INSS Updates Medical Leave Manual with Oncologists: What Changes for Companies in 2026

Key data

Medical leaves have a direct cost for companies during the first days and an indirect cost in productivity throughout their duration. The instrument that determines if a leave "lasts reasonably" is the Manual of Optimal Times for Temporary Disability, and that manual is about to change.

The INSS has signed an agreement with the University of Alcalá (UAH) and the Spanish Society of Medical Oncology (SEOM) to review its fifth edition. The resolution publishing this agreement was published in the BOE on August 3, 2026, although the agreement came into force on July 21, 2026. The timeline to complete the review is one year from that date.

What does this regulation establish?

The agreement distributes roles among the three signatory entities in a very specific way:

A relevant point for any company or professional who wants to use the manual: copyright belongs exclusively to the INSS. Neither UAH nor SEOM acquire distribution rights over the resulting document.

The updated manual will be the reference tool used by INSS medical inspectors to assess whether the duration of a leave is reasonable or whether, on the contrary, a review or medical discharge is warranted. Until now, the fifth edition in force did not incorporate the most recent scientific advances in oncology, which generated outdated criteria in one of the groups of pathologies with the greatest impact on leave duration.

Economic and operational impact

For companies, the impact of this change has two dimensions:

1. Change in leave control criteria. When the new manual comes into force, INSS medical inspectors and mutual insurance companies will have updated benchmarks to determine if an oncological leave complies with expected timeframes. This can result in more rigorous reviews or, conversely, in recognition of longer durations if scientific evidence supports it.

2. Impact on absenteeism management. Companies that actively manage absenteeism through mutual insurance companies will see how the reference criteria of those mutual companies are updated. Return-to-work plans and internal leave monitoring protocols must align with the new optimal times when the new edition is published.

The cost of temporary disability for companies is not just the salary of the first days: it includes worker replacement, loss of productivity and, in some cases, additional contributions. A more precise manual can reduce litigation around medical discharges and provide more certainty to all parties.

Who does it affect?

• Companies with workers on sick leave, especially those with medium or large workforces where absenteeism has relevant economic impact.
• Workers with oncological processes, who will have their leaves evaluated with scientifically updated criteria by SEOM.
• Mutual insurance companies collaborating with Social Security, which use the manual as a reference for their own assessments and discharge proposals.
• INSS medical inspectors, who are the direct users of the manual for making decisions about the continuation or end of a leave.
• Labor and HR advisors who advise companies on the management of temporary disabilities and need to know the new benchmarks when they are published.

Practical example

An industrial company has a 45-year-old worker on leave for an oncological process for six months. The mutual insurance company, when reviewing the case, consults the Manual of Optimal Times to determine if the duration is consistent with the diagnosis.

With the current fifth edition, the reference times for that type of process may not reflect recent therapeutic advances in oncology. With the new edition reviewed by SEOM and scientifically endorsed, the medical inspector will have updated criteria: if the new optimal times recognize that this process requires more recovery time, the company and the mutual company will have less margin to pressure an early discharge. If, on the other hand, the new criteria reflect that current treatments allow faster recovery, the inspector can cite that evidence to review the leave earlier.

In both cases, the company gains legal certainty: discharge or extension decisions will be backed by updated scientific criteria, which reduces the risk of challenges and labor conflicts.

What should companies do now?

1. Identify active oncological temporary disability processes in your workforce. These are the ones that will be most directly affected by the manual update when it comes into force.
2. Review internal leave monitoring protocols with your labor advisor or HR department, to be prepared when the new manual is published (maximum timeline: July 2027).
3. Coordinate with your mutual insurance company to learn how they plan to adapt their assessment criteria to the new manual once it is available.
4. Do not make discharge or extension decisions based on the current manual as if it were definitive: in the coming months the criteria will change, and acting on outdated criteria can generate labor conflicts.
5. Follow the publication of the new edition of the manual through the BOE and INSS channels. When it is published, it will be time to update internal procedures.

Official source

Consult 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-2026-16916