Background: A Benefit Claim Arising from Cosmetic Surgery
A woman voluntarily underwent abdominoplasty and liposuction at a private clinic in Bilbao, Spain. Following the surgery, she applied to her company’s mutual insurance provider for nearly two months of temporary disability leave (Incapacidad Temporal, IT) and requested the corresponding benefits.
Initial Rejection: Lack of Medical Necessity
The woman’s claim was first denied by her mutual insurance provider, a decision later upheld by the court of first instance. Both the insurer and the court reasoned that the employee had no prior medical history of abdominal pain or related pathology. The surgery was deemed purely cosmetic, undertaken voluntarily to improve her appearance, and therefore did not meet the legal criteria for receiving disability benefits.
Final Ruling: Basque High Court Upholds Decision
Although the woman later submitted a diagnostic report of ‘diastasis recti’ to the court in an attempt to prove medical necessity, the High Court of Justice of the Basque Country (Tribunal Superior de Justicia del País Vasco, TSJPV) did not accept this argument on appeal and upheld the original verdict. The High Court reiterated that the social security system is designed to address non-voluntary situations such as illness, accidents, or congenital deformities, not to provide financial support for personal choices related to cosmetic enhancement.
Significance of the Ruling: Defining the Boundaries of Public Funds
The Basque High Court’s decision is based on existing precedents from Spain’s Supreme Court, reinforcing a key legal principle: neither the social security system nor employers are obligated to cover the costs of an employee’s ‘personal matter’ of improving their appearance. The ruling clearly states that the recovery period following a voluntary cosmetic surgery with no prior pathological basis does not qualify for disability benefits intended to compensate for lost wages. This precedent sharply defines the scope of public healthcare and social security funds, preventing public resources from being used for non-medically necessary personal expenses.
