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Occupational Disease Declaration Chile (DIEP)

Declaración Individual de Enfermedad Profesional Chile (DIEP)

Conforme a la Ley N° 16.744/1968 Art. 77 y DS N° 109/1968 — ACHS / IST / Mutual de Seguridad / ISL

DECLARACIÓN INDIVIDUAL DE ENFERMEDAD PROFESIONAL (DIEP)

Ley N° 16.744/1968 Art. 77 — DS N° 109/1968

Organismo Administrador: [Organismo Administrador]

SECCIÓN I: DATOS DEL EMPLEADOR

Razón Social: [Nombre Empresa]

RUT: [RUT Empresa]

Domicilio: [Domicilio Empresa]

Actividad Económica: [Actividad Económica]

SECCIÓN II: DATOS DEL TRABAJADOR

Nombre Completo: [Nombre Trabajador]

RUT: [RUT Trabajador]

Fecha de Nacimiento: [Fecha de Nacimiento]

Cargo: [Cargo]

Antigüedad en la Empresa: [Antigüedad]

SECCIÓN III: DATOS DE LA ENFERMEDAD PROFESIONAL

Diagnóstico: [Diagnóstico]

Agentes Causantes: [Agentes Causantes]

Tiempo de Exposición: [Tiempo de Exposición]

Fecha de Primeros Síntomas: [Fecha Primer Síntoma]

Clasificación DS 109/1968: [DS 109/1968]

Relato de Labores y Exposición Profesional:

[Descripción Laboral]

SECCIÓN IV: ANTECEDENTES MÉDICOS

Médico que Diagnostica: [Médico Tratante]

Centro de Atención: [Centro de Atención]

Grado Estimado de Incapacidad: [Grado Incapacidad]

Nota: La calificación definitiva de la enfermedad como de origen profesional, y la determinación del porcentaje de invalidez, serán realizadas por el [Organismo Administrador] conforme a los Arts. 7 y 77 de la Ley 16.744/1968 y el DS 109/1968. En caso de desacuerdo, el trabajador podrá recurrir ante la COMPIN y, en última instancia, ante la Superintendencia de Seguridad Social (SUSESO).

SECCIÓN V: DECLARACIÓN Y FIRMA

[Quien Declara] declara que los antecedentes consignados en la presente Declaración Individual de Enfermedad Profesional (DIEP) son verídicos, y que la enfermedad indicada guarda relación directa con las labores y condiciones de exposición descritas.

La presente DIEP se presenta ante el [Organismo Administrador] conforme al Artículo 77 de la Ley N° 16.744 de 1968 y el DS N° 109 de 1968, para los efectos de la evaluación, calificación y otorgamiento de beneficios médicos, subsidios y pensiones que correspondan.

En [Ciudad], a [Fecha].

Declarante: [Nombre Declarante]

En representación / Por sí mismo/a

Firma: _________________________

Empleador: [Nombre Empresa] — RUT: [RUT Empresa]

Firma: _________________________

Trabajador / Declarante

________________

Signature

Empleador

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Occupational Disease Declaration Chile (DIEP)?

Occupational Disease Declaration Chile (DIEP — Declaración Individual de Enfermedad Profesional) is the formal administrative instrument governed by Ley N° 16.744 of 1 February 1968 — the foundational statute establishing Chile's compulsory insurance against occupational accidents and diseases — and regulated in detail by Decreto Supremo N° 109 of 1968 (DS 109), which classifies the diseases considered professional in origin and sets the procedural rules for their declaration and evaluation.

Ley 16.744 Article 7 defines occupational disease (enfermedad profesional) as any pathological condition caused directly and principally by the exercise of work or by the result of the activity habitually performed by the worker, and which produces incapacity or death. DS 109 Annex contains the official list (nómina) of recognized occupational diseases and their causative agents — including pneumoconiosis (silicosis, neumoconiosis del minero), noise-induced hearing loss (hipoacusia por ruido), occupational asthma (asma profesional), contact dermatitis (dermatitis de contacto profesional), musculoskeletal disorders (enfermedades músculo-esqueléticas de extremidades superiores e inferiores por sobrecarga), and chemical intoxications from agents such as plomo (lead), mercurio (mercury), asbesto (asbestos), benceno (benzene), and pesticidas (pesticides). Ley 16.744 Article 7 inciso 2 also allows recognition of diseases not listed in DS 109 if the worker demonstrates the occupational causal relationship (relación causal laboral) through medical evidence evaluated by the Organismo Administrador and, on appeal, by the Superintendencia de Seguridad Social (SUSESO).

