical examination by the INSS.

This means that not every illness guarantees the benefit; it must prevent work for more than 15 consecutive days.

Finally, it is worth highlighting the importance of keeping contributions up to date.

A worker who fails to contribute for a prolonged period may lose their insured status, which makes access to the sickness benefit.

To illustrate, consider the case of Ana, a freelance designer who discovered a repetitive strain injury (RSI).

As an individual contributor, she needed to prove 12 months of contributions and undergo an assessment to secure the benefit.

This requirement, although bureaucratic, protects the system against fraud and ensures that aid reaches those who truly need it.

Table:

Criterion	Description
Insured Quality	Be affiliated with the INSS and have your contributions up to date or within the grace period.
Shortage	Minimum of 12 monthly contributions, except in specific cases.
Temporary Disability	Proven by medical examination, lasting more than 15 days.
Diseases Exempt from Waiting Period	Cancer, HIV, multiple sclerosis, among others provided for by law.

3. How does the Application Process Work?

Let us now move on to the practical operation of the sickness benefit.

Applying for benefits can seem like a bureaucratic maze, but with the right information, the process becomes clearer.

Initially, the worker must access the portal My INSS (website or app) or call 135 to schedule a medical examination.

Beforehand, it is essential to gather documents such as your work card, proof of contributions, medical reports, and exams that demonstrate your health condition.

After scheduling, the medical examination is the heart of the process.

During the assessment, the INSS doctor verifies whether the incapacity is real, temporary and prevents work.

An important detail: the expert does not just assess the illness, but its relationship with the insured's professional activity.

For example, a herniated disc may incapacitate a bricklayer, but not necessarily a copywriter.

This personalized analysis ensures that the benefit is granted fairly, although it can sometimes generate controversy.

If approved, the sickness benefit starts to be paid after the 16th day of absence (the first 15 days are the employer's responsibility, in the case of CLT workers).

The amount corresponds to 91% of the average contribution salary, limited to the INSS ceiling (R$ 7,786.02 in 2025).

If the request is denied, the insured may appeal administratively or seek legal assistance.

A practical example is that of João, a ride-hailing driver who was involved in a motorcycle accident.

After the assessment, he received the benefit for six months, which allowed him to focus on rehabilitation without financial worries.

Stage	Details
Scheduling	Through My INSS or phone 135.
Documentation	ID, CPF, work card, medical reports and exams.
Medical Expertise	Assessment of incapacity by the INSS doctor.
Payment	From the 16th day of absence, based on the average salary.

4. Impacts and Challenges of Sick Pay

In addition to the technical aspects, it is crucial to reflect on the impact of sickness benefit in society.

In 2023, according to the INSS, approximately 2.5 million temporary disability benefits were granted, highlighting the relevance of the program.

This number reflects not only the prevalence of illness and accidents, but also the dependence of millions of Brazilians on this support to maintain financial stability during health crises.

On the other hand, the system faces challenges.

Delays in expert assessments, for example, can leave workers in a vulnerable situation, waiting months for a response.

Furthermore, subjectivity in medical evaluation raises questions.

Is the system really prepared to serve everyone equally?

This rhetorical question invites us to think about the flaws and possible improvements, such as investments in technology to streamline processes or greater training for experts.

Despite this, the sickness benefit remains a pillar of social protection.

It not only supports the worker, but also promotes public health by encouraging adequate recovery.

Just like a seatbelt in a car, the benefit does not prevent an accident, but it minimizes its damage, allowing the insured to return to work safely and with dignity.

5. Tips to Ensure Benefit Without Complications

Finally, some practical guidelines can facilitate access to sickness benefit.

First, keep your documentation organized.

Detailed medical reports, including ICD (International Classification of Diseases), recent exams and specialist reports increase the chances of approval.

Additionally, be honest during the assessment, clearly explaining how the illness affects your work routine.

Another point is to know your rights.

Many insured individuals are unaware, for example, that they can request an extension of their benefit if recovery takes longer than expected.

It is also worth seeking legal advice in the event of unfair denials.

Information, in this context, is a powerful ally, like a compass on an unknown path.

Finally, invest in prevention.

Contributing regularly to the INSS (National Social Security Institute) and taking care of your health are ways to avoid surprises.

THE sickness benefit It's there to help, but ideally you'll never need it.

With planning and responsibility, workers can face unforeseen events with greater peace of mind, knowing that the social security system is on their side.

Tip	How to Apply
Complete Documentation	Gather updated medical reports, exams, and reports.
Knowledge of Rights	Find out about extensions, appeals and exemptions from waiting periods.
Prevention	Keep your contributions up to date and prioritize your physical and mental health.

Conclusion

In short, the sickness benefit It is more than a financial benefit, it is a social protection mechanism that reflects the commitment to the well-being of Brazilian workers.

Understanding who can apply and how the process works is essential to ensuring it serves its purpose.

Despite challenges such as bureaucracy and delays in assessments, the system remains an indispensable safety net.

Therefore, whether you are an employee, self-employed or special insured, knowing your rights and preparing for the process can make all the difference.

THE sickness benefit It doesn't solve all problems, but it offers the necessary support so that a health crisis doesn't become a life crisis.

After all, in an unpredictable world, having a safety net is what allows us to move forward.