Everything you need to know about work accident insurance
Suffering an accident at work is something no one wants, but the truth is that it can happen at any time. Knowing how to act and what your rights are can make all the difference, whether you are in an office, working from home or even on your way to work.
What is considered an accident at work?
According to Law no. 98/2009 (Lei n.º 98/2009), an accident at work is any event that occurs at the workplace and during working hours, causing bodily injury, functional impairment or illness. These incidents can lead to a reduction in the worker''s capacity to work or to earn or, in more serious cases, result in death. The law also covers accidents that happen during work-related journeys, such as the route between home and the workplace.
Work accident insurance exists to ensure that workers have access to the medical care they need and that they receive adequate compensation in the event of temporary or permanent incapacity resulting from a work accident or a condition associated with carrying out their profession (occupational illness).
And what is the "workplace"?
You would be mistaken if you think it is only the office or the factory. The law includes all the places where the worker must be in order to fulfil their contractual obligations, as long as they are under the employer''s control. And "working time" also covers more than you might imagine: it includes the moments of preparation before starting work, breaks such as the lunch hour and the journeys to and from work.
Is work accident insurance mandatory?
Yes! All companies are required by law to have work accident insurance for all employees. This insurance serves to ensure that the worker receives the necessary medical care and financial compensation in the event of temporary or permanent incapacity.
If the company does not take out this insurance, it will be committing a very serious offence. And, in the event of an accident, it will be responsible for covering all the costs out of its own funds.
How does work accident insurance work?
- Initial medical assessment: after the accident, the doctor assesses the worker''s condition and determines whether time off is needed
- Notifying the insurer: the employer must report the accident and the medical leave to the insurer
- Medical follow-up: the worker will be entitled to ongoing medical assistance and the necessary treatments until recovery
- Financial compensation: during the leave, the work insurance ensures the payment of compensation, which varies according to the degree of incapacity (temporary partial or absolute).
And what does it cover?
In practical terms, should you have an accident at the workplace or during working time, the insurance covers:
- Medical and hospital assistance: includes treatments, surgery, consultations and tests needed for the worker''s recovery
- Medication and pharmacy expenses: all health-related costs for the worker resulting from the accident are borne by the insurer
- Transport and accommodation expenses: if the worker needs to travel for treatment or stay away from their place of residence, these expenses are included
- Psychological support for the family: if necessary, psychotherapeutic support can be made available to the family of the injured worker.
In addition to healthcare, the insurance also provides for financial compensation that varies according to the degree of incapacity, which may be temporary or permanent, and includes daily allowances or lifelong pensions. Take a look at the point below.
How much do you receive from work insurance?
The amount of compensation varies according to the type and degree of incapacity resulting from the accident.
- Temporary partial incapacity: a daily allowance of 70% of the loss of earning capacity
- Temporary absolute incapacity: 70% of pay for the first 12 months and 75% for the following period
- Permanent partial incapacity: an annual pension equivalent to 70% of the reduction in earning capacity
- Permanent absolute incapacity: a lifelong pension of 80% of pay, plus 10% per dependant (up to the limit of pay).
If the accident results in death, pensions are due to the spouse, children and other family members, with amounts that vary according to the degree of kinship.
And if you are working from home? Am I entitled to the insurance?
Yes, even when working from home you are protected by work accident insurance. However, the accident must:
- Occur at the place stated as your workstation (usually your home)
- Happen during working hours and within the scope of the duties carried out.
It is advisable for the remote working arrangement to be formalised and reported to the insurer, with information such as the place of work, hours and duties performed.
Work accident insurance for self-employed workers?
As provided for in Decree-Law no. 159/99 of 11 May (Decreto-Lei n.º 159/99), those who are self-employed are also required to have work accident insurance. Those working under "green receipts" (recibos verdes, Portugal''s self-employment invoicing regime) are likewise required to take out this insurance. If you do not have the mandatory insurance, you may be subject to fines of between 50 and 500 euros.
Sick leave for a work accident: what it is
This is the period of time off work granted to the worker who has suffered an accident at work and is temporarily unable to carry out their duties. To formalise this time off, a document is issued certifying the worker''s illness or incapacity to carry out their professional activity.
Is sick leave for a work accident the same as SNS medical leave?
No. Although both schemes offer support in the event of temporary incapacity for work, there are important differences:
- SNS (the Portuguese National Health Service) medical leave (also known as the Temporary Incapacity Certificate – CIT (Certificado de Incapacidade Temporária)) is issued by authorised bodies (health centres, hospitals or walk-in services) and applies to illnesses or accidents outside the work context, being paid by Social Security
- Work accident sick leave applies exclusively to accidents at work, and is issued by the attending doctor designated by the insurer responsible for following the clinical case. The entire process is managed and guaranteed by the insurer taken out by the employer.
What to do in the event of a work accident?
- Prioritise your safety and health. Call the emergency medical services or go to the nearest hospital to receive first aid
- Inform your employer. Report the accident verbally or in writing within 48 hours of the event (or as soon as possible, if there is anything preventing this)
- Keep all medical documentation. Make sure you obtain medical reports and receipts for expenses related to the accident
- Confirm that the accident has been reported to the insurer. Ensure that the employer reports the event to the insurance company within 24 hours of becoming aware of it
- Follow the recovery and compensation process. Stay informed about the rights guaranteed by the insurance, such as medical assistance and any compensation.
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