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Spain’s Supreme Court has ruled that the Social Security Administration cannot automatically deny a new claim for temporary disability benefits when a worker experiences a relapse of an illness after a prolonged medical exit. The ruling, delivered by the Social Court of the High Court, establishes that if a new medical certificate is issued by the National Health Service, the Social Security Administration must justify any rejection with medical criteria, or approve the benefit.
The decision addresses a common grievance among workers who, after exhausting an extended period of sick leave, find themselves unable to return to work due to a recurrence of the same condition, only to be denied further economic support. Unive Abogados, the law firm representing the plaintiff, stated the ruling ends “one of the most unfair and repeated situations experienced by thousands of workers after exhausting a prolonged medical leave: relapsing in the same pathology and remaining unfit for work, yet being left without economic benefits due to administrative automatism.”
The firm noted that many workers have previously been denied continuation of benefits as the Social Security Administration deemed a relapse occurred too soon after a prior claim. This was particularly prevalent when workers reached the 545-day limit for temporary disability benefits without being granted a permanent disability pension. in such cases, any subsequent claim within 180 days was routinely denied.
The case originated with a scaffolding fitter who was on sick leave for anxiety from March 2016 to November 2017. Following the end of that leave, the Social Security Administration denied his application for a permanent disability pension. One month later, the administration again denied benefits for the same condition, despite a medical certificate from the National Health Service. The denial was based on the argument that less than six months had passed since the previous claim and that it concerned the same illness.
The worker initially appealed the decision to the Superior Court of Justice of Murcia, which upheld the Social Security Administration’s ruling. He then appealed to the Supreme Court, which ultimately ruled in his favor. According to Unive Abogados, the ruling has significant social implications, particularly for conditions characterized by relapses, such as mental health disorders, cancer, rheumatic diseases, and chronic illnesses. “The Supreme Court prevents these relapses from resulting in a gap in coverage, especially when the system itself has denied the worker a permanent disability,” the firm stated.
The Supreme Court’s decision aligns with a previous ruling in 2020 (case number 5036/17) which also addressed the valuation of services provided in collaborating mutual insurance companies of the Social Security system, though that case focused on integration within the National Health System. A more recent ruling, STS 713/2025, dated June 5, 2025, further clarifies that these mutual insurance companies are closely aligned with centers integrated into the National Health System. The earlier ruling (53/2024) from January 16, 2024, specifically stated that these mutual companies are not part of the National Health System.
