ven if we take all possible precautions and care, we can all suffer an accident at work. That is why, in Portugal, all employers are obliged to provide their employees with workers' compensation insurance.
But what is considered an occupational accident? When and how do you activate your workers' compensation insurance? And how does it apply to employees who work from home? In this article, we provide the answers to some questions you may have about workers' compensation insurance.
How does it work?
Workers' compensation insurance covers the medical care required to restore the victim's or injured worker's state of health, working and earning capacity, as well as all expenses related to hospital care, medicine and pharmaceuticals, accommodation and transport, and psychotherapeutic support for the family (when recognised as necessary by the doctor).
In addition to medical assistance, the insurance guarantees payment of any compensation for temporary or permanent incapacity resulting from an accident at work or an occupational disease.
Is it compulsory?
According to Portuguese Law, more specifically the article 1 of Decree-Law (DL) no. 159/99, of May 11th, workers' compensation insurance is compulsory. Law no. 98/2009, of September 4th regulates this insurance for employees.
The lack of a valid workers' compensation insurance policy is considered a very serious offence. Thus, without a valid policy, the company is left with the burden of paying all expenses arising from the accident, resorting, if necessary, to its own assets. This includes medical treatment and possible pensions.
Workers' compensation insurance for self-employed workers
DL no. 159/99, of May 11th regulates workers' compensation insurance for self-employed persons in Portugal. According to article 2 of this Decree-Law, workers' compensation insurance for the self-employed is governed, with the necessary adaptations, by the provisions of Law 98/2009, of September 4th and complementary diplomas, with some exceptions, mentioned in the following articles of the same Law.
What is an occupational accident?
According to article 8 of Law 98/2009, of September 4th, an occupational accident/a work accident is any accident that occurs at the workplace, during the time dedicated to professional activity, or during the commute from home to work and vice versa, which results in a bodily injury, functional disorder or illness that causes a reduction in the worker's capacity to work or earn, or in extreme cases, death.
When can it be considered an occupational accident?
This insurance covers accidents that occur not only during the agreed eight-hour period (from 9 a.m. to 6 p.m., for example), but also while travelling from home to work and from work to home. It is important to note that it is still considered an accident at work when the worker interrupts or deviates from the normal route. However, this must be due to the employee's needs, force majeure or unforeseeable circumstances.
Lunch breaks are also 'safe', and the employee is similarly protected during the commute between the workplace and the meal location, and vice versa. However, insurance does not cover accidents that occur at the meal location.
What can be considered an occupational accident?
In order to be considered an accident at work, it must occur in the workplace, that is, in the place (or places) where the worker is or has to go in the course of his/her work and where he/she is, directly or indirectly, subject to the control of the employer. For the purposes of accidents at work, the place where the worker is teleworking is also considered to be the place of work, provided that it is stated in the teleworking agreement.
What other situations are included in the concept of workplace?
The following may also be included in the concept of workplace:
- Meetings or activities as a workers' representative, whether in the company or elsewhere;
- Professional training, in the workplace or outside of it, whenever there is the express authorisation of the employer for such attendance;
- Parties and social gatherings organised by the company, work outside the office or activity outside the usual hours, provided that this service has been indicated, or consented to, by the employer;
- Journey between workplace and meal place;
- Journey between workplaces (if more than one);
- Place where the worker receives any form of assistance or treatment, due to a previous accident.
What if the accident occurs during teleworking?
The employer is legally obliged to take out a workers' compensation insurance policy, which protects its employees, whether they work face-to-face in the office, from home, or from any other place. Thus, teleworkers are still protected by employment insurance. However, to be considered a work accident, the following conditions must be met:
- The accident happened at the place communicated to the employer as a telework place;
- The accident happened during working hours and only within the scope of the exercise of the worker's functions.
The Portuguese Insurance and Pension Funds Supervisory Authority (ASF) warns that the telework regime must be duly formalised between the employer, the worker and the insurance company. In addition to authorisation records for teleworkers, companies must also provide the insurance company with an indication of the place where the worker is providing work, schedules, and the rights and duties of workers.
How to activate workers' compensation insurance
In the event of an accident at work, the injured worker must be taken to the nearest hospital for first aid. If the employer did not witness the accident, the worker - or someone representing him/her - must report the accident to the employer, verbally or in writing, within 48 hours of the event. If the employee's condition, or other duly proven circumstances, do not allow this period to be complied with, it starts counting from the time when the impediment ceases to exist.
On the other hand, if the injury becomes apparent after the 48 hours following the accident, the period starts to run from the date when the injury is certified.
The employer has 24 hours to notify the insurance company of the accident.
How much can you receive from the workers' compensation insurance?
According to the Law no. 98/2009, of September 4th, the insurance companies contracted by the companies must pay the benefits for disability resulting from an occupational accident. According to the same Law, insurers are obliged to pay 70% of the injured worker's gross salary during the first 12 months of temporary incapacity and 75% after that period.
The final amount to be received from the workers' compensation insurance depends on several factors, mainly on the degree and type of incapacity, both determined after the work accident. The incapacity can be temporary partial, temporary absolute, permanent partial, permanent absolute, permanent absolute for regular work, or permanent absolute for all work.
In case of incapacity, workers' compensation insurance provides two types of benefits: payment-in-kind, such as coverage for hospital care, transportation, pharmaceutical expenses, and others, and in cash, such as indemnities, benefits, pensions, and allowances.
How long does it take the insurance company to pay out?
In an occupational accident case, there is no fixed time limit for the insurance company to pay out, but it usually takes between one and four months.
When the case is concluded, the Portuguese labour court notifies the parties (the injured worker, the insurance company and, in some cases, the employer), who must appear in court to receive the amount due. If the incapacity is greater than 30% or absolute, the injured person receives an annual pension for life, which must be paid in 14 monthly instalments by the 3rd day of each month.
Sick leave through workers' compensation insurance
If the accident at work results in the need for the employee to take a sick leave - a document, issued by a doctor appointed by the insurance company, certifying the illness and/or the employee's inability to perform their professional activity for a certain period of time - the insurance will cover the costs due as a result of the sick leave.
How to access workers' compensation insurance Coverflex?
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Implementing insurance in your company through Coverflex is simple and quick, and we are here to support you in the process. Click here to contact us!