Starting in 2026, examinations and reports required for INSS (Brazilian National Social Security Institute) assessments will have to be paid for by the Institute itself, according to a court decision and a new regulation.
The INSS medical examination process will undergo one of the biggest transformations in recent years starting from… January 1, 2026From that date, the insured You will no longer be required to pay out of your own pocket. Expensive tests or specialized opinions required by the federal medical expert for the conclusion of the expert evaluation. In practice, this means the end of a common and unfair situation: the expert requested tests such as… Magnetic resonance imaging, computed tomography, or specialist reports…and the insured person, often unemployed or on sick leave, had to bear high costs to avoid having their benefit denied. The new regulation promotes a change supported by the constitutional principles of human dignity and social security protection, guaranteed by article 194 of the Federal Constitution.
This change did not arise from an isolated administrative initiative. It stems from a decision of the Federal Court, delivered in Public Civil Action No. 5000295-09.2015.4.04.7200/SC, which acknowledged that It is not legal to transfer the cost of essential medical examinations for social security assessments to the insured party..
The court ruled that if the examination is necessary for the INSS (Brazilian National Social Security Institute) itself to form a conviction about the right to the benefit, The cost cannot be imposed on the citizen., especially when it comes to people in situations of economic vulnerability.
With the publication of new ordinanceThis judicial understanding is then incorporated into the administrative practice of the INSS (Brazilian National Social Security Institute), with mandatory application throughout the national territory.
What changes in practice for those undergoing expert evaluation?
From 2026 onwards, whenever the federal medical expert to consider that there is insufficient evidence to complete the expert analysis based solely on the documents already submitted, and to request supplementary examinations or technical reports. the cost will be the responsibility of the INSS (Brazilian National Social Security Institute)..
This applies to high-cost examinations, such as imaging tests, specialized evaluations, and other procedures necessary to prove disability, impairment, or a health condition relevant to the benefit.
The insured party no longer runs the risk of having their request denied simply because not having the money to pay for exams required by the state itself..
To which types of orders does this rule apply?
The new obligation imposed by the INSS (Brazilian National Social Security Institute) is not limited to initial benefit applications. It also applies to situations that, in practice, generate even more insecurity for the insured.
Included are new applications for social security and welfare benefits, the requests for extension of disability benefits and the requests for reinstatement of benefits that were terminated after expert analysis.
In other words, whenever a federal medical examination is required and additional tests are needed, the cost can no longer be passed on to the insured party.
How will the INSS (Brazilian National Social Security Institute) cover the costs of these exams?
Although the obligation has already been defined, the operating model This will be detailed further by the INSS in conjunction with the Federal Department of Medical ExpertiseNew regulations will need to establish how the costing will work in practice.
Among the forms foreseen are the Direct reimbursement to the insured., upon presentation of supporting documents, the performance of the examinations by means of partnerships with affiliated clinics and laboratories, or other administrative mechanisms that guarantee free access to the required exams.
The central point is that none of these solutions will impose a cost on the insured., respecting the court decision.
Why is this change so relevant from a legal standpoint?
From a legal standpoint, the measure reinforces fundamental constitutional principles, such as… access to social security, dignity of human person and right to due administrative process without excessive burden on the citizen.
The courts made it clear that the state cannot demand complex technical evidence and, at the same time, transferring the cost of these exams to those who depend on the benefit to survive.The new rule corrects a historical distortion in the functioning of INSS (Brazilian National Social Security Institute) medical examinations.
What should the insured person do starting in 2026?
From the date the rule comes into effect, the insured person who has examinations required by the expert You should not automatically pay out of your own pocket.If this occurs, it will be possible to challenge the requirement administratively and, if necessary, judicially, based on the decision of the Public Civil Action and the current ordinance.
This change also tends to reduce litigation regarding benefits denied due to “lack of examinations,” one of the most frequent reasons for lawsuits against the INSS (Brazilian National Social Security Institute).
A new scenario for medical expertise in Brazil
The obligation of the INSS (Brazilian National Social Security Institute) to cover the costs of supplementary examinations represents a structural change in the relationship between the insured individual and the federal medical examiners. The focus shifts to… fair assessment of health conditionand not the citizen’s financial ability to produce technical evidence.
Starting in 2026, the INSS (Brazilian National Social Security Institute) will no longer penalize those who cannot pay and will assume full responsibility for its own evaluation process. For millions of Brazilians, this is not just an administrative change; it is a concrete guarantee of access to basic social security rights.
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