Sick Leave Manual 2026: INSS Updates Optimal Times with UAH and Specialists

Key data

The criteria that determine how long a sick leave should last are about to change. The INSS has activated the revision of the fifth edition of the Manual of Optimal Times for Temporary Incapacity, the document used by medical inspectors to assess whether a sick leave is reasonable or is being prolonged beyond what scientific evidence justifies. The Resolution of July 20, 2026 publishes the agreement signed between the INSS, the University of Alcalá (UAH) and the Spanish Association of Specialists in Occupational Medicine (AEEMT).

For companies, this is not a minor change: when reference times are updated, the bases on which the INSS can summon a worker for review, propose discharge or initiate a permanent disability proceeding also change.

What does this regulation establish?

The agreement defines the framework for collaboration between the three entities to review and update the Manual of Optimal Times for Temporary Incapacity. Each organization has a specific role:

The manual establishes tables of standard and optimal duration of sick leaves by disease, organized by pathology. These tables are the technical reference used by INSS medical inspectors when evaluating whether a temporary incapacity process is within expected parameters or whether a review, summons or discharge proposal is warranted.

The new edition must reflect updated medical knowledge recognized by the scientific community, which may result in changes to the times assigned to certain pathologies, both upward and downward.

Economic and operational impact

The Manual of Optimal Times for Temporary Incapacity is not a theoretical document: it is the operational tool that directly determines when the INSS can intervene in a sick leave. If the reference times for a pathology are reduced in the new edition, the INSS can act sooner; if they are extended, sick leaves for that pathology will have more margin without intervention.

For companies, the impact translates into several areas:

• Cost of sick leaves: companies assume payment of the benefit from day 4 to 15 in common contingencies. The longer sick leaves are prolonged, the greater the direct cost to the employer.
• Workforce planning: updated reference times allow better anticipation of the expected duration of an absence and planning of replacements.
• Relationship with mutual insurers: collaborating mutual insurers also use this manual as a reference for their own reviews and discharge proposals. An update to the manual affects their criteria for action.
• Inspections and reviews: INSS medical inspectors base their summons on these times. An update can increase or reduce the frequency of reviews for certain pathologies.

Who does it affect?

• Companies with workers on sick leave: especially those managing high volumes of temporary incapacity or with sectors with high accident rates.
• HR departments and absenteeism managers: must be aware of the new reference times when the manual is published.
• Collaborating mutual insurers of Social Security: their criteria for action in temporary incapacity reviews aligns with this manual.
• INSS medical inspectors: are the direct users of the manual in their evaluations.
• Workers in temporary incapacity situation: the new reference times may influence when they are summoned for review or offered discharge.
• Labor advisors and management firms: must know the changes to properly advise their clients on sick leave management.

Practical example

Imagine a logistics company with 80 employees. An employee goes on sick leave for acute low back pain. Currently, the INSS medical inspector consults the current Manual of Optimal Times and checks whether the duration of that sick leave exceeds the standard time assigned to that pathology. If it does, they can summon the worker for review or propose medical discharge.

With the new fifth edition of the manual, the times assigned to musculoskeletal pathologies—frequent in logistics—could be revised upward or downward according to the updated scientific evidence provided by UAH and AEEMT. If the standard time for low back pain is reduced, the INSS could act sooner; if it is extended, the sick leave would have more margin without intervention.

The HR manager of that company cannot ignore this change: their absenteeism management policy, agreements with the mutual insurer and internal criteria for monitoring sick leaves must be adjusted as soon as the new manual comes into use.

What should companies do now?

1. Identify the volume of active sick leaves and their pathology: before the new manual comes into force, it is advisable to have a clear map of ongoing temporary incapacity cases and the most frequent pathologies in your workforce.
2. Review agreements with the collaborating mutual insurer: ensure that your mutual insurer is also aware of the update and how it will affect their review and discharge proposal criteria.
3. Update internal absenteeism management protocols: when the new manual is published (within a maximum of one year from the signing of the agreement), internal criteria for monitoring sick leaves must align with the new reference times.
4. Inform the HR department and labor advisors: this change directly affects temporary incapacity management. Ensure that those managing sick leaves in your company know the process and are monitoring the publication of the new edition.
5. Follow the publication of the fifth edition of the manual: the review period is one year. When the INSS publishes the new edition, it will be time to review in detail the changes in times assigned to the pathologies most relevant to your sector.

Official source

Consult 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-2026-16435