How long sick leave can last and what the INSS can do

Terms used

• Baja — The baja is your officially recognised sick leave from work, during which you receive sick pay.
• INSS — The INSS is the national social security body that manages sick pay and decides on discharge and permanent incapacity.
• Alta — The alta is the official discharge that ends your sick leave.
• Mutuas — The mutuas are insurers that work with employers and can manage and review sick leave.

Key rules

• Maximum length: Sick leave lasts up to 365 days, extendable by a further 180 days when recovery is expected.
• Who decides: The INSS examines you before the 365 days end and decides whether to discharge you, extend, or start permanent incapacity proceedings.
• Missed examination: If you miss a medical examination without good reason, your sick pay is suspended, and it ends if you do not justify the absence within 10 working days.
• Relapses: Relapses of the same condition within 180 days are added to the time already used.

How long can sick leave last?

Sick leave lasts up to 365 days. It can be extended by a further 180 days when recovery is expected. That makes 545 days in total. The INSS decides on the extension, not your doctor alone.

If your condition comes back, periods of relapse for the same condition within 180 days are added together. A short break does not restart the count.

What the INSS does before the 365 days end

The INSS is the only body that decides what happens at this point. Before the 365 days run out, it examines you. A medical team inside the INSS, the Equipo de Valoración de Incapacidades (EVI), looks at your case.

The INSS can choose one of four paths:

• Discharge (alta): your leave ends and you go back to work.
• Extension: your leave continues for up to 180 more days if recovery is expected.
• Permanent incapacity proceedings: the INSS starts the process to decide whether you have a lasting incapacity.
• Postponed decision: if your condition is expected to stabilise, the INSS can delay classifying it. The delay can last up to 730 days in total from the start of your leave.

The decision below sets these options side by side.

Other people who can check your leave

The INSS is not the only one that can review your leave. The regional health service's medical inspectors (Inspección Médica) and the mutuas (insurers that work with employers) can also review it. They can call you to a medical examination. In some cases they can issue an alta.

If you miss a medical examination

If you miss an examination without good reason, your sick pay is suspended. It ends altogether if you do not justify the absence within 10 working days.

Good reasons keep your right to the benefit. Examples are an illness that stops you travelling or a cause you could not avoid. If you justify the absence in time, the pay is reinstated. Keep proof, such as a medical report, and send it quickly.

The exact time limits and procedure are set by regulation. Check your summons letter for the details that apply to you.

Choosing between options

What can the INSS decide when your 365 days of sick leave end?

• Discharge (alta): You have recovered enough to go back to work.

• Permanent incapacity proceedings: Your condition is unlikely to let you return to work.

• Postponed decision: Your condition is expected to stabilise, so the decision waits up to 730 days in total from the start of your leave.

The INSS alone decides, after examining you with its team of medical evaluators, before your 365 days end.

Timeline and deadlines

• Sick leave runs with pay: for up to 365 days from the start of your leave

• Leave is extended if recovery is expected: by a further 180 days, 545 days in total

• Justify an examination you could not attend: within 10 working days of the missed appointment

What to watch out for

• Missing a medical examination: If you miss a medical examination without good reason, your sick pay is suspended, and it ends if you do not justify the absence within 10 working days. Go to every summons. If you cannot, tell the office that called you straight away and send proof of the reason, such as a medical report, within 10 working days.

• A review can end your leave early: The INSS, the regional health service's medical inspectors and the mutuas can review your leave at any time and, in some cases, discharge you. Keep your medical reports up to date and bring them to any examination.

Frequently asked questions

What happens if the 365 days of sick leave run out and I am not better?

Before the 365 days end, the INSS examines you and decides what comes next. It can discharge you, extend your leave, start permanent incapacity proceedings, or postpone the decision. You do not have to ask for this yourself.

Can the INSS delay deciding on permanent incapacity?

Yes, the INSS can postpone its decision on permanent incapacity for up to 730 days in total from the start of your leave, when your condition is expected to stabilise. This applies only to workers who reach 365 days of leave.

Who besides the INSS can call me to a medical examination?

Yes, the regional health service's medical inspectors and the mutuas (employer-linked insurance bodies that manage sick pay) can also review your leave and summon you. In some cases they can issue a discharge too.

Do I keep my sick pay if I miss a summons for a good reason?

Yes, you keep your right to sick pay if your reason is justified, such as an illness that stops you travelling or an unavoidable cause. Your payment is then reinstated.