What it is and how it differs from sick leave
Sick leave (temporary incapacity) covers the time treatment lasts. Permanent incapacity (IP) is granted when, once treatment has ended or stabilised, you are left with lasting effects that reduce or remove your ability to work. It does not depend on the diagnosis itself ("having cancer") but on functional limitations: neuropathy that prevents fine motor tasks, a stoma with complications, low anterior resection syndrome, severe fatigue, chronic pain, metastatic disease on continuous treatment…
The four degrees
| Degree | What it means | Benefit (indicative) |
|---|---|---|
| Partial | Your performance in your occupation is reduced by at least 33 %, but you can still do it | Lump sum (24 monthly payments) |
| Total | You cannot do your usual occupation, but can do others | Pension of 55 % of the base (75 % from age 55 if you do not work, "qualified total") |
| Absolute | You cannot do any job | Pension of 100 % of the base |
| Severe incapacity (gran invalidez) | You need another person for essential acts (dressing, eating, moving around) | Absolute + supplement for the carer |
These are the general percentages; the actual amount depends on your contribution base and years contributed. Use the Social Security simulator.
Who assesses it and how it starts
The decision is made by the INSS (Spanish social security institute) on the opinion of the Incapacity Assessment Team (EVI), the so-called "medical tribunal". An assessing doctor will call you, review your reports and examine you; in practice the decision rests mainly on the written reports.
The file can be opened:
- By the INSS: when sick leave runs out (365 or 545 days), or earlier if the inspectorate proposes it.
- At your request: you can apply at any time, even while on sick leave, using the Social Security form (online or by appointment). You do not need a lawyer to apply.
Which reports to provide
This is where the case is won or lost. Ask each specialist for an up-to-date report describing limitations, not just diagnoses: "grade 2 neuropathy with loss of sensation in the hands preventing fine manipulation", "4-6 urgent bowel movements a day", "fatigue requiring rest after 2 hours of activity". Include oncology, surgery, gastroenterology, rehabilitation, psychology/psychiatry where relevant, and test results. Describe in writing what your job involves (tasks, physical effort, shifts). If you hold a disability certificate, attach it (a different assessment, but it helps).
Reviews
The decision usually sets a review date for improvement or worsening (for example, after 2 years). In cancer it is common for the first award to be reviewable until 5 disease-free years have passed. If you improve, the degree may be lowered or withdrawn; if you worsen, you can request a review yourself. At retirement age the pension is renamed a retirement pension with the same amount.
Compatibility with work
Total incapacity is compatible with a job different from your usual occupation (you lose the extra 20 % of the qualified rate if you work). Absolute and severe incapacity are in principle incompatible with working, with some exceptions carved out by the courts for marginal activities; seek advice before accepting a job.
If it is refused or a lower degree is granted
- Prior claim (reclamación previa) to the INSS within 30 working days of notification. Add new reports if you have them.
- If rejected (or unanswered after 45 days), claim before the Social Court within 30 working days. A lawyer is advisable here; legal aid covers low incomes, and associations such as AECC or GEPAC can guide you.
Many cancer-related incapacities are recognised in court after an initial refusal: a "no" from the INSS is not the end.
What to ask at your appointment
- Can you write a report describing my functional limitations for the medical board?
- Are my after-effects likely to be permanent, or is improvement expected? Over what timeframe?
- Do you recommend rehabilitation or treatment for the after-effects before the assessment?
- Social worker: can you help me with the application and paperwork?
- Association: do you offer legal advice to prepare a claim if it is refused?