Sick leave for rheumatological disease: INSS updates standard timeframes with SER and UAH

Key data

The criteria used by INSS to evaluate sick leave for rheumatological diseases will change. The National Institute of Social Security has entered into an agreement with the University of Alcalá (UAH) and the Spanish Society of Rheumatology (SER) to review and update the fifth edition of the Manual of optimal timeframes for temporary disability, the reference tool used by medical inspectors to evaluate the duration of work-related sick leave.

The resolution publishing this agreement was signed on September 29, 2026 and entered into force on September 25, 2026, with publication in the BOE on October 5, 2026. The deadline for completing the review is one year from the entry into force.

What does this regulation establish?

The agreement establishes the distribution of roles among the three signatory entities to carry out the manual update:

The Manual of optimal timeframes for temporary disability is the guide used by INSS medical inspectors to determine whether the duration of a medical leave is appropriate according to the diagnosed condition. When a worker exceeds the standard timeframes recorded in the manual, the inspector may summon the patient for review and, if appropriate, propose medical discharge or initiate a permanent disability process.

The update focuses specifically on rheumatological conditions, that is, musculoskeletal diseases such as rheumatoid arthritis, osteoarthritis, fibromyalgia, spondyloarthritis or systemic lupus erythematosus, among others. The SER will provide updated clinical criteria to review whether the timeframes currently recorded in the manual remain appropriate to available scientific evidence.

Economic and operational impact

The manual update may have relevant economic and operational consequences for companies and mutual insurance companies, although the specific direction of the change (whether timeframes are extended or reduced) will not be known until the new revised edition is published.

• If standard timeframes are extended for certain rheumatological conditions, longer sick leaves will be less questioned by inspectors, which may reduce conflict in temporary disability management but increase total benefit costs for mutual insurance companies and companies.
• If timeframes are reduced or adjusted downward for any condition, inspectors will be able to act sooner, shortening sick leaves that currently continue without review.
• For companies with high claims rates in musculoskeletal conditions (logistics, construction, manufacturing, healthcare), this change may directly affect their workforce planning and indirect absenteeism costs.
• Collaborating mutual insurance companies will need to update their internal temporary disability monitoring protocols once the new version of the manual is published.

Who does it affect?

• Workers on medical leave for rheumatological conditions: arthritis, osteoarthritis, fibromyalgia, spondyloarthritis and other musculoskeletal diseases.
• INSS medical inspectors: will use the updated manual as a reference for their evaluations.
• Companies with employees on temporary disability due to rheumatological causes, especially in sectors with high prevalence of these conditions (logistics, construction, manufacturing, hospitality, healthcare).
• Collaborating mutual insurance companies of Social Security: manage temporary disability benefits and will need to adapt their monitoring criteria to the new manual.
• Primary care physicians and specialists who issue and manage sick leave certificates.

Practical example

A worker at a logistics company is diagnosed with axial spondyloarthritis and goes on medical leave. The INSS medical inspector, when reviewing the case, consults the Manual of optimal timeframes for temporary disability to determine whether the duration of the sick leave complies with the standards for that condition.

With the current fifth edition of the manual, the inspector applies the current timeframes. Once the review agreed upon in this agreement is completed—within a maximum period of one year from September 25, 2026—the inspector must apply the new timeframes scientifically endorsed by SER. If the new table establishes a different standard timeframe for that condition, the decision on the continuation or discharge of the sick leave may differ from current criteria.

For the company, this translates into greater or lesser predictability regarding the duration of absences due to this type of disease, with direct impact on operational planning and replacement costs.

What should companies do now?

1. Identify the volume of active rheumatological sick leaves in your workforce to assess the potential impact of the change in criteria when the revised manual is published.
2. Coordinate with your collaborating mutual insurance company to be informed as soon as the new edition of the manual is published and understand how it affects ongoing temporary disability cases.
3. Review internal temporary disability management protocols for musculoskeletal conditions, especially if your sector has high prevalence of these diseases.
4. Mark the one-year deadline (until September 25, 2027 as a maximum target date) to be prepared before the new manual enters operational use.
5. Consult with your occupational health service or labor advisory if you have workers with prolonged sick leave due to rheumatological conditions, to anticipate possible reviews by INSS.

Official source

View complete regulation at 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-2026-20728