Puerto Rico Non-Occupational Temporary Disability Insurance (SINOT)

Quick Facts

Benefit amount: Up to $113 per week (2025 maximum), calculated as 65% of average weekly wages.
Duration: Up to 26 weeks of benefits during a benefit year.
Funding: Employers contribute 0.6% and employees 0.3% of wages up to the taxable wage base; employers can deduct the employee contribution from payroll.
Administration: Managed by the Puerto Rico Department of Labor and Human Resources through the State Insurance Fund Corporation (CFSE) or authorized private insurers.

Program Overview

Puerto Rico’s Seguro por Incapacidad No Ocupacional Temporal (SINOT) provides cash benefits to workers who are temporarily unable to work due to non-work-related illnesses, injuries, or pregnancy. Established in 1968, SINOT ensures that most salaried and hourly workers receive partial wage replacement during short-term disabilities. The program also includes a maternity benefit that coordinates with Puerto Rico’s extended maternity leave provisions.

Employers must secure coverage either through the state-administered fund or approved private plans. Benefits are modest compared to other jurisdictions, so employees often supplement income with employer-provided short-term disability plans or savings. SINOT works alongside Puerto Rico’s maternity leave law (Ley 3) and federal protections like FMLA.

Eligibility Requirements

Employment coverage: You must work for a covered employer and have earned at least $150 in the base year. Most private employers are covered; certain agricultural and domestic workers may be exempt unless the employer elects coverage.
Medical certification: A licensed physician must certify the disability using the prescribed SINOT medical form, including diagnosis, treatment, and expected recovery date.
Waiting period: There is a seven-day unpaid waiting period, except for maternity claims, which have no waiting period.
Timely filing: Submit the claim within 30 days of the disability start. Late submissions can lead to denial or reduced benefits unless you show good cause.

Benefit Calculation

Average weekly wage (AWW): Calculated from the wages earned in the base period (first four of the last five completed quarters).
Weekly benefit: 65% of AWW, up to $113 per week in 2025.
Duration: Up to 26 weeks per benefit year. Maternity benefits provide up to 8 weeks (4 weeks prenatal and 4 weeks postpartum) with potential extensions for complications.
Dependents allowance: SINOT does not include dependents supplements.

Application Process

Inform employer. Notify your supervisor or HR of the disability and request SINOT claim forms.
Complete employee section. Provide personal information, employment details, and the date you stopped working.
Medical certification. Have your healthcare provider complete the Physician’s Report (Formulario SINOT-1), detailing diagnosis and expected recovery.
Employer statement. Employers verify wages and confirm coverage under the state plan or private insurer.
Submit claim. File with the State Insurance Fund Corporation or the authorized insurer within 30 days. Keep copies and request a receipt.
Benefit determination. The insurer reviews the claim and issues payment or denial. Benefits are typically paid biweekly via check or direct deposit.

Required Documentation

Completed SINOT-1 claim form with physician certification.
Medical records supporting the disability, such as lab results, imaging, or hospitalization summaries.
Proof of earnings if wage records are incomplete.
For maternity claims, proof of pregnancy (medical certificate) and delivery confirmation.

Coordination with Other Benefits

Maternity leave: Puerto Rico law provides eight weeks of paid maternity leave (extendable for medical reasons). SINOT benefits may supplement wages if employer pay is less than statutory requirements.
Workers’ compensation: SINOT excludes work-related injuries, which are covered by the State Insurance Fund’s workers’ compensation benefits.
Unemployment insurance: Not payable while receiving SINOT benefits.
Short-term disability plans: Some employers offer supplemental coverage that increases the weekly benefit. Coordinate claims to avoid overpayment.

Strategies for Maximizing Benefits

File immediately: Submit the claim within 30 days to avoid reductions. If hospitalized, have a family member deliver the paperwork.
Ensure complete medical documentation: Detailed notes help justify extended benefits, especially for chronic conditions or complicated pregnancies.
Combine with employer leave: Use accrued vacation or sick leave to cover the waiting week or supplement the modest SINOT benefit.
Budget for lower income: Plan for the relatively low maximum benefit by adjusting expenses, seeking community aid, or arranging payment plans with creditors.
Keep communication logs: Record dates and names of contacts at CFSE or the insurer. Documentation assists with appeals.

Common Mistakes to Avoid

Missing the filing deadline: Late claims are a frequent reason for denial. If unavoidable, provide evidence (hospitalization, natural disaster) showing why you could not file earlier.
Incomplete physician report: Ensure all sections are filled out, including ICD codes and treatment plans. Illegible handwriting can delay processing.
Working or receiving full wages: Report any wages earned during disability. Benefits may be reduced but not reporting can lead to overpayments and penalties.
Assuming coverage for exempt workers: Domestic workers and some agricultural employees may not be covered unless the employer voluntarily participates.

Appeals Process

If your claim is denied or benefits are reduced, request reconsideration within 15 days. Provide additional medical evidence or wage records. If still unsatisfied, file an appeal with the Secretary of Labor within 30 days. Hearings allow testimony and presentation of evidence. Further appeals can go to the Puerto Rico Court of Appeals.

Example Scenarios

Surgery recovery: Rosa underwent gallbladder surgery and missed six weeks of work. Her doctor certified the disability, and she received SINOT benefits at the maximum rate while using savings to cover the remaining income gap.
Pregnancy: Carla took four weeks of prenatal leave and four weeks postpartum under Puerto Rico maternity leave law. Complications extended her leave by two weeks, which SINOT covered after her doctor provided updated certification.
Chronic illness: Luis’ diabetes led to hospitalization and a three-week recovery period. With comprehensive medical records, his claim was approved quickly.

Resources

Advanced Tips

Language access: Request materials in Spanish or English as needed. Bring a translator to hearings if you prefer English.
Keep tax records: SINOT benefits are subject to Puerto Rico income tax. Track payments for filing Form 499R-2/W-2PR.
Coordinate with disability accommodations: If your doctor expects you to return with restrictions, begin ADA accommodation discussions early.
Prepare for hurricanes: Store digital copies of forms. After natural disasters, the Department of Labor may extend deadlines—monitor announcements.

Frequently Asked Questions

Can I receive SINOT if I work for multiple employers? Yes. Report all employers on your claim. Wages from covered employers are combined to calculate benefits.

What if I move off-island during recovery? You may continue to receive benefits if you remain under medical care and submit proof of treatment. Notify the insurer of your new address and treating physician.

Does SINOT cover organ donation recovery? Yes. Recovery from organ donation surgery is treated as a qualifying disability with appropriate medical certification.

Are public employees covered? Many public employees participate in separate disability systems. Confirm coverage with your agency’s human resources office.