Medical leave 2026: INSS updates maximum timeframes with new experts

Key data

The manual that determines how long medical leave can last in Spain has not been updated since 2018. Now, the INSS has signed an agreement with the University of Alcalá (UAH) and the Spanish Society of Endocrinology and Nutrition (SEEN) to review the fifth edition of the Manual of Optimal Times for Temporary Disability. The review has a maximum timeframe of one year from the entry into force of the agreement (July 21, 2026).

This manual is not an academic document: it is the operational reference used by INSS medical inspectors when evaluating whether leave is justified and whether its duration is reasonable. When an inspector reviews the file of one of your employees, they consult this manual. That is why its update has direct consequences for any company with workers on temporary disability.

What does this regulation establish?

The agreement formalizes collaboration between three organizations with differentiated roles:

The result will be an updated version of the tables that assign a standard duration to each condition. These tables are the core of the manual: they indicate, for example, how many days is reasonable for leave due to a particular surgical intervention, a chronic disease, or a musculoskeletal injury.

The participation of SEEN—specialists in endocrinology and nutrition—suggests that a relevant part of the review will focus on metabolic, endocrine, and nutrition-related conditions, areas in which clinical evidence has evolved considerably since 2018.

The copyright of the final document belongs exclusively to the INSS, which ensures that the manual maintains its official character and cannot be modified or distributed without authorization from the organization.

Economic and operational impact

The Manual of Optimal Times for Temporary Disability is the tool that determines whether leave is "long" or "short" according to objective medical criteria. Its update can have two opposite effects for companies:

• Reduction of unjustified prolonged leave: If the new tables incorporate more recent clinical evidence, inspectors will be able to act with greater precision on leave that exceeds updated timeframes. This can reduce absenteeism costs in companies with high claims rates.
• Recognition of previously undervalued conditions: Some chronic or metabolic diseases that in 2018 had short standard times could see their timeframes extended if scientific evidence justifies it. This would affect workforce planning in sectors with high prevalence of these conditions.

While the new manual is not published—which may occur by mid-2027—INSS medical inspectors will continue using the 2018 version. Companies should take this into account in their current management of leave: the rules of the game do not change yet, but they will.

Who does it affect?

• Companies with employees on temporary disability: any company, regardless of size or sector, that has or may have workers on leave.
• HR departments and payroll managers: who manage IT processes, coordinate with mutual insurance companies and monitor prolonged leave.
• Mutual insurance companies collaborating with Social Security: who manage IT for common and occupational contingencies and use the manual as a reference in their evaluations.
• INSS medical inspectors: who are the direct users of the manual in their resolutions.
• Workers on sick leave: whose recognized duration may be affected by new criteria once the revised manual is published.
• Labor advisors and HR consultants: who advise companies on absenteeism management and IT.

Practical example

A logistics company with 80 employees currently has 4 workers on leave for endocrine or metabolic conditions (diabetes, morbid obesity, hypothyroidism). The INSS medical inspector reviewing those leaves applies today the standard times from the 2018 edition.

When the revised manual enters into force—presumably before July 2027—the reference times for those conditions could have changed. If SEEN scientifically endorses different durations, the inspector will apply the new criteria. This can mean that leave that today is considered "within reasonable timeframe" becomes subject to review, or vice versa.

For the HR manager of that company, the practical message is clear: now is the time to review the history of leave for endocrine and metabolic conditions and anticipate how its management could change when the new manual is in effect.

What should companies do now?

1. Audit the current status of active leave: Review which employees are on IT, for what condition and how long they have been. Compare with the times from the 2018 edition of the manual to identify cases that are already in the risk zone.
2. Pay special attention to endocrine and metabolic conditions: SEEN's participation indicates that these areas will be subject to priority review. If you have employees on leave for diabetes, obesity, thyroid or other metabolic conditions, anticipate possible changes in recognized times.
3. Coordinate with your mutual insurance company: Inform your collaborating mutual insurance company that the manual is under review and request that they keep you informed of any changes in IT evaluation criteria.
4. Update internal absenteeism management protocols: When the new manual is published—within a maximum of one year from July 21, 2026—you will need to update your internal procedures. Prepare that review now to avoid acting in urgency.
5. Follow the publication of the revised manual: The INSS will publish the new manual once the review is complete. Subscribe to regulatory alerts so you don't miss the publication and application date.

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-2026-16745