Medical leave 2026: INSS updates manual setting duration with cardiologists and UAH

Key data

Your employees' medical leaves have an "internal clock" that INSS inspectors use to decide whether a leave is reasonable or should be reviewed. That clock is called the Manual of Optimal Times for Temporary Disability, and it has just begun its official update process.

The Resolution of July 20, 2026 of the General Technical Secretariat publishes the agreement by which the INSS, the University of Alcalá (UAH) and the Spanish Society of Cardiology (SEC) commit to reviewing the fifth edition of this manual. The result will be a new version of the standard duration tables for cardiac pathologies, with scientific and methodological endorsement.

What does this regulation establish?

The agreement defines the distribution of roles among the three signatory entities and the project timeline:

The Manual of Optimal Times for Temporary Disability is the reference tool used by INSS medical inspectors to assess whether the duration of a work leave complies with clinical standards. When a leave exceeds the guideline times in the manual, a review or medical discharge process can be triggered.

This update focuses on cardiac pathologies, which are one of the most frequent and costly causes of prolonged temporary disability. The SEC will review and scientifically endorse the specific tables for these diseases, while the UAH will ensure the methodological rigor of the process.

The copyright of the resulting manual belongs exclusively to INSS, which ensures that the tool remains under public control and can be updated or distributed according to system needs.

Economic and operational impact

For companies, this agreement has direct practical consequences for absenteeism management:

• Change in leave control criteria: Once the new version of the manual is approved, INSS inspectors will have updated tables with greater scientific support to evaluate leaves for cardiac pathologies. This can result in more rigorous reviews or, conversely, in greater understanding of certain complex cases.
• Impact on workforce planning: Companies with employees in temporary disability due to cardiac causes must be alert to possible changes in guideline periods, as these affect the forecast of returns to work and the hiring of replacements.
• Management of discharges and returns to work: If the new standard times are reduced or extended compared to the current fifth edition, the moment when INSS can propose medical discharge will change, with direct effect on the internal organization of companies.
• Cost of temporary disability for the company: Although the economic benefit is managed by Social Security from day 16 onwards, the first 15 days are the responsibility of the employer. Greater precision in standard times can influence the total duration of leaves and, therefore, the indirect cost for the company.

Who does it affect?

• Companies with employees in temporary disability, especially those with workers suffering from cardiac pathologies.
• HR departments and absenteeism managers who manage long-term leaves.
• CFOs and financial directors who budget for absenteeism costs and replacements.
• INSS medical inspectors, who are the direct users of the updated manual.
• Workers on medical leave due to cardiac causes, whose temporary disability duration may be affected by the new criteria.
• Labor advisors and management firms that advise companies on Social Security matters.
• Mutual insurance companies collaborating with Social Security, which also participate in the management of temporary disabilities.

Practical example

Imagine that one of your employees suffers a myocardial infarction and enters a situation of temporary disability. Currently, the INSS medical inspector consults the fifth edition of the Manual of Optimal Times to see what the standard guideline duration is for that type of cardiac pathology.

If the leave extends beyond that guideline time, INSS can summon the worker for a medical review and assess whether discharge or referral to permanent disability is appropriate.

With the new review promoted by this agreement, those tables for cardiac pathologies will be updated with the scientific endorsement of the Spanish Society of Cardiology and the methodological support of the University of Alcalá. The result may be that certain cardiac processes have guideline times different from the current ones, which will change the moment when INSS activates the review of the leave.

As a company, this means you must be prepared to adapt your workforce planning and return-to-work forecasts when the new manual comes into application, likely before July 2027.

What should companies do now?

1. Identify employees in temporary disability due to cardiac pathologies: Make an inventory of workers currently on leave due to cardiac causes to anticipate the impact when the new standard times come into force.
2. Review internal absenteeism management protocols: Make sure your HR department or labor advisory is aware that the duration criteria for temporary disability for cardiac pathologies will be updated within one year.
3. Plan replacements with margin: If you have employees in long-term temporary disability due to cardiac causes, keep in mind that guideline periods may change and affect return-to-work forecasts.
4. Consult with your collaborating mutual insurance company: Mutual insurance companies also manage temporary disabilities and can guide you on how the manual update will affect leave monitoring processes in your company.
5. Stay alert to the publication of the updated manual: The period to complete the review is one year from July 20, 2026. When the new version is published, you must update your internal leave management criteria.

Official source

Consult complete regulation at 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-2026-16536