Italy’s National Social Security Institute (INPS) has introduced an important change to the treatment of sick leave that will benefit employees who are unable to obtain an immediate medical appointment. Under INPS Circular No. 92 issued on 4 September 2026, sickness protection can now extend to the day immediately preceding the issue of the medical certificate, even where the medical examination takes place in a doctor’s office rather than during a home visit.

What has changed?

Traditionally, for social security purposes, a sickness absence was generally considered to start on the date the medical certificate was issued.

This date is important because it affects:

• the calculation of the waiting period
• entitlement to sickness benefits
• benefit payment rates
• the maximum compensable period
• associated medical control obligations.

Previously, INPS recognised the day immediately before the certificate only in limited circumstances, principally where the doctor had conducted a home visit. The new guidance expands this protection to include outpatient consultations at a doctor’s surgery.

Why was the change introduced?

INPS acknowledged the practical challenges facing employees in obtaining same-day medical appointments. The Institute specifically referred to:

• a reduction in the number of general practitioners.
• increased workloads for family doctors.
• the growing use of scheduled outpatient appointments.
• broader changes in the organisation of healthcare services.

The reform is intended to prevent workers from losing social security protection simply because they cannot secure a medical appointment immediately after becoming ill.

Conditions for backdating

The protection is not automatic. To benefit from the additional day the following must apply:

• the attending doctor must expressly certify that the employee was ill from the previous day
• the relevant field in the electronic medical certificate (‘declares to have been ill since…’) must be completed
• the backdating can only extend to the immediately preceding day.

The circular does not permit backdating beyond one day.

Important exceptions

The extended protection does not apply where the preceding day was:

• a Saturday
• a Sunday
• a weekday public holiday.

In such circumstances, employees are expected to make use of continuity-of-care or out-of-hours medical services instead.

Impact on employers

While the change is primarily aimed at protecting employees, employers should understand that the recognised start date of sickness absence may now differ from the date of the medical consultation itself.

This may affect:

• sick pay calculations
• waiting-period calculations
• payroll processing
• absence management procedures.

The waiting period remains particularly important because, under many arrangements, the first three days of sickness are treated differently from subsequent periods covered by INPS benefits.

Fuente: Crowe