DIVERGENT DECISIONS REACHED BY SOCIAL SECURITY MEDICAL EVALUATORS AND OCUPATIONAL EXPERT PHYSICIANS
Camila Lucia Dedivitis Tiossi (1)
(1) Hospital Darcy Vargas, São Paulo-SP
Controversies are generated when the Social Security medical examiner and an occupational physician reach divergent conclusions regarding the ability of a worker to return to his duties, often causing serious damage to the worker. In such cases the employee seeks the judiciary to resolve the dispute involving medical issues and labor and social security laws.
We performed a retrospective analysis of 25 judicial evaluations in suits against the National Social Security Institute (INSS ) held in April 2010 in Santa Isabel Forum – São Paulo. The age ranged from 31 to 65 years (mean 48.6 years) with male predominance ( 14M : 11F ) . The insured required disability retirement (15 cases) , followed by medical leave (8 cases) and social benefit (2 cases) . Twenty individuals received some kind of social benefit previously. The most common occupation among these individuals was maid/cleaner (7 cases). The main disease group was found to correlate with osteoarticular diseases (20 cases), followed by cardiovascular (4 cases).
The judicial expert report concluded that only 4 of these individuals were found to be unfit for any work . Sixteen found themselves able to work with restrictions -four fit for any activity. When we analyze ability to perform the main occupational activity, we found that most insured are unfit (72%). This fact creates a lot of conflict to workers leading to actions with the Judiciary system.
Keywords: medical expert evaluation, social security, disability claims, judicial system.