Disability - Re-examination

In a re-examination, whether conducted at the request of the insured or at the initiative of the National Insurance Institute, the NII may reduce the percentage of medical disability and the degree of incapacity.

Re-examination at the initiative of the insured

A person whose claim for a disability pension was rejected (because less than a 60% medical disability was determined for him, or less than a 40% medical disability with at least one of the impairments being 25%, or less than a 50% medical disability in the case of a housewife, or if he was deemed not to have lost his earning capacity or lost less than 50% of his capacity), and a person for whom a partial degree of incapacity was established, may request a re-examination of the degree of incapacity if 6 months have passed since the NII’s last determination in the matter.

If new facts pertaining to the medical or occupational situation are discovered or arise, which can affect the degree of incapacity, a request can be submitted for a re-examination, even if less than 6 months have elapsed since the last determination. Medical documents and certification of income from employment must be attached to the request.

A person whose claim was rejected for another reason, such as high income, and his income was reduced, may submit a repeat claim without waiting.

A person for whom a degree of incapacity of not over 74% was established may only request a re-examination of the percentage of his medical disability, if he meets the following conditions:
1.   More than 12 months have elapsed since the last determination of the percentage of his medical disability.
2.   A certified physician on behalf of the National Insurance Institute determined that his medical condition has worsened.
3.   He is not hospitalized in an institution.

In a re-examination of the degree of incapacity, the medical disability is also re-examined and reestablished.