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Social Security Benefits Can Be Granted Even When the Sequela Is Considered Mild, Without Work Absence, and Ensures Retroactive Payment If the Request Is Denied Administratively, According to Judicial Understanding Applied to the Case of Total Loss of Vision in One Eye After an Accident.
A worker who suffers a permanent sequela and has some limitation in exercising their activity may be entitled to accident assistance, even when the reduction in capacity is considered small and there is no work absence.
This was the understanding adopted by the 3rd Chamber of Public and Collective Law of the Court of Justice of Mato Grosso, recognizing the right of a mechanic who completely lost vision in the right eye after an accident at work.
In the assessment of the panel, monocular vision constitutes a visual sensory disability and, therefore, tends to impact how the worker performs normal tasks.
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The decision also determined that payment should be made with retroactive effects, since the date when the INSS denied the request in the administrative process.
Work Accident Caused Total Loss of Vision
The case involves a mechanic who was injured while handling a tire.
According to the process, he was hit by a spatula, causing perforation of the right eyeball and leading to complete loss of vision in that eye.
With the sequela consolidated, the worker approached the INSS and, in 2013, requested accident assistance.
However, the request was denied on the grounds of lack of incapacity for work.
In practice, the agency argued that the condition would not prevent the insured from performing their functions.
In light of the denial, the mechanic appealed to the courts to obtain the benefit.
He claimed that the loss of vision in one eye reduced his work capacity and started to require more effort to carry out routine activities in the profession.
INSS Contested Incapacity and Benefit Amount
In the first instance, the decision favored the worker. The court ordered the INSS to grant accident assistance.
The agency appealed to the Court of Justice of Mato Grosso on two central points. On one hand, it argued that there was no reduction in the capacity of the insured to perform their usual activities.
On the other hand, it questioned the method of calculation applied in the ruling. The initial decision had set the monthly income at 100% of the benefit salary.
In analyzing the appeal, the court maintained the recognition of the right to accident assistance.
However, it revised the percentage of the monthly amount to align it with what is provided by social security legislation.
Minimal Capacity Reduction Guarantees the Right
The rapporteur of the case, Judge Marcio Vidal, highlighted that monocular vision is recognized by law as a visual sensory disability.
In the vote, he stated that, “once it is shown that the worker has a consolidated injury resulting from a work accident, which leads to a reduction in their usual labor capacity, granting the benefit is imposed.”
The decision followed the understanding of the Superior Court of Justice, which consolidated the thesis that it is not necessary to prove relevant incapacity.
It is sufficient to demonstrate reduction in capacity for usual work, even if minimal.
This understanding also applies when the sequela requires more effort from the worker to perform the same activity.
Amount of Assistance and Retroactive Payment
Although it maintained the right to the benefit, the panel adjusted the monthly income amount.
The court set the payment at 50% of the benefit salary, the percentage provided for in the Social Security Benefits Law.
Another relevant point was the starting date for payment.
The accident assistance should be paid since February 2013, the date when the request was denied administratively by the INSS.
In practice, this allows for the receipt of retroactive amounts when the denial is reversed judicially.
This starting point often varies according to the insured’s history. When there is no prior grant of sick leave assistance, court decisions usually set the beginning of payment at the date of the denied administrative request.
Benefit Can Be Paid Even with Worker Active
Accident assistance has compensatory nature. It is intended for insured individuals who, after an accident, are left with permanent sequelae that reduce their capacity for usual work.
Thus, the benefit can be paid even when the worker continues to perform their job.
In the analyzed case, the court gave weight to the legal recognition of monocular vision as a disability and the understanding that minimal capacity reduction does not prevent the grant.
Still, each case depends on the technical evidence and how the examination describes the impact of the sequela on the insured’s concrete activities.
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