The claimant, a midwife by profession, submitted a claim for permanent disability on the grounds of work-related stress, formally diagnosed as "adaptive disorder with chronic mixed anxious-depressive symptoms". Her symptoms included, among others, tension, irritability, despair, restlessness and psychosomatic complaints, alongside progressive exhaustion — all arising from the cumulative difficulties inherent in her work as a midwife. Added to this were reported behaviours by Hospital Management that she described as harassment, to the point of reaching what is commonly known as "burnout syndrome", which led her to submit her resignation in order to take up work elsewhere — a plan she was subsequently forced to abandon due to a family illness.
Written by Josep Conesa
Employment and insolvency lawyer
It is important to highlight that upon returning to her post following a period of temporary disability (IT), the stressful situations re-emerged and many of the previous conditions resurfaced, ultimately wearing down her mental and emotional state.
Total permanent disability in relation to one's usual occupation is understood as the situation in which the employee is prevented from carrying out all or the essential tasks of their profession. It is crucial to assess the claimant's residual functional capacity, since this degree of disability should only be recognised where the existing sequelae prevent the performance of the duties inherent to the occupational activity with the requisite professionalism, dedication and consistency.
The claimant is entitled to the pension she seeks, as the functional limitations she experiences prevent her from carrying out the duties of her profession with the required professionalism and effectiveness. Psychiatric expert evidence confirms the existence of sustained burnout over time, which has progressively eroded her personal coping mechanisms, with repercussions extending beyond the strictly professional sphere into other areas of her life.
Attempts to overcome the stress — through various means such as prolonged separation from the stressful environment, the development of new routines, or the prospect of a change of post — have all proved unsuccessful upon her return to work.
Keeping the claimant in her current post and working environment prevents a proper and adequate recovery from her condition, which is consistent with burnout syndrome, and entitles her to recognition of total permanent disability with effect from the date of the medical assessment panel's (EVI) report.
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In Las Palmas de Gran Canaria, on 13 November 2015.
Heard before me, [Name], JUDGE of employment tribunal No. 10 of Las Palmas de Gran Canaria and its province, in open court, proceedings concerning Permanent Disability, brought before this Court under case no. ........................, initiated at the request of Edurne, represented by Mr Domingo ..............., against the NATIONAL INSTITUTE OF Social Security, represented by Ms Susana Porta Grandal, on the following grounds.
BACKGROUND FACTS
At the hearing, following an account of the background, the claimant reaffirmed their claim seeking recognition of total permanent disability status on grounds of common illness.
The National Social Security Institute (INSS) opposed the claim and filed a defence setting out the submissions recorded in the minutes. The evidentiary phase was then opened, during which the evidence proposed by the parties and declared admissible was examined and placed on the court record. Once the evidence had been heard, the parties made their final submissions and the case was declared ready for ruling.
ESTABLISHED FACTS
FIRST. – The claimant, born on NUM000/75, works by profession as a midwife, is registered under the General Social Security Scheme, and her regulatory base for the purposes of these proceedings is €2,548.53.
SECOND. – Following the expiry of a period of temporary disability (IT), permanent disability proceedings were initiated. A medical assessment report was issued on 03/11/14, and the Medical Assessment Team (EVI) issued its opinion on 06/11/14 in the following terms:
" Residual clinical picture determined as follows:
Adjustment disorder with chronic mixed anxiety-depressive symptoms, and the following physical and functional limitations:
Stable psychiatric condition under psychopharmacological treatment and psychological therapy, presenting with: asthenia, apathy, and feelings of helplessness causing significant subjective distress, without behavioural cognitive disorder and without impairment of overall functional capacity."
THIRD. – By resolution dated 26/11/14, the claimant's application for permanent disability was refused, in accordance with the recommendation of the Medical Assessment Team (EVI). A pre-administrative claim was lodged against that decision and was subsequently dismissed.
FOURTH. – The claimant has been suffering from an Anxiety-Depressive Syndrome of several years' duration, with reactive features linked to her working conditions, for which she has been undergoing psychopharmacological treatment and, since December 2011, psychotherapeutic treatment.
She had been presenting anxiety-related symptoms including tension, irritability, despair, restlessness and psychosomatic complaints, alongside a progressive exhaustion largely attributable to stress and sleep disturbances, a pessimistic outlook regarding her ability to continue in her current working environment, a sense of feeling misunderstood, and worsening difficulties in her immediate surroundings that were significantly affecting her interpersonal relationships and family life.
The onset of all these symptoms has been linked to problems in the workplace, with frequent intrusive recollections of past events, experienced in a strongly negative way, together with anxiety symptoms including anticipatory anxiety, while a latent desire to return to work remained present throughout.
These difficulties began in a clear and overt manner from 2004 onwards, following her progressive experience of the various challenges associated with her role as a midwife — challenges she describes across several areas (competence-related issues, relationships with physicians and nurses, understaffing and the resulting work overloads, etc., in accordance with she reports) — with a press conference in 2004 culminating in a state of anxiety that led to sick leave.
