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

Key data

The tool that determines if a work leave "lasts as long as it should" is being renewed. The INSS has signed an agreement with the University of Alcalá (UAH) and the Spanish Society of Senology and Breast Pathology (SESPM) to review the fifth edition of the Manual of Optimal Times for Temporary Incapacity, the reference used by INSS medical inspectors when evaluating whether the duration of leave is appropriate.

The Resolution of July 20, 2026, published in the BOE on July 28, 2026 and entering into force on July 17, 2026, formalizes this agreement and establishes the framework for collaboration between the three entities. For companies, this means that the criteria by which the duration of leave in the field of senology and breast pathology is judged will be updated and gain scientific support.

What does this regulation establish?

The agreement defines the role of each party in updating the manual:

The Manual of Optimal Times for Temporary Incapacity is the key guidance tool used by INSS medical inspectors to assess whether the duration of a work leave is appropriate. It is not a binding regulation in itself, but it has direct and real impact: when an inspector considers that leave exceeds the manual's guidance times, they can initiate actions that may result in medical discharge or process reviews.

The incorporation of SESPM ensures that the tables relating to breast and senology pathologies reflect the current state of clinical evidence, which may modify—upward or downward—the times considered "optimal" for certain pathologies in this specialty.

Economic and operational impact

For companies, the cost of temporary incapacity is not just the payment of benefits. It also includes managing replacements, loss of productivity, and in some cases, the costs of salary supplements agreed in collective agreements. Any change in the manual's guidance times can have direct consequences:

• If guidance times are reduced for a senology pathology, inspectors may act sooner to review the leave, which may shorten the IT period and reduce costs for the company.
• If guidance times are extended to better reflect current clinical evidence, longer-duration leave in these pathologies will have more scientific support and be less susceptible to accelerated review.
• Scientific updating strengthens the legal certainty of the process: both workers and companies will know that the criteria applied are endorsed by a reference scientific society.

From an operational perspective, companies should not make any immediate changes. The impact will arrive when the revised fifth edition of the manual is published and in use by inspectors, which will occur at most one year after July 17, 2026.

Who does it affect?

• Companies with employees in temporary incapacity situations, especially those with workers on leave for pathologies related to senology and breast pathology.
• HR managers and people directors who manage IT processes and salary supplements during leave.
• INSS medical inspectors, who use the manual as a guidance reference in their assessments.
• Workers on work leave whose IT duration may be reviewed in light of new guidance times.
• Labor advisors and management firms that support companies in managing IT processes and possible challenges to medical discharge.
• Mutual insurance companies collaborating with Social Security, which also use this manual as a reference in their leave monitoring processes.

Practical example

A service sector company has an employee on leave for a pathology included in the senology field. The leave has been active for 90 days and the collaborating mutual requests a review from the INSS. The medical inspector consults the Manual of Optimal Times for Temporary Incapacity (currently in its fourth edition) to assess whether the duration is appropriate for that specific pathology.

With the entry into force of the revised fifth edition—which will have the scientific endorsement of SESPM and methodological support from UAH—that same inspector will have updated tables reflecting the most recent clinical evidence. If the new edition modifies the guidance time for that pathology, the inspector's assessment will change accordingly: the company could see that the leave is reviewed sooner or, conversely, that it has more support to continue without generating inspection alerts.

The maximum period for this to occur is one year from July 17, 2026, the date the agreement enters into force.

What should companies do now?

1. Identify active IT processes in your company related to senology and breast pathology pathologies. These are the ones that may be affected when the fifth edition of the manual comes into use.
2. Review salary supplements agreed in collective agreements for IT situations. If guidance times change, it may affect the total cost the company assumes during leave.
3. Inform the HR department or management firm that the INSS reference manual is undergoing updates, with a maximum period of one year (until July 2027).
4. Coordinate with the collaborating mutual to stay informed of when the new edition of the manual is available and in use by inspectors.
5. Do not make immediate operational changes: the real impact will arrive when the revised fifth edition is published and in use. Until then, inspectors continue using the current edition.

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-2026-16433