The General Social Security Law explains that the fact that a beneficiary does not attend a review in the medical court does not mean the automatic extinction or loss of his permanent disability pension. Now, the regulations are strict with the control of benefits, so if the citizen does not appear at the appointments required by the managing entity, the financial benefit will be suspended on a precautionary basis, thus avoiding undue payments while the situation is clarified.
As explained in article 52 of the General Social Security Law (available in this BOE), when a beneficiary fails to comply with the obligation to appear for the examinations or present the required supporting documents, the payment of the benefit will be paused. However, if the absence is later justified within the period or the requested information is provided, the interested party may request the reactivation of the pension, paying it again and with a maximum retroactivity of 90 calendar days.
Why is the payment of the pension suspended if one does not attend?
The reason is because Social Security and mutual collaborators have the obligation and the right to periodically verify that the health causes that gave rise to the benefit (whether a temporary or permanent disability) are maintained over time. Thus, if the worker does not attend, the administration understands that their current status cannot be evaluated and preventively stops payment.
To understand how this mechanism works, we must analyze the three key steps established by the current regulations in case of non-appearance, which are:
- The call and the absence, since the administration or the mutual insurance company summons the worker for a medical examination and examination. If the beneficiary does not appear on the indicated date and time, the control protocol is activated.
- The precautionary suspension, since, in the event of non-appearance, regulations such as article 175.3 of the LGSS (applicable to withdrawals) dictate that the benefit is suspended. Clarify that the right is not lost immediately, but the monthly payment is paused to check whether the lack was justified or not.
- The final resolution, because if the process ends by demonstrating that the absence was justified, the suspension is lifted and the right to payment is reinstated. If it is not justified, the final outcome will depend on the type of benefit being received.
Key difference between medical leave and pension
This measure is aligned with the system’s obligations regime. In this sense, you should know that, although the terms are often confused, the law clearly distinguishes between a permanent disability pension and a temporary disability benefit (medical leave). In the specific case of the temporary disability subsidy, the new regulation explains in article 174.1 of the LGSS that unjustified failure to appear at medical appointments is a direct cause of termination of the right.
Thus and with everything explained, Social Security always guarantees the protection of the worker, but adjusts the payment of benefits to strict compliance with medical follow-ups. In short, if the non-appearance is due to a reason of force majeure and is duly justified, the citizen recovers his benefit and maintains his coverage, lifting the suspension of payment.
On the other hand, if it is not possible to justify this absence and it is a medical leave, the subsidy will be terminated. It is at that moment when the worker definitively loses the right to continue receiving the financial benefit for temporary disability.