Respiratory illness sick leave: INSS updates standard timeframes with medical experts

Key data

The criteria that determine whether sick leave for asthma, COPD, pneumonia or other respiratory pathologies is granted or shortened are about to change. The INSS has signed an agreement with the University of Alcalá (UAH) and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) to review and update the fifth edition of the Manual of Optimal Timeframes for Temporary Incapacity, whose latest version dates from 2018.

The agreement, published in the BOE on July 28, 2026 through the Resolution of July 20, 2026 from the General Technical Secretariat, entered into force on July 17, 2026. From that date, the one-year review timeline has already begun.

What does this regulation establish?

The agreement defines the distribution of roles among the three signatory organizations and the conditions for joint work:

• SEPAR will assume the scientific review of the standard duration tables for sick leave due to respiratory and thoracic pathologies, and will validate their medical validity.
• UAH (University of Alcalá) will provide the methodological support necessary to structure and validate the review process.
• INSS coordinates the project and retains full copyright of the resulting manual. Neither SEPAR nor UAH acquire distribution rights over the final document.

The updated manual will be a guiding tool for INSS medical inspectors when evaluating temporary incapacity processes. It is not strictly binding, but in practice it sets the reference standard used by both INSS inspectors and collaborating mutual insurance companies to assess whether sick leave is appropriate, excessive or insufficient.

The review focuses exclusively on the field of respiratory and thoracic pathologies, which is SEPAR's specialty. The rest of the manual is not modified by this agreement.

Economic and operational impact

For companies, the direct cost of sick leave is not limited to the subsidy paid by Social Security. It also includes loss of productivity, the need to cover the position and, in many cases, the salary supplement paid by the company during the first few days. Sick leave due to respiratory pathologies—flu, pneumonia, COPD, severe asthma—are among the most frequent, especially during seasons of high incidence.

When the manual of optimal timeframes is updated, INSS medical inspectors and mutual insurance companies will have new references to decide whether sick leave is appropriate or should be reviewed. This can have two opposite effects depending on how the scientific review evolves:

• More restrictive criteria: if updated medical evidence indicates that certain pathologies recover faster than the 2018 manual indicated, sick leave could be shortened or reviewed earlier.
• Broader criteria: if SEPAR validates that certain respiratory pathologies require more recovery time than the previous manual indicated, sick leave could be extended with greater scientific support.

In any case, the operational impact for companies will arrive when the manual is published and inspectors begin to apply it, presumably before July 2027.

Who does it affect?

• Companies with workers on sick leave for respiratory or thoracic pathologies: the duration criteria applied to those processes may change.
• INSS medical inspectors: will have an updated manual with scientific validation from SEPAR to guide their resolutions.
• Collaborating mutual insurance companies of Social Security: use the manual as a reference to manage and monitor temporary incapacity processes for mutualista companies.
• Workers on sick leave for respiratory diseases: their processes may be evaluated with updated criteria compared to those in force since 2018.
• HR departments and absenteeism managers: must be alert to the publication of the new manual to adjust their forecasts and internal policies.

Practical example

Imagine a logistics company with 80 employees. One of its workers goes on sick leave for moderate pneumonia. Currently, the INSS medical inspector consults the 2018 manual to assess whether the duration of sick leave is appropriate according to the optimal timeframes established for that diagnosis.

Once SEPAR completes its scientific review—within a maximum of one year from July 17, 2026—the inspector will have an updated table with the most recent medical evidence. If that evidence determines that moderate pneumonia has a different recovery time than what the 2018 manual indicated, the reference criterion will change. The company, the mutual insurance company and the worker themselves will see how the process is managed with new standards.

The specific result will depend on what SEPAR's scientific review concludes, which has not yet been published. But the process is already underway and the maximum publication deadline is July 2027.

What should companies do now?

1. Identify the volume of sick leave for respiratory pathologies in your workforce. Review absenteeism data from the last two years to find out how many temporary incapacity processes in your company correspond to respiratory or thoracic diseases. This will give you an idea of the potential impact when the new manual comes into application.
2. Inform your collaborating mutual insurance company. Ask your mutual insurance company if it already has information about the manual review process and how it plans to adapt its sick leave management criteria when the new document is available.
3. Update internal IT management protocols. If your company has sick leave monitoring procedures, make sure they include a mechanism to incorporate the new manual criteria when published, presumably before July 2027.
4. Follow the publication of the updated manual. The INSS will publish the results of the review once the one-year period is complete. Stay alert to that publication to adjust your absenteeism forecasts and associated costs.
5. Consult with your labor advisor. If you manage a significant volume of sick leave for respiratory pathologies, it is advisable that a professional specialized in Social Security analyze how the new manual may affect your specific processes.

Official source

View complete regulation in official source (BOE-A-2026-16434)

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-2026-16434