Key data
| Regulation | Resolution of July 22, 2026, from the General Technical Secretariat, publishing the Agreement between the INSS, the University of Alcalá and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery, for the review of the fifth edition of the Manual of Optimal Times for Temporary Incapacity |
|---|---|
| BOE Publication | July 31, 2026 |
| Entry into force | July 21, 2026 |
| Signatory organizations | INSS, University of Alcalá, Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) |
| Execution deadline | One year from the entry into force of the agreement |
| Copyright of the manual | Belong exclusively to the INSS |
| Category | Social Security |
| Year | 2026 |
If your company manages sick leave for ear, nose or throat conditions—sinusitis, otitis, vertigo, tonsil surgery, vocal nodules or similar—the reference framework used by INSS medical inspectors and mutual insurance companies to evaluate those sick leaves is about to be updated.
The Resolution of July 22, 2026 publishes the agreement by which the INSS commissions the University of Alcalá and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) to review the fifth edition of the Manual of Optimal Times for Temporary Incapacity in the ENT field. The deadline to complete that review is one year from the entry into force of the agreement (July 21, 2026).
What does this regulation establish?
The Manual of Optimal Times for Temporary Incapacity is the reference tool used by INSS medical inspectors and collaborative mutual insurance companies to assess whether the duration of sick leave is reasonable according to the diagnosis. It is not strictly binding, but in practice it decisively guides control and medical discharge decisions.
The signed agreement establishes the following division of roles among the three organizations:
- INSS: Drives and finances the review. Retains exclusive copyright over the resulting manual.
- Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC): Reviews and endorses standard sick leave times for ENT pathologies, providing specialized clinical criteria.
- University of Alcalá: Provides methodological rigor to the review process.
The result will be an updated version of standard times for ear, nose, throat and head and neck surgery pathologies, which will replace the criteria currently in force in the fifth edition of the manual.
Economic and operational impact
The direct impact for companies does not occur today, but when the revised manual comes into use—likely before July 2027. However, there are operational consequences worth anticipating:
- Possible shortening or lengthening of recognized times: If the new clinical criteria reduce standard times for certain ENT pathologies, mutual insurance companies and inspectors may push for earlier medical discharge. If they extend them, long-duration sick leave in this area will have more technical support.
- Greater rigor in ENT sick leave control: The participation of a specialized scientific society gives the manual greater clinical authority, which strengthens the position of the INSS and mutual insurance companies in review processes.
- Impact on contributions and replacement costs: Companies that bear the cost of prolonged sick leave for ENT conditions—especially in sectors such as call centers, education, hospitality or healthcare, where voice and hearing pathologies are frequent—may see their absenteeism calculations altered.
There are no direct economic figures or associated penalties in this resolution. The impact is indirect: it changes the technical criteria that support temporary incapacity control decisions.
Who does it affect?
- Companies with workers on sick leave for ENT pathologies: Any company with employees suffering from ear, nose, throat or head and neck surgery conditions.
- Sectors with high prevalence of ENT pathologies: Education, call centers, hospitality, healthcare, music and performing arts, industry with noise exposure.
- Collaborative mutual insurance companies of Social Security: Will use the updated manual as a reference in their control and discharge proposal processes.
- INSS medical inspectors: Will apply the new standard times in their evaluations.
- Workers on sick leave for ENT conditions: The new criteria may affect the recognized duration of their temporary incapacity.
- Labor and HR advisors: Must update their absenteeism management criteria once the revised manual is public.
Practical example
Imagine a company with 80 employees in the telephone customer service sector. Each year it manages an average of 12 sick leaves for ENT pathologies: laryngitis, vocal nodules, otitis or positional vertigo. Currently, the medical inspector or mutual insurance company uses the times from the fifth edition of the manual to assess whether the duration of those sick leaves is reasonable.
When the review is completed—within a maximum of one year from July 21, 2026—those same conditions will have updated reference times endorsed by SEORL-CCC. If, for example, the new criteria reduce the standard time for acute laryngitis, the mutual insurance company may propose discharge earlier than it would today. If they extend it for head and neck surgery, the company will need to plan longer replacements without risk of conflict with the worker.
The specific impact will depend on the final content of the revised manual, which has not yet been published. What is relevant is knowing that the reference framework will change and preparing for it.
What should companies do now?
- Identify the volume of ENT sick leave in your company: Review how many temporary incapacities for ear, nose, throat or head and neck surgery conditions you have managed in the last two years. This will give you a measure of the potential impact.
- Communicate it to your collaborative mutual insurance company: Ask your mutual insurance company if they already have information about the manual review process and when they expect to apply the new criteria.
- Update absenteeism management protocols: Anticipate that reference times for ENT sick leave may change before July 2027. Review your internal procedures with the HR department or your labor advisor.
- Be alert to the publication of the revised manual: When the INSS publishes the new version of the manual, the changes will be immediately applicable by inspectors and mutual insurance companies. Subscribe to regulatory alerts so you don't miss that publication.
- Consult with your labor advisor: If you have workers currently on sick leave for long-duration ENT conditions, analyze with your advisor whether the new criteria may affect those ongoing cases.
Frequently asked questions
What is the INSS Manual of Optimal Times for Temporary Incapacity?
It is the technical tool used by INSS medical inspectors and collaborative mutual insurance companies to assess whether the duration of sick leave is appropriate according to the diagnosis. It establishes standard reference times by type of pathology. Although it is not legally binding, in practice it decisively guides control and medical discharge proposal decisions.
When will the new sick leave times for ENT pathologies come into force?
The agreement came into force on July 21, 2026 and establishes an execution deadline of one year. Therefore, the review must be completed before July 21, 2027. The new criteria will be applicable when the INSS publishes the updated version of the manual, which could occur at any time within that deadline.
What ENT pathologies may be affected by the manual update?
The resolution does not specify which specific pathologies will be reviewed, but the scope is that of Otorhinolaryngology and Head and Neck Surgery: ear conditions (otitis, vertigo), nose (sinusitis, polyps), throat (laryngitis, vocal nodules, tonsillitis) and head and neck surgical interventions. All standard times in this field are subject to review.
Who owns the copyright to the revised manual?
The copyright of the Manual of Optimal Times for Temporary Incapacity belongs exclusively to the INSS, as established by the agreement published in the resolution of July 22, 2026.
What role do the University of Alcalá and SEORL-CCC play in this review?
The Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) reviews and endorses standard sick leave times for ENT pathologies, providing specialized clinical criteria. The University of Alcalá provides methodological rigor to the process. The INSS drives and finances the review and retains copyright over the result.
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-2026-16746