Sick Leave Manual 2026: What Changes for Companies and Workers

Key data

The criteria that determine how long a sick leave can last will be updated for the first time since 2018. The INSS has signed an agreement with the University of Alcalá (UAH) and the Spanish Society of General and Family Doctors (SEMG) to review the fifth edition of the Manual of Optimal Times for Temporary Incapacity, the reference tool used by INSS medical inspectors to assess whether the duration of a sick leave is clinically justified.

The agreement was published in the BOE of August 3, 2026 and entered into force on July 21, 2026. For any company managing employees in temporary incapacity situation, this update process is relevant: when it concludes, the benchmarks that justify or question the duration of a sick leave may be different from the current ones.

What does this regulation establish?

The resolution publishes the collaboration agreement between three entities with differentiated roles:

The purpose of the agreement is to update the fifth edition of the Manual of Optimal Times for Temporary Incapacity, whose current version dates from 2018. This manual records, by pathology, the sick leave times considered clinically reasonable. INSS medical inspectors use it as a reference to assess whether a temporary incapacity benefit should be maintained, reviewed, or terminated.

The deadline for completing the review is one year from the entry into force of the agreement (July 21, 2026), which sets the delivery deadline around July 2027.

Economic and operational impact

This agreement does not generate direct costs for companies at this time. However, its future operational impact may be significant:

• Change in sick leave control criteria: When the new edition of the manual is published, the optimal times by pathology may increase or decrease compared to those from 2018. This directly affects INSS inspectors' decisions on whether a sick leave is reasonable or if the worker should be called for medical review.
• Management of temporary incapacity in the company: Companies that use the current manual as an internal reference to anticipate INSS behavior regarding prolonged sick leaves will need to update their criteria when the new edition is published.
• Impact on contributions and absenteeism costs: If the new optimal times are more restrictive for certain pathologies, the number of medical reviews and benefit terminations could increase, with direct effect on worker reintegration.
• 8-year update: The gap from 2018 to 2026 means the new edition will incorporate updated clinical criteria for pathologies that have evolved significantly (mental health, chronic diseases, musculoskeletal pathologies).

Who does it affect?

• Companies with employees in temporary incapacity situation: Any company managing sick leaves will be affected when the new manual comes into application, as the criteria for reasonable duration may change.
• HR departments and absenteeism managers: Will need to update their internal temporary incapacity management protocols as soon as the new edition is published.
• Workers on sick leave: The new optimal times will determine whether their sick leave is considered compliant with clinical standards or if the INSS can call them for review.
• INSS medical inspectors: They are the direct users of the manual. The new edition will update the benchmarks they apply in their evaluations.
• Mutual insurance companies collaborating with Social Security: Also use the manual as a reference in managing temporary incapacity benefits.
• Labor advisors and management firms: Must be aware of the new criteria to properly advise their clients on prolonged sick leaves.

Practical example

A logistics company has a warehouse employee on sick leave for acute lower back pain lasting 45 days. The HR department consults the Manual of Optimal Times (2018 edition) to estimate whether the INSS might call the worker for medical review.

With the new edition of the manual—which must be ready before July 2027—the optimal times for musculoskeletal pathologies such as lower back pain could be revised upward or downward depending on updated clinical evidence. If the new benchmark reduces the optimal time for this pathology, the INSS could activate sick leave control sooner than would occur with 2018 criteria. If it extends it, the company should anticipate a longer management of the situation.

The key for the HR manager is not to assume that current criteria will remain unchanged and to monitor the publication of the new edition to update internal absenteeism management protocols.

What should companies do now?

1. Identify the potential impact on your workforce: Review how many employees you currently have in temporary incapacity situation and what pathologies are most frequent in your company. These will be the areas where the new manual will have the greatest effect.
2. Mark July 2027 on your calendar: This is the deadline for the review to be completed. From that point on, the new manual could come into application. Schedule a review of your sick leave management protocols for that date.
3. Do not make temporary incapacity management decisions based on current criteria being definitive: The 2018 benchmarks are in force today, but they will change. Any internal protocol that uses them as a reference will need to be updated.
4. Inform your labor advisor or management firm: Ensure that whoever manages sick leaves in your company is aware of this update process and has planned to incorporate the new criteria when they are published.
5. Follow the publication of the new edition of the manual: The INSS will publish the new version when it is ready. Subscribe to regulatory alerts to receive it as soon as it is published and be able to update your protocols without delay.

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-2026-16918