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A court in Spain has upheld the ruling of a mutual insurance company not to pay a teacher sick leave on the grounds that she had taken time off work "for cosmetic surgery".
The woman started her sick leave on 20 March 2023, the day before the operation, but three months later (28 June) the mutual insurance company refused her the benefit. Disagreeing with the decision, she took the case to court. Now, the High Court of Justice of Galicia has upheld the ruling of the court in Vigo, which had ruled in favour of the mutual insurance company.
Prior to the aesthetic procedure the woman had been on sick leave with "work-related anxiety problems", according to the judgement consulted by SUR.
It was therefore a question of deciding whether the woman was entitled to receive temporary incapacity benefit during the period claimed as a result of the lifting operation performed at the private Vithas Hospital, without there being evidence of the existence of a previous illness that made the operation necessary, or rather whether it was for purely aesthetic purposes.
Article 128.1. of the General Law on Social Security (LGSS) states: "The following shall be considered situations that determine temporary incapacity: a) Those due to common or professional illness and accident, whether or not work-related, while the worker receives health care from the Social Security and is unable to work, with a maximum duration of twelve months, extendable for another six months when it is presumed that during this time the worker may be medically discharged as a result of recovery".
The judges argued that in this case it is not so much that the healthcare received by the beneficiary was not provided by the Social Security doctors, nor was it provided as a benefit to be financed by the Social Security, "but rather that the situation in which the plaintiff voluntarily placed herself is not due to a common illness, occupational illness or accident, which prevents her from receiving the benefit claimed".
In her allegations, the woman stated that the excess fat on her neck had affected her mood, making her "feeling anxious and suffering from body dysmorphic disorder and that this is corroborated by the primary care doctor".
However, the ruling stated that this "contradicts" the fact that if this were the case, the intervention would have been prescribed by Sergas (Galician health service). "Furthermore, although it is true that the plaintiff remained in a situation of temporary incapacity due to an anxiety disorder related to work-related problems, it has not been accredited that it had any relation with the intervention carried out", the ruling stated.
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