Resolution SBS No. 1755-2020: Modifying the Manual for Evaluation and Qualification of Degree of Invalidity (MECGI)

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Lima, July 2, 2020
Resolution S.B.S.
No. 1755-2020

The Superintendent of Banks, Insurance and Private Pension Fund Administrators

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Single Consolidated Text (TUO) of the Law on the Private System of Pension Fund Administration was approved;

That, by Supreme Decree No. 004-98-EF, the Regulation of the aforementioned Law was approved;

That, additionally, in accordance with the Third Final and Transitional Provision of the Regulation of the Law, the Superintendence is empowered to issue the complementary operational norms necessary for the proper functioning of the Private System of Pension Fund Administration (SPP);

That, through Supreme Decree No. 061-2007-EF, article 129 of the cited Regulation of the Law was modified, referring to the Technical Medical Commission (CTM), which establishes that it is responsible for reviewing the technical norms for the evaluation and qualification of the degree of invalidity, reaching the Superintendence the proposals corresponding to the modification of the respective Manuals for Evaluation and Qualification of the Degree of Invalidity to which the Medical Committee of the AFP (COMAFP) and the Medical Committee of the Superintendence (COMEC) must adhere, as well as the other functions assigned to it by the Superintendence;

That, the Superintendence has carried out a review of the formula and the table of combined values contained in the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), of Subtitle IV of Title VII of the Compendium of Norms of the Regulatory Superintendence of the SPP, referred to the Norms for Evaluation and Qualification of the Degree of Invalidity, approved by Resolution No. 058-94-EF/SAFP and its amendments, for the sum of impairments that allow the determination of the nature and degree of invalidity, considering it necessary to establish clarifications regarding the criteria that apply regarding the sum of these values when two or more impairments are presented in the work capacity of affiliates for the determination of invalidity in the SPP, as well as the criteria for the consideration of the decimal part in the scoring of impairments in work capacity and the complementary factors that correspond, so as to optimize the methodology applied in the invalidity evaluation and qualification processes in the SPP;

That, for the purpose of collecting public opinions regarding the proposals for modification to the regulation of the Private System of Pension Fund Administration, the pre-publication of the draft resolution on the matter was ordered on the electronic portal of the Superintendence, in accordance with what is established in Supreme Decree No. 001-2009-JUS;

Having the approval of the Adjunct Superintendencies of Private Pension Fund Administrators, and of Legal Advice; and,

In exercise of the powers conferred by numeral 9 of article 349 of the General Law of the Financial System and of Insurance and the Organic Law of the Superintendence of Banking and Insurance, Law No. 26702 and its amendments, subsection d) of article 57 of the SPP Law, as well as by what is established in the Third Final and Transitional Provision of its Regulation;

RESOLVES:

Article First.- Modify the fourth paragraph of section I referred to the Qualification of Invalidity, of the instructions contained in the Introduction for the use of the norms for the evaluation and qualification of invalidity of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), Subtitle IV of Title VII of the Compendium of Norms of the Regulatory Superintendence of the SPP, approved by Resolution No. 058-94-EF/SAFP and its modifying norms, in the following manner:

“(...)

In cases where there is only one affected organ or system, the Norms indicate the percentage value of the impairment presented by the organ or system and the global value that it has in the person.
To combine two or more diagnoses expressed in percentage values, the formula known as Balthazar must be used, in the following manner: A%+B%*(100%-A%) which combines the values of A and B, where A = value of impairment A and; B = value of impairment B. In this text, this latter procedure is called “combined sum”. To this end, to establish the global impairment of the person, which constitutes the resulting value from the application of the Balthazar formula plus the sum of values for complementary factors, the following criteria must be used:

i. For the application of the Balthazar formula, diagnoses expressed in percentages must be ordered from highest to lowest.
ii. The values of impairments A and B, for the purpose of initiating the application of the formula, are noted without rounding, according to the value that would have been granted by this manual and/or the respective protocols, which is composed of an integer figure and up to two decimals;
iii. The combinations of A and B and the resulting value are considered with all their decimals;
iv. The complementary factors, if assigned, are noted according to the value recorded in the Introduction section of this manual, which contemplate an integer figure and one (1) decimal;
v. The determination of the global impairment of the person which constitutes the final value of the invalidity qualification, expressed as the arithmetic sum of the values noted in items iii. and iv., is expressed to two (2) decimals, truncated.

In the event that in the evaluation of a particular affiliate and/or beneficiary more than two impairments in their work capacity are presented, the development of the aforementioned formula is applied, based on successively combining the impairment values; in such case, the partial values are cumulative with respect to the final value of the total impairment.

For the combination of two (2) or more percentages that result from impairments due to diagnoses such as Rheumatoid Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematosus, Osteoarthritis in weight-bearing joints, Fibromyalgia, among others, that result from evaluating and qualifying invalidity applying the following criteria: personal aspects, clinical-therapeutic aspects, labor aspects and social-quality of life aspects, the guidelines issued by the Superintendence are followed. When an affiliate has been qualified by application of the aforementioned criteria, the complementary factors referred to in the aforementioned subsection iv. are not assigned.

For the purposes of issuing opinions, medical committees must have software for the application of the combined sum of impairments formula that adopts the criteria indicated.

(...)”.

Article Second.- Repeal the Combined Values Tables that form part of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its modifying norms.

Article Third.- Incorporate the Forty-sixth Final and Transitional Provision to Title VII of the Compendium of Norms of the Regulatory Superintendence of the SPP, approved by Resolution No. 232-98-EF/SAFP, in the following manner:

“Forty-sixth.- What is established in articles first and second of Resolution SBS No. 1755-2020 applies to Invalidity Evaluation and Qualification Requests (SECI) that are signed from the entry into force of the aforementioned resolution. The Combined Values Tables continue to be applicable for those SECI that have been signed before the entry into force of the aforementioned resolution.”

Article Fourth.- This resolution enters into force from the day following its publication in the official newspaper “El Peruano”.

Register, communicate and publish,

SOCORRO HEYSEN ZEGARRA
Superintendent of Banks, Insurance and Private Pension Fund Administrators