The Organismos Administradores — entities that administer the Ley 16.744 insurance on behalf of affiliated employers and their workers — are: the Asociación Chilena de Seguridad (ACHS), the Instituto de Seguridad del Trabajo (IST), the Mutual de Seguridad CChC (Construction Chamber mutual), and BancoEstado-affiliated employers covered directly by the Instituto de Previsión Social (IPS, successor to INP). All employers in Chile with dependent workers are required by Ley 16.744 Article 8 to be affiliated to an Organismo Administrador and to pay the monthly base premium (cotización básica) of 0.90% of taxable remuneration plus an additional premium (cotización adicional diferenciada) based on occupational risk activity, regulated by DS N° 110/1968 and updated periodically by the Superintendencia de Seguridad Social.

The DIEP is the mechanism by which a suspected occupational disease enters the Ley 16.744 evaluation process. Under Ley 16.744 Article 71, the employer (empleador) is obligated to report any worker who presents a disease that may be of occupational origin. Under Article 72, workers themselves may file the DIEP directly with the Organismo Administrador when the employer fails to act. The Organismo Administrador receiving the DIEP must evaluate the worker medically and occupationally within the statutory timeframes established by SUSESO Circular N° 3335 and subsequent SUSESO Compendium updates.

The DIEP triggers the Ley 16.744 evaluation process, which includes: occupational history review (anamnesis laboral); clinical examination by the Organismo Administrador's physicians; workplace inspection or review of hygiene reports (informes de higiene ocupacional) prepared by certified hygienistas industriales; and determination of whether the disease qualifies as professional (calificación de enfermedad profesional) or common (enfermedad común) to be treated under FONASA or ISAPRE. The worker has the right to appeal the Organismo Administrador's resolution before SUSESO within 90 days under Ley 16.744 Article 77 and SUSESO Compendio de Normas del Seguro Social de Accidentes del Trabajo y Enfermedades Profesionales.

When Do You Need a Occupational Disease Declaration Chile (DIEP)?

An Occupational Disease Declaration Chile (DIEP) is required whenever a worker develops a health condition that may be causally linked to their habitual work activity, triggering the Ley N° 16.744/1968 evaluation and compensation process administered by the Organismos Administradores.

Miners and construction workers in Chilean extractive industries — working in copper mines operated by Codelco, Anglo American Chile, or Antofagasta Minerals; gold mines in Atacama Region; or coal mines in Arauco Region — frequently present DIEP filings for silicosis (neumoconiosis del minero), a progressive fibrotic lung disease caused by inhalation of crystalline silica dust. DS 109 expressly lists silicosis as a recognized occupational disease, and employers in the mining sector must maintain dust exposure records (registros de exposición al polvo) and medical surveillance programs under DS N° 594/1999 (Reglamento sobre Condiciones Sanitarias y Ambientales Básicas en los Lugares de Trabajo), administered by the Secretarías Regionales Ministeriales de Salud (SEREMI de Salud) under the Ministerio de Salud.

Factory workers and industrial employees exposed to continuous noise levels above 85 dB(A) — in manufacturing plants, shipyards (ASMAR — Astilleros y Maestranzas de la Armada), sawmills, printing facilities, and bottling plants — file DlEP claims for noise-induced hearing loss (hipoacusia profesional por ruido). The Organismo Administrador performs audiometric testing (audiometría) to evaluate the degree of hearing loss and establish the occupational causal relationship against the worker's documented noise exposure history.

Agricultural workers in Chile's wine and fruit export sectors — in the Maule, Ñuble, Biobío, and O'Higgins Regions — may develop occupational skin conditions (dermatitis de contacto profesional) from sustained exposure to pesticides, fungicides, herbicides, and fertilizers. Workers handling organophosphate and carbamate pesticides may present DIEP claims for organophosphate poisoning, documented through cholinesterase level testing.

Office workers, supermarket checkout operators, call center employees, and data entry workers in Santiago's financial and commercial districts file DlEP claims for upper extremity musculoskeletal disorders — tendinitis, bursitis, epicondilitis, and syndrome del túnel carpiano (carpal tunnel syndrome) — caused by repetitive strain and ergonomic deficiencies. DS 109 updated classifications and SUSESO Circular N° 3243 (2015) recognize these disorders as compensable occupational diseases when the occupational causal relationship is demonstrated.

Healthcare workers in hospitals regulated by the Ministerio de Salud (MINSAL) — nurses, physicians, laboratory technicians, and dental professionals — may file DlEP claims for occupational infections (tuberculosis, hepatitis B, COVID-19 when caused by occupational exposure) and latex allergy. The employer (the hospital or clínica) has the affirmative obligation under Ley 16.744 Article 71 to report these diseases to the Organismo Administrador.

The DIEP must be filed promptly: under SUSESO guidelines, late reporting may affect the worker's rights to retroactive subsidies (subsidio por incapacidad laboral temporal — SIL) paid by the Organismo Administrador during the evaluation period.

