Key data
| Regulation | Resolution of September 2, 2026, from the General Technical Secretariat, publishing the Agreement between the INSS, the University of Alcalá and the Spanish Society of Nephrology for the review of the fifth edition of the Manual of optimal timeframes for temporary disability |
|---|---|
| Publication in BOE | September 12, 2026 |
| Entry into force | September 1, 2026 |
| Affected parties | Workers on sick leave for kidney pathologies, companies with employees on temporary disability, INSS medical inspectors |
| Category | Social Security — Temporary Disability |
| Execution deadline | 1 year from the entry into force of the agreement |
| Revised edition | Fifth edition of the Manual of optimal timeframes for temporary disability |
| Manual ownership | Exclusive copyright of the INSS (UAH and SEN do not acquire distribution rights) |
Companies that have employees on temporary disability for kidney pathologies need to know that the rules of the game are going to change. The INSS has formalized an agreement with the University of Alcalá (UAH) and the Spanish Society of Nephrology (SEN) to review the fifth edition of the Manual of optimal timeframes for temporary disability, the tool that medical inspectors use to assess whether sick leave has a reasonable duration or should be reviewed.
The resolution publishing this agreement was signed on September 2, 2026, published in the BOE on September 12, 2026 and entered into force on September 1, 2026. The review process has a maximum deadline of one year.
What does this regulation establish?
The Manual of optimal timeframes for temporary disability is the technical reference used by INSS medical inspectors to determine whether the duration of sick leave complies with clinical standards. When a worker exceeds the timeframes set out in that manual, the inspector can summon the worker, review the sick leave and even propose its termination.
The fifth edition of this manual will be reviewed in its chapter on nephrological pathologies (diseases of the kidney and urinary system). The agreement distributes responsibilities as follows:
| Entity | Role in the agreement |
|---|---|
| National Institute of Social Security (INSS) | Coordination of the review process and exclusive ownership of the manual's copyright |
| Spanish Society of Nephrology (SEN) | Review and scientific endorsement of standard duration tables for nephrological pathologies |
| University of Alcalá (UAH) | Methodological support for the review process |
A relevant fact for companies: the copyright of the resulting manual belongs exclusively to the INSS. Neither the UAH nor the SEN acquire distribution rights. This means that the manual is a tool for internal use by the medical inspection, not a freely accessible document for employers.
Economic and operational impact
For companies, the impact of this agreement is not immediate, but it is strategic. The tables resulting from this review will determine how long a worker can be on sick leave for a kidney pathology before the INSS intervenes to review the process.
Two possible scenarios depending on the outcome of the review:
- If the new standard timeframes are extended: sick leave for kidney disease may last longer without triggering the inspector's review, which may mean higher costs in contributions and replacements for the company.
- If the new standard timeframes are reduced: the INSS may intervene earlier, potentially shortening the duration of sick leave and reducing the indirect cost for the employer, although it may also generate conflicts with workers who need more recovery time.
Companies with greater exposure are those with older workforces or with workers in sectors with high physical demands, where chronic kidney pathologies are more frequent. The cost of long-term sick leave includes not only Social Security contributions during the first days, but also the management of replacement, loss of productivity and possible labor conflicts arising from the termination of sick leave.
Who does it affect?
- Companies of any size and sector that have or may have workers on sick leave for kidney pathologies (kidney failure, kidney transplant, dialysis, chronic urinary tract infections, etc.).
- Workers on temporary disability for kidney disease, whose sick leave may be reviewed with the new criteria once the updated manual is published.
- INSS medical inspectors, who will have to apply the new tables in their evaluations.
- HR departments and personnel management managers who manage temporary disability processes.
- Labor advisors and management firms that advise companies on long-term sick leave.
- Mutual insurance companies collaborating with Social Security, which also use these criteria in their monitoring processes.
Practical example
Imagine a logistics company with 80 employees. One of its workers, a 52-year-old warehouse operator, has been on sick leave for 5 months for chronic kidney failure. The INSS medical inspector summons the worker to review the sick leave and applies the tables from the Manual of optimal timeframes for temporary disability in its current edition.
With the review underway, that same inspector, in approximately one year, will apply the updated tables with the scientific endorsement of the Spanish Society of Nephrology. If the new criteria consider that standard recovery for that specific pathology requires more time, the inspector will have scientific basis not to pressure the termination of sick leave. If the criteria are adjusted to the sick leave, the company could see the temporary disability situation resolved sooner.
The HR manager of this company cannot do anything to change the outcome of the review, but can anticipate: document the worker's medical process well, maintain communication with the mutual insurance company and know the new standard timeframes when they are published.
What should companies do now?
- Identify workers on sick leave for kidney pathologies: review whether you have employees currently on temporary disability for kidney or urinary system diseases. They are directly affected when the new tables are published.
- Coordinate with your mutual insurance company: mutual insurance companies collaborating with Social Security closely follow manual updates. Ask your mutual insurance company to inform you when the new edition is published and what changes in the standard nephrological timeframes.
- Update internal temporary disability management protocols: when the revised manual is available (maximum deadline: September 2027), update the internal criteria used by your HR department or advisory firm to manage sick leave for kidney pathology.
- Document ongoing medical processes well: if you have workers on sick leave for these pathologies, ensure that medical documentation is complete and up to date. This is key if the INSS initiates a review.
- Inform affected workers: employees on sick leave for kidney disease should know that the criteria for evaluating their sick leave may change in the next year. This does not imply any immediate action, but it is advisable that they are informed.
Frequently asked questions
When will the new tables for the duration of sick leave for kidney disease come into force?
The agreement entered into force on September 1, 2026 and establishes an execution deadline of one year. Therefore, the review of the nephrological tables should be completed before September 1, 2027. The publication of the updated manual will depend on the INSS, which is the exclusive holder of the copyright.
What is the Manual of optimal timeframes for temporary disability and what do INSS inspectors use it for?
It is the technical reference tool used by INSS medical inspectors to assess whether the duration of sick leave is reasonable according to the worker's pathology. If a worker exceeds the timeframes set out in the manual, the inspector can summon them for review and, if appropriate, propose the termination of sick leave. The review specifically affects the tables for nephrological pathologies (kidney diseases).
What entities participate in the manual review and what does each one do?
Three entities participate: the INSS, which coordinates the process and is the exclusive holder of the copyright of the manual; the Spanish Society of Nephrology (SEN), which reviews and scientifically endorses the standard duration tables for nephrological pathologies; and the University of Alcalá (UAH), which provides methodological support. Neither the SEN nor the UAH acquire distribution rights over the resulting manual.
Can a company access the Manual of optimal timeframes for temporary disability?
The copyright of the manual belongs exclusively to the INSS. It is not a document for free distribution to employers. Companies can learn about the general criteria through their collaborating mutual insurance companies or their labor advisors, but the manual is a tool for internal use by the medical inspection.
What impact does this review have on companies that have workers on sick leave for kidney disease?
The impact will depend on the outcome of the review. If the new standard timeframes are extended, sick leave may last longer without triggering the inspector's review, which may increase costs for the company. If they are reduced, the INSS may intervene earlier. In any case, companies should be alert to the publication of the updated manual (expected before September 2027) and update their internal temporary disability management protocols.
Official source
View complete regulation in official source
Notice: This article is for informational purposes only and does not constitute legal advice. For specific decisions, consult a qualified professional. Source: https://www.boe.es/diario_boe/txt.php?id=BOE-A-2026-19112