From that point, she experienced her situation as a combination of "burnout" (consistent with burnout syndrome, which led her to give notice to leave her post and work elsewhere — a plan she abandoned due to a family illness) and conduct on the part of Hospital Management that she describes as workplace harassment.
The cumulative effect of these stressors and conflicts progressively wore down her mood and resilience until her personal resources and coping mechanisms were overwhelmed.
She subsequently returned to work as a midwife, a return made possible by several factors:
- The diagnosis of burnout syndrome itself, which enabled her to develop both better emotional regulation and practical tools for managing stressful situations.
- A period of separation from the environment that had caused her difficulties — specifically, 15 months of temporary disability (IT) — which allowed her to recover. Those 15 months were not spent passively: during this time she engaged in activities such as sport, intellectual pursuits and meditation.
Upon returning to her post, whilst approaching it with renewed resolve, she found herself once again exposed to stressful situations, with many of the same conditions recurring that had originally led to her temporary incapacity for work.
Reimmersion in the stressful environment has once again produced symptoms including anxiety, irritability and insomnia; she is subject to increased stress and finding that her poor fit with the role is generating further difficulties and friction. Her own sense of professional self-worth is also being affected, giving rise to feelings of professional inadequacy.
FIFTH. – The claimant presents affective symptoms (anxiety and depression) arising from a sustained experience of injustice in her working conditions in the exercise of her profession as a midwife. The behaviours she has experienced as unjust fall within the definition of workplace harassment (mobbing).
Her primary experience is one of physical and mental exhaustion, together with feelings of frustration arising from the work-related stress described above. This results in a difficulty adapting to her usual role in the delivery suite. She currently requires psychopharmacological medication and psychotherapeutic treatment.
Furthermore, with regard to her occupational adjustment, the presence of emotional exhaustion, a sense of depersonalisation in her work and in her relationships with patients, and a low sense of personal accomplishment all point to the advisability of a change of post.
Her determination to improve working conditions within the midwifery profession has been a contributing factor in the development of what is known as burnout syndrome.
SIXTH. – She was on sick leave (temporary disability (IT)) from 20/04/15 to 03/07/15, and again from 02/10/15 onwards.
LEGAL GROUNDS
Facts 1, 2, 3 and 6 are derived from the administrative file, whilst facts 4 and 5 are derived from the clinical documentation on record and from the medical and psychological expert reports submitted by the claimant.
The grade of total permanent disability (IPT) in relation to the usual occupation is defined in the consolidated text of the General Social Security Act (Article 137) as that which prevents the employee from performing all or the core tasks of that occupation, provided the worker is able to engage in a different one. Case law has taken into account, in specific cases, the particular circumstances relating to the greater or lesser physical demands of the occupation, as well as the degree of physical fitness required to perform it (judgments of the Supreme Court of 17 January and 29 June 1989 (LA LEY 123742-NS/0000)). The usual occupation is therefore essential and decisive for an accurate legal classification of the claimant's residual condition, given that identical injuries and sequelae may or may not constitute permanent disability depending on the activities and tasks required by the alleged incapacitated person's profession. It must be borne in mind that Article 137 of the consolidated text of the General Social Security Act links the grade of total permanent disability now under consideration to the usual occupation; accordingly, such grade should only be recognised where the existing sequelae prevent the claimant from performing the tasks inherent to their occupational activity with the level of professionalism, dedication and consistency that an employment relationship demands.
The claimant is entitled to the pension she claims, as the functional limitations described in proven facts 4 and 5 prevent her from carrying out the tasks of her profession with the requisite professionalism and effectiveness, in direct application of Art. 137 General Social Security Act (LGSS).
In the claimant's case, and as the psychiatric expert concludes, a sustained deterioration over time had progressively eroded her personal coping mechanisms, with repercussions extending beyond the strictly occupational sphere into other areas of her life. That deterioration ultimately resulted in burnout syndrome.
Through various mechanisms — prolonged separation from the stressful situation, the development of new routines, maintaining hope of returning to her role, and the expectation of a transfer to a non-hospital post — she managed to improve her condition and was able to resume work; however, upon returning to her post she experienced a progressive relapse.
Remaining in her current post and working environment prevents proper and adequate recovery and causes her to relapse once more into symptoms consistent with burnout syndrome. For all these reasons, she is entitled to recognition of the grade of total permanent disability (IPT), with effect from the date of the EVI opinion.
Having regard, in addition to the above, to the general and applicable legal provisions,
RULING
TO UPHOLD the claim brought by Edurne against the NATIONAL Social Security INSTITUTE, recognising the claimant's entitlement to the grade of TOTAL PERMANENT DISABILITY arising from a common illness, and ordering the respondent body to pay the claimant a pension of 55% of the regulatory base indicated above, with financial effect from 06/11/14, with the relevant adjustments in respect of temporary disability (IT) benefits received since that date to be applied at the enforcement stage of the ruling.
