Medical assessments for sick leave will follow updated clinical criteria

The Spanish National Institute of Social Security (INSS), the University of Alcalá (UAH), and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) have signed a formal agreement to update the fifth edition of the Manual of Optimal Times for Sick Leave (BOE-A-2026-20727). This resolution, published on September 28, 2026, formalizes a collaborative effort to ensure that the medical control of social security benefits is based on the most current scientific knowledge available.

What changes

The core objective of this agreement is the technical revision and update of the fifth edition of the Manual of Optimal Times for Sick Leave. This manual serves as the primary technical reference for medical inspectors within the INSS. By integrating updated clinical data from academic and specialized medical institutions like UAH and SEIMC, the manual will provide more precise and scientifically validated duration tables for various pathologies.

Specifically, the updated manual will influence the medical assessment processes for several key benefits managed by the INSS, including:

• Temporary Disability (Incapacidad Temporal): The standard duration for recovery from specific illnesses or injuries.
• Risk during Pregnancy (Riesgo durante el Embarazo): Clinical criteria to determine when a pregnancy poses a risk to the mother or fetus.
• Risk during Natural Breastfeeding (Riesgo durante la Lactancia Natural): Assessment of conditions affecting the breastfeeding process.
• Permanent Disability Pensions (Incapacidad Permanente): Technical support for evaluating long-term incapacity.

The agreement ensures that medical inspectors have access to objective technical tools, as mandated by Royal Decree 625/2014, which requires the availability of tables regarding optimal duration and the incidence of certain processes on labor activities.

Context

In the Spanish social security system, the management of Sick Leave in Spain (Incapacidad Temporal) relies heavily on the medical evaluation of the worker's condition. To prevent arbitrary decisions and ensure fairness, the administration uses standardized tables to estimate how long a person should reasonably be unable to work due to a specific medical condition.

The current framework is governed by the legal structure of the Social Security administration and specifically by Royal Decree 625/2014, which regulates the management and control of temporary disability processes during the first 365 days. This new agreement between the INSS, a university, and a professional medical society represents a move toward higher scientific rigor, ensuring that the administrative functions of the Social Security in Spain (Seguridad Social) are aligned with the latest advancements in microbiology and infectious diseases.

Who is affected and how

Because this is an administrative agreement between public and private entities to update technical manuals, the impact is indirect but significant for certain profiles:

• Individuals (Particulars): People who request or receive benefits for temporary disability, pregnancy risk, or breastfeeding risk will be subject to medical assessments based on these new criteria. While the manual does not change the law itself, it changes the technical benchmark used by doctors to decide if a person's recovery time is "optimal" or if their disability is justified.
• Medical Inspectors: The professionals working for the INSS will receive updated scientific tools and knowledge, allowing them to apply more objective criteria during medical examinations.
• Medical and Academic Sectors: The University of Alcalá and SEIMC gain a formal framework for collaboration, allowing academic research and clinical expertise to directly influence public administration management.

What to do and when

This regulation is an administrative agreement (convenio) that establishes a framework for collaboration and does not impose new obligations, deadlines, or sanctions on private citizens, freelancers, or companies. Therefore, this regulation does not require any immediate action from the general public or business owners.

The agreement itself has a duration of four years, with the possibility of being extended for up to four additional years through a unanimous agreement by the signing parties. For the administration, the focus will be on the technical development and eventual implementation of the updated manual within the medical inspection services.

If you have concerns regarding a specific medical assessment or the duration of a sick leave benefit, we recommend consulting with the specialized labor area at BMC to evaluate your specific situation.