Supreme Court Rules: Social Security Can’t Automatically Deny Benefits for Recurring Illnesses

The Spanish Supreme Court has issued a ruling clarifying the conditions under which social security benefits can be denied to workers who experience a recurrence of illness after a prolonged period of medical leave. The court determined that social security authorities cannot automatically deny a new claim for temporary disability benefits simply because a worker relapses with the same condition following an extended absence.

According to the ruling, if a new medical certificate is issued by the National Health Service, social security is required to justify its denial with specific medical reasoning. Absent such justification, the benefits must be granted. This effectively prevents the automatic rejection of claims based solely on the proximity of the new illness to a previous one.

The law firm Unive Abogados hailed the decision as ending “one of the most unfair and repeated situations experienced by thousands of workers” after exhausting a long period of sick leave – relapsing with the same ailment and remaining unable to work, only to be denied economic support due to administrative procedures. The firm noted that many workers have previously found themselves without benefits because social security deemed the relapse “too close” to the prior illness.

This practice was particularly prevalent when workers reached the 545-day limit for temporary disability benefits without being granted a permanent disability pension. In such cases, any subsequent medical leave within 180 days was routinely denied, Unive Abogados explained.

The Origin of the Ruling

The case originated with a scaffolding worker who was on sick leave for anxiety from March 2016 to November 2017. Following the end of that leave, social security denied his application for a permanent disability pension.

Just one month later, the worker submitted a new claim for sick leave due to the same anxiety condition. While the National Health Service approved the leave, social security rejected the benefit payment, citing the fact that less than six months had passed since the previous episode and that it concerned the same illness.

The worker appealed the decision, and the Superior Court of Justice of Murcia initially upheld social security’s ruling. However, the worker then took the case to the Supreme Court, which ultimately ruled in his favor.

“The social relevance of this ruling is enormous,” Unive Abogados stated. “Many pathologies – mental health disorders, oncological processes, rheumatic diseases, or chronic illnesses – do not evolve linearly, but with relapses. The Supreme Court prevents these relapses from resulting in a gap in coverage, especially when the system itself has denied the worker a permanent disability.”

The ruling addresses a critical issue in the administration of social security benefits, particularly concerning conditions characterized by recurring episodes. The previous practice of automatically denying benefits based on the timing of a relapse created a significant hardship for workers legitimately unable to return to work. The Supreme Court’s decision shifts the burden of proof to social security, requiring a medically substantiated justification for any denial of benefits in such cases.

This ruling has implications beyond the specific case at hand. It establishes a precedent that will likely influence how social security handles similar claims in the future, potentially leading to a more equitable and compassionate approach to workers experiencing relapses of chronic or recurring illnesses. The decision underscores the importance of individualized medical assessments and the need to avoid rigid administrative rules that can undermine the purpose of the social security system – to provide economic security to those unable to work due to illness or disability.

The case also highlights the potential for legal challenges to social security decisions, particularly when those decisions appear to be based on arbitrary or inflexible criteria. Workers who have been denied benefits based on similar grounds may now have grounds to appeal those decisions, citing the Supreme Court’s ruling as supporting precedent.

While the ruling does not guarantee automatic approval of all relapse claims, it significantly strengthens the position of workers seeking benefits and ensures that social security authorities cannot simply deny claims without providing a valid medical rationale. This represents a significant victory for workers’ rights and a step towards a more just and equitable social security system.