What to Include in Your Occupational Disease Declaration Chile (DIEP)

A valid Occupational Disease Declaration Chile (DIEP) under Ley N° 16.744/1968 and DS N° 109/1968 must contain the following essential elements to ensure that the Organismo Administrador can properly evaluate the claim and that the worker's rights under Chile's occupational disease insurance are protected:

Worker Identification (Individualización del Trabajador): Full legal name, RUN (Rol Único Nacional — issued by the Servicio de Registro Civil e Identificación), date of birth, sex, nationality, and domicilio of the affected worker. The worker's contact information must be current to ensure the Organismo Administrador can communicate evaluation schedules, medical appointments, and resolution notices.

Employer Identification (Individualización del Empleador): Company name (razón social), RUT (Rol Único Tributario), legal address, economic activity code (código de actividad económica — SII classification), and name of the legal representative (representante legal). The employer's Organismo Administrador affiliation number (número de afiliación) identifies which mutual or entity administers the Ley 16.744 coverage for the reporting employer.

Work History and Job Exposure (Historial Laboral y Exposición Ocupacional): Detailed employment history showing dates of service (fecha de ingreso), job title (cargo o función), workplace location (nombre y dirección del centro de trabajo), department or section (área o sección), and — critically — a description of the specific occupational exposures. For silicosis claims: dust type, concentration levels (mg/m³), use of respiratory protection (elementos de protección personal — EPP) and whether properly provided by the employer per DS 594. For noise-induced hearing loss: noise exposure levels (dB(A)), measurement dates, and audiogram history. For musculoskeletal disorders: description of repetitive tasks, ergonomic conditions, workstation measurements, and task frequency.

Disease Description (Descripción de la Enfermedad): The specific disease or condition suspected to be of occupational origin, onset date (fecha de inicio de síntomas), progression, current symptoms, and any prior treatment received (tratamientos previos). The DS 109 disease code (código de enfermedad DS 109) should be indicated where applicable to facilitate the Organismo Administrador's classification process.

Medical Documentation (Documentación Médica): Attached medical certificates (certificados médicos) from treating physicians, diagnostic test results (examinations: radiografías, espirometrías, audiometrías, electromiografías, niveles de colinesterasa), hospital discharge summaries (epicrisis), and any specialist reports. The Organismo Administrador's physicians will review these documents as part of the calificación process under DS 109.

Declarant Information (Quien Suscribe la DIEP): Identification of who is filing the DIEP — the worker (trabajador), the employer (empleador under Ley 16.744 Art. 71), or the treating physician (médico tratante). Under Ley 16.744 Article 72, the worker can file directly if the employer fails to report within the statutory period. Signature, date, and place of filing.

Organismo Administrador Filing (Presentación ante el Organismo Administrador): The DIEP must be directed to the specific Organismo Administrador covering the employer — ACHS (Asociación Chilena de Seguridad), IST (Instituto de Seguridad del Trabajo), Mutual de Seguridad CChC, or IPS for public sector employers. Each Organismo Administrador has its own DIEP form but must accept any document containing the required information per SUSESO Compendio de Normas.

Appeal Rights Notice (Información sobre Recursos): The DIEP form should note the worker's right to appeal the Organismo Administrador's calificación resolution to SUSESO within 90 days under Ley 16.744 Article 77, and the further right to appeal to the Juzgados del Trabajo (labour courts) under the Código del Trabajo if the SUSESO resolution is unfavorable.

Benefits Triggered by a Successful DIEP (Prestaciones Activadas): A successful DIEP calification triggers: free medical treatment (prestaciones médicas gratuitas) including surgery, hospitalization, rehabilitation, prosthetics, and medication; temporary disability benefit (subsidio por incapacidad laboral temporal — SIL) equivalent to 100% of the worker's average taxable remuneration over the three months prior to the disease onset, paid by the Organismo Administrador; and, if the worker sustains permanent disability of 15% or more, disability pension (pensión por invalidez) calculated under Ley 16.744 Articles 35–43.

Forms-legal.com provides this Occupational Disease Declaration Chile template as a reference tool for workers and employers navigating the Ley 16.744 reporting process. Workers with suspected occupational diseases should consult with their Organismo Administrador and may seek assistance from the Dirección del Trabajo (DT), SUSESO, or an abogado laboralista to protect their statutory rights. Los usuarios de forms-legal.com pueden descargar este documento de forma gratuita en formato PDF o DOCX, completar los campos del formulario guiado y obtener un documento listo para firma.

Sources & Citations

Statutory citations link to official government sources.

  1. Ley 16.744AR official

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Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Occupational Disease Declaration Chile (DIEP) (Chile) [Legal document template]. Forms Legal. https://forms-legal.com/chile/employment/health-safety/occupational-disease-declaration-chile

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@misc{formslegal-occupational-disease-declaration-chile,
  author       = {{Forms Legal}},
  title        = {Occupational Disease Declaration Chile (DIEP) (Chile)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/chile/employment/health-safety/occupational-disease-declaration-chile}},
  note         = {Free legal document template}
}

Frequently Asked Questions

Statute-referenced template — Template last modified June 2026

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