Medical Leave Manual Updated 2026: What Changes for Companies with IT Employees

Key data

The criteria that INSS medical inspectors use to evaluate the duration of a medical leave are about to change. The INSS has entered into an agreement with the University of Alcalá (UAH) and the Spanish Society of Neurology (SEN) to review the fifth edition of the Manual of Optimal Times for Temporary Disability, the reference tool that sets how long a leave should last according to the condition.

The resolution publishing this agreement was signed on September 2, 2026 and became effective on September 1, 2026. The deadline to complete the review is one year from that date. This means that before September 2027, the duration tables for neurological leaves will have been updated with the scientific endorsement of the SEN and the methodological support of the UAH.

What does this regulation establish?

The agreement formalizes collaboration between three institutions with clearly differentiated roles:

The result will be an updated version of the standard duration tables for neurological conditions within the manual. These tables indicate how many days are considered reasonable for a leave to last according to the diagnosis, and are the objective reference used by INSS medical inspectors when evaluating whether a leave complies with clinical criteria or should be reviewed.

The manual affects millions of workers, as it is the central tool for managing temporary disability benefits in Spain. The update of neurological tables means that duration criteria for conditions such as migraines, vertigo, neuropathies, or sleep disorders, among others, may change compared to current values in the fifth edition.

Economic and operational impact

For companies, the impact is indirect but real. Temporary disability has a dual cost: the direct cost of the benefit (which from the fourth day until the fifteenth day is borne by the company) and the operational cost of covering the worker's absence.

If the new tables shorten standard times for certain neurological conditions, medical inspectors may call the worker in for review sooner, which could reduce the average duration of some leaves. If they extend them, the opposite will occur.

From an operational perspective, companies should consider that:

• INSS medical inspectors will use the new tables as a reference for their decisions.
• Leaves due to neurological conditions (migraine, vertigo, multiple sclerosis, neuropathies, etc.) are among the most frequent and have the longest average duration in the working population.
• A scientific update of optimal times can affect both the duration of active leaves and the criteria for medical discharge.
• HR departments and absenteeism managers should monitor the publication of the new manual version, expected before September 2027.

Who does it affect?

• Companies with employees on temporary disability: especially those with high incidence of leaves due to neurological conditions. The change in standard times directly affects their workforce planning and absenteeism costs.
• Workers on leave due to neurological causes: the criteria determining whether their leave is appropriate or should be reviewed will change within one year.
• INSS medical inspectors: they are the direct users of the manual. They will apply the new tables once the reviewed version is published.
• Mutual insurance companies collaborating with Social Security: they use the manual as a reference in their IT control processes.
• Labor advisors and HR managers: they must know the changes to properly advise their clients and companies about expected leave duration.
• Primary care physicians: although not direct recipients of the manual, optimal times influence decisions on discharge and leave extensions.

Practical example

A services sector company has an employee on leave due to chronic migraine. Currently, the INSS medical inspector evaluates the duration of that leave using the tables from the fifth edition of the Manual of Optimal Times for Temporary Disability.

When the SEN completes its scientific review (before September 2027), the tables for neurological conditions such as migraine will have been updated with more recent clinical criteria. If the revised optimal time for that condition differs from the current one, the medical inspector will apply the new criterion in their decisions.

For the company, this can translate into:

• An earlier call-in of the worker if the new optimal time is shorter than the current one.
• A longer recognized leave period if scientific evidence supports a longer duration.
• Greater predictability in planning absences, with updated criteria endorsed by the SEN.

What should companies do now?

1. Identify the volume of active neurological leaves: review how many employees are currently on IT due to neurological conditions to assess the potential impact of the manual update.
2. Inform the HR department and labor advisors: communicate that the criteria for neurological leave duration will change before September 2027, so they can factor this into workforce planning.
3. Monitor the publication of the new manual version: the INSS will publish the reviewed version once the process is complete. Stay alert to its official publication to update internal absenteeism management criteria.
4. Review IT management protocols: ensure that internal procedures for monitoring leaves are aligned with INSS criteria and will be updated when the new manual version is published.
5. Consult with the collaborating mutual insurance company: mutual companies also use the manual as a reference. Coordinate with them to anticipate how they will apply the new criteria.

Official source

View complete regulation at official source

Disclaimer: 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-2026-19193