From long sick leave to incapacity, what happens next

Terms used

• INSS — The INSS is Spain's national social security institute, which decides on sick leave extensions and permanent incapacity.
• Alta médica — The alta médica is the medical discharge that ends your sick leave and means you must return to work.
• Demora de calificación — The demora de calificación is the INSS delaying its decision on permanent incapacity while your sick pay continues.
• Subsidio — The subsidio is the sick-leave benefit paid to you while you are on temporary incapacity.
• Prórroga de efectos — The prórroga de efectos is the continued payment of sick pay while the INSS delays its decision on permanent incapacity.

Key rules

• Maximum leave: Ordinary sick leave cannot go beyond 545 days in total.
• Who decides: Only the INSS decides whether you are extended, discharged or moved to permanent incapacity.
• Pay during delay: If the INSS delays its decision, your sick pay continues until it resolves, up to 730 days from the start of the leave.
• Refusal: If the INSS refuses the pension, the sick pay ends.

How long sick leave can last

Ordinary sick leave lasts up to 365 days, extendable by 180 days, for a maximum of 545 days. The extension only applies if you are expected to recover in that time.

Who decides at the end

The INSS is the only body that decides. It acts within 3 months of the 365th day. It has three options:

• Extend the leave for up to 180 days, if recovery is expected.
• Discharge you with an alta médica. You are fit for work and must return.
• Start a permanent incapacity process. This is the route when you are not expected to recover enough to work.

After the 545-day maximum, the INSS must decide between an alta médica and permanent incapacity. The leave cannot simply carry on.

Do relapses count?

Yes. If the same illness returns and less than 180 days have passed since the earlier leave, the days are added together. Keep your dates of leave and discharge so you can check the count.

Will you still be paid while the INSS decides?

Often yes. The INSS can delay its classification of your case, called demora de calificación. While it does, you stay in alta and your sick pay (subsidio) continues until the INSS resolves your case. This can last up to 730 days from the start of your sick leave. This extension of payment is called prórroga de efectos.

When the INSS resolves your case:

• If it grants the pension, the pension takes over from there.
• If it refuses, the sick pay ends.

If a refusal is likely, plan for your income and your return to work before that point. Ask your employer or a labour adviser what you would need to do.

What to do now

• Note the date your leave started and work out your 365th day.
• Watch for letters from the INSS. Reply on time and attend any medical examination.
• Use the decision, timeline and questions below to see which outcome fits you.

Choosing between options

What will the INSS decide when your sick leave reaches its limit?

• Extension of the leave: The INSS expects you to recover, so it extends your leave for up to 180 days.

• Return to work (alta médica): The INSS decides you are fit to work and discharges you.

• Permanent incapacity: The INSS starts the process to declare a permanent incapacity because you are not expected to recover enough to work.

• Delay of the decision (demora de calificación): The INSS needs more time, so your sick pay continues until it resolves, for up to 730 days from the start of your leave.

The INSS is the only body that decides, within 3 months of the 365th day. After 545 days it must choose between discharge and permanent incapacity.

Timeline and deadlines

• Ordinary sick leave runs: for up to 365 days from the start of your leave

• The leave can be extended if you are expected to recover: for up to 180 days more, a maximum of 545 days in total

• The INSS must decide on an alta or a permanent incapacity: after the 545 days

Frequently asked questions

Does my sick pay continue while the INSS decides on permanent incapacity?

Yes, your sick pay (subsidio) continues if the INSS delays its decision after 545 days, until it resolves or until 730 days from the start of your leave. You stay in alta, which means still registered as on leave, and the INSS keeps paying you.

What happens to my payments if the INSS grants or refuses the pension?

If the INSS grants the pension, the pension replaces your sick pay from that point.

Can the INSS delay its decision beyond the maximum sick leave?

Yes, the INSS can delay classifying your incapacity (demora de calificación) for up to 730 days from the start of your leave. This lets your sick pay continue while it decides.

Do relapses of the same illness count towards the maximum?

Yes, a relapse of the same illness counts towards the same total if fewer than 180 days passed between the two leaves. A relapse after a longer gap normally starts a new count.