The Decree established the procedure that EPS´s shall periodically observe to review the medical leave for general illness and set the minimum content of the rehabilitation assessment to be issued by the EPS before the 120th day of medical leave.
Likewise, the Decree established that EPS shall recognize and pay medical leave exceeding 540 days arising from a general illness in the following cases:
- When there is a favorable concept of rehabilitation issued by the attending doctor, which states that it is required to continue a medical treatment.
- When the patient has not recovered during the illness or injury that caused the medical leave due to a general illness, having followed the protocols, care guides and the recommendations of the attending doctor.
- When new situations prolonging the recovery time of the patient have occurred due to concomitant illnesses.
On the other hand, with the aim of avoiding the irregular use of disabilities, Decree 1333 defined the following behaviors as violation of rights:
- When the EPS or the respective entity establishes that the contributor has not followed the treatment and the therapies ordered by the attending doctor, has not attended the assessments, examinations and controls or has not complied with the procedures and recommendations required for his/her rehabilitation in at least 30% of the situations described.
- When the contributor does not attend the exams and assessments to determine the loss of work capacity.
- When an alleged alteration or possible fraud is detected during the medical leave, those who detect such situations will be obliged to take the case to the competent authorities.
- The execution of allegedly illegal acts or conducts related to his/her health status.
- When fraud is detected when granting the medical leave certificate.
- When it is detected that the contributor seeks recognition and payment of medical leave both in the EPS and in the Labor Risk Administrator (“ARL” for its initials in Spanish) for the same cause, generating a double charge to the Social Security System.
- When charges are made to the Social Security System in Health with false data.
- When it is detected that during the time of medical leave, the contributor is undertaking an alternative activity that prevents him/her from recovering and from which he/she receives an income.
The behaviors described in numerals 1, 2 and 6 must be resolved by the EPS and those corresponding to numerals 3, 4, 5 and 7 must be brought to the attention of the competent authorities. In the case of numeral 8, the employer must inform the EPS about the occurrence of the conduct and provide the relevant evidence.
According to the above, in the following events the EPS or the competent authority may suspend the payment of the medical leave:
- When the EPS or the competent authority, as the case may be, determines that any of the causes of violation of rights previously described took place.
- When the contributor does not comply with the requirements indicated in article 126.96.36.199 of Decree 780 of 2016 (Regulatory Decree of the Health and Social Protection Sector).
- When the contributor is in default according to the articles 188.8.131.52 and 184.108.40.206 of Decree 780 of 2016.
- When the medical leave due to general illness was caused by esthetic treatments and their complications, or if it comes from treatments excluded by the criteria provisioned in article 15 of Law 1751 of 2015.
Finally, Decree 1333 regulated the payment of economic benefits arising from medical leave due to a general illness for which it established the following rules:
- As from the execution of the master accounts for collection, the contributors and independent workers will not be able to deduct the values corresponding to medical leave due to general illness and maternity and / or paternity leave from the health contributions.
- The EPS or respective entity will make the direct payment of these economic benefits to the contributor, directly or through wire transfer within a maximum period of 5 business days, counted as from the authorization of the economic benefit. If the EPS or competent entity does not comply with this term, it must recognize default interest to the contributor.
- The review and liquidation of applications for recognition of economic benefits will be made within 15 business days following the request of the contributor.