Temporary Disability Benefit (Auxílio-Doença): Requirements and Waiting Period

This page is a translation of the original Portuguese text, provided for convenience. It deals with Brazilian law. If there is any discrepancy, the Portuguese version prevails. Read the original in Portuguese

The temporary disability benefit is the social security benefit owed to an insured person who cannot perform his or her work activity for more than fifteen consecutive days because of illness or accident. To qualify, you must meet a minimum waiting period of twelve monthly contributions, except in the cases the law exempts under Law No. 8.213/91.

Concept and Legal Basis of the Benefit

The temporary disability benefit is based on Article 59 of Law No. 8.213/91. It was formerly called auxílio-doença (sickness benefit), and it received its current name under Law No. 13.846/2019, which adjusted the original text without changing its structure of requirements. The statute provides that the benefit is owed to an insured person who is unable to perform his or her job or usual activity for more than fifteen consecutive days.

The disability that justifies the benefit must be temporary. That is what sets it apart from permanent disability retirement. For that type of benefit, the law assumes the insured person cannot be rehabilitated and return to work. With the temporary disability benefit, by contrast, doctors expect the person to recover and regain the capacity to work.

The benefit amount equals 91% of the salário-de-benefício (the benefit base salary). That base is calculated as the simple arithmetic average of the contribution salaries for 100% of the contribution period since July 1994, as provided in Article 26 of Constitutional Amendment No. 103/2019. The floor is the national minimum wage in effect, and the ceiling is the maximum limit of the Regime Geral de Previdência Social (RGPS, Brazil’s General Social Security Regime), which is updated every year by ministerial ordinance.

Waiting Period (Carência): Concept and General Rule

The carência, or waiting period, is the minimum number of monthly contributions an insured person must have paid into the system before the disability begins for the benefit to be granted. It serves an actuarial function: it prevents someone who is already ill and has no contribution history from joining the social security system and drawing benefits right away.

For the temporary disability benefit, Article 25, item I, of Law No. 8.213/91 sets the waiting period at twelve monthly contributions. An employee under the CLT (Brazil’s Consolidated Labor Laws) meets this requirement for every month of work with registered pay, because the employer is required to withhold and pay the contributions. Self-employed contributors and optional insured persons must pay their own contribution slips, and each month paid counts as one contribution toward the waiting period.

When the waiting period is counted, contributions made under different regimes throughout the insured person’s contribution history are taken into account. Periods of RGPS membership before any break in membership can be added to later periods, as long as the person regains insured status before the disability begins.

Waiver of the Waiting Period: Statutory Exceptions

Article 26, item II, of Law No. 8.213/91 sets out the situations in which the waiting period is waived for the temporary disability benefit. The legislature recognized that certain causes of disability call for immediate protection, regardless of the insured person’s contribution history.

Three groups are covered by the waiver:

• Accidents of any nature or cause: these include typical workplace accidents as well as household accidents, traffic accidents, and any chance event that causes a disability. The person only needs to have insured status at the time of the event.
• Occupational diseases or work-related diseases: these are illnesses resulting from the performance of work or from the environmental conditions in which it is performed, as defined in Article 20 of the same law, including diseases treated as equivalent by decree.
• Diseases and conditions listed by the ministries: the list includes active tuberculosis, leprosy, mental alienation, malignant neoplasm (cancer), blindness, irreversible and disabling paralysis, severe heart disease, Parkinson’s disease, ankylosing spondyloarthrosis, severe nephropathy (kidney disease), advanced stages of Paget’s disease, acquired immunodeficiency syndrome, radiation contamination, severe liver disease, and multiple sclerosis, among others.

The waiver of the waiting period does not remove the other requirements: you must still prove your insured status and your inability to work through a federal medical examination.

Insured Status and the Grace Period

Besides the waiting period, you must still have insured status on the date the disability begins. That status remains active as long as you hold a job or make monthly contributions. Once the work activity or contributions stop, you enter what is called the grace period, during which you keep all your rights with social security without making payments.

The grace period is twelve months for most insured persons. It extends to twenty-four months if you have more than one hundred twenty monthly contributions with no break longer than twelve months. For an unemployed insured person who proves that status through registration with the appropriate agency of the Ministry of Labor, the period can also be extended. If you lose insured status before the disability begins, you cannot receive the benefit, even if you fully met the waiting period earlier.

Frequently Asked Questions

Who is entitled to the temporary disability benefit?

Any RGPS insured person who becomes unable to perform his or her work or usual activity for more than fifteen consecutive days, as long as the person keeps insured status and has met the waiting period of twelve monthly contributions. In cases of accident, occupational disease, or a disease on the ministerial list, the waiting period is waived, and only insured status is required.

What is the required waiting period, and when can it be waived?

The general rule requires twelve monthly contributions before the disability begins. The waiting period is waived in the following cases: an accident of any nature (work-related or not), an occupational or work-related disease, and serious diseases or conditions with irreversible effects that appear on the list prepared by the Ministries of Health and Social Security, such as malignant neoplasm, active tuberculosis, and severe heart disease.

How long can the temporary disability benefit be received?

The law sets no maximum duration for the benefit. The INSS (Brazil’s National Social Security Institute) conducts periodic medical examinations to check whether the disability continues. As long as you remain unable to work and the examination confirms it, the benefit continues. If the disability becomes permanent, you may be entitled to permanent disability retirement, provided you meet the specific requirements for that benefit.

As informações deste artigo são de caráter informativo e não substituem consulta jurídica individualizada. Cada caso possui particularidades que exigem análise específica.