Sick leave in Spain runs on a system called incapacidad temporal (IT). It has two halves that people constantly confuse: a medical half — the official sick note, issued through the public health system — and an economic half, the benefit paid by Social Security, the mutua or your employer. This guide covers both in plain English, including the point that catches out almost every expat with private cover: your private doctor cannot sign you off sick.
Baja médica is the everyday Spanish phrase for being signed off sick. The formal name for the situation is incapacidad temporal (IT); the formal name for the paperwork is the parte de baja médica. When a Spanish colleague says "estoy de baja", a doctor in the public system has certified that they are temporarily unable to work, and a file now exists in the Social Security system with their name on it.
A baja is not a private arrangement with your employer, nor a courtesy note for missing a few days. It is an administrative act involving your doctor, the Instituto Nacional de la Seguridad Social (INSS), often a mutua colaboradora, and your employer.
Social Security sums up the purpose of the benefit in one sentence: it covers the loss of income that occurs when a worker, because of illness or accident, is temporarily unable to work and requires healthcare from the Social Security system — "está imposibilitado temporalmente para trabajar y precisa asistencia sanitaria de la Seguridad Social".
That definition contains the logic of the whole system: two conditions bolted together — unable to work and receiving care from the Social Security system. The second is exactly why a private consultation, however good, does not by itself produce a baja.
Source: Seguridad Social — Gestión de la prestación de Incapacidad Temporal.
If you take one thing from this guide, take this: a private doctor cannot issue the official baja médica. Not a Sanitas doctor, not a private clinic, not a private specialist, not a private video consultation. The sick note that creates a Social Security file and triggers the benefit is issued through the public system.
Social Security is explicit about who holds that power in the first year of an absence. Issuing the parte de baja, the confirmation reports and the discharge report sits with the Servicio Público de Salud, with the INSS able to issue discharges for all purposes, and the mutua colaboradora issuing reports for work accidents and occupational disease. No route on that list runs through your private insurer.
So if you are employed in Spain and might ever need signing off, be registered in the public system too, with a health card and an assigned family doctor, even if you use private cover for everything else. Our guide to how Spanish public healthcare works covers registration. It costs nothing and removes the worst scenario: needing a baja urgently with no public doctor to go to.
A private doctor's report is not useless here — a diagnosis, a scan or a specialist letter is useful supporting evidence to take to your public doctor. It is simply not the certificate.
Sources: Seguridad Social — Gestión y control / Impugnaciones; BOE — Real Decreto 625/2014.
A Spanish sick-leave episode is a sequence of documents: the parte de baja that opens it, the partes de confirmación that keep it open, and the parte de alta that closes it.
The opening report, issued after a face-to-face examination. The doctor records the diagnosis, the start date, whether the cause is a common or professional contingency, and an estimated duration — which sets how often you are called back. Real Decreto 625/2014 groups absences into four bands, very short, short, medium and long, each with its own review rhythm.
The follow-up reports that keep the absence live: you attend a review, the doctor confirms you are still unable to work, a confirmation report is issued. Miss those appointments without good reason and the process can be closed against you — an alta por incomparecencia, discharge for failing to appear, is a real and very avoidable outcome.
The discharge report that ends the absence and returns you to work — because you have recovered, because you have improved enough to work, or on other grounds in the rules. Once issued, the absence and the payment attached to it stop.
Sources: BOE — Real Decreto 625/2014; BOE — Real Decreto 1060/2022; Seguridad Social — Gestión y control.
Nearly every question about Spanish sick leave — who issues the note, who pays, from which day, who reviews you — has the same first answer: it depends which contingency it is. Spain splits causes into two families.
Everyday illness unrelated to your job, plus accidents that are not work accidents: flu, surgery, a slipped disc from gardening, a broken ankle on a Sunday hike, mental health conditions. The parte de baja comes from the public health service. For this family Social Security requires a contribution history from employees — a period of "180 días en los cinco años inmediatamente anteriores al hecho causante" in the case of common illness. Worth knowing if you have only recently started contributing in Spain.
Accidente de trabajo and enfermedad profesional: injury arising out of your work, including in many cases the journey to and from it, and illnesses recognised as caused by your occupation. Here the mutua covering your employer normally takes charge and its own medical services issue the reports.
Entry is more generous: Social Security states that for work accidents and occupational diseases no prior contribution period is required, and the benefit starts from the day after the absence begins, with the employer covering the full wage for the day it starts.
Sources: Seguridad Social — Situaciones protegidas / Beneficiarios / Requisitos; Seguridad Social — Nacimiento del derecho / Duración / Prórroga.
Here the two-part structure shows clearly: the doctor decides whether you are off, and a different set of bodies decides what you receive and pays it.
Social Security states that recognising the right lies with the INSS, the Instituto Social de la Marina (ISM) for maritime workers, or the mutua colaboradora covering the relevant contingencies for your employer — and that the cost of the benefit "corre a cargo del INSS, ISM, Mutua Colaboradora con la Seguridad Social o empresa autorizada para colaborar en la gestión".
There is an important wrinkle for ordinary illness. Social Security sets out that where the cause is common illness or a non-work accident, the benefit is paid from the fourth day of the absence, and that from the fourth to the fifteenth day inclusive the cost falls on the employer — "desde el día cuarto al decimoquinto de baja, ambos inclusive, el subsidio estará a cargo del empresario". For a work accident or occupational disease it runs from the day after the absence starts, with the employer paying the full wage for that first day.
We deliberately do not publish percentage rates or euro figures here. The amount is calculated from your base reguladora — broadly your contribution base — with percentages that differ by contingency and by how long the absence has run, and those are exactly the numbers that get amended. Check your payslip, your collective agreement and Social Security's own Cuantía page. Many collective agreements also top up the statutory amount, sometimes substantially.
Sources: Seguridad Social — Reconocimiento del derecho y pago; Seguridad Social — Cuantía.
A mutua colaboradora con la Seguridad Social is a non-profit association of employers authorised to collaborate in managing Social Security. It is not a private insurer, you did not choose it, and it is not optional — your employer arranged cover with one, and if you are self-employed you formalised cover with one too.
Its role depends on the contingency. For work accidents and occupational disease it typically manages the case throughout and its doctors issue the reports. For ordinary illness the public health service issues them — but the mutua may still be involved economically, may call you in for review, and can make a discharge proposal to the public health inspectorate if it believes you have recovered.
A proposal is not a decision — it goes to the public system, which decides. But it does mean you can be summoned to an examination by an organisation you have no relationship with, sometimes at short notice. Attend, or formally justify why you cannot: non-attendance at properly convened examinations is a recognised ground for ending an absence. Keep every letter and email from the mutua and the INSS, plus copies of your partes — if a dispute arises later, the paper trail is what your adviser works from.
Sources: Seguridad Social — Gestión y control / Impugnaciones; BOE — Real Decreto 625/2014.
The medical half of the system is essentially the same for both. The administrative and financial half is not.
| Question | Employee (Régimen General) | Autónomo (RETA) |
|---|---|---|
| Who certifies you unfit for work | Public health service doctor (mutua for work accidents and occupational disease) | Same |
| Can a private doctor issue it | No | No |
| Who recognises and pays the benefit | INSS, ISM or the mutua; employer bears part of the cost for ordinary illness | Normally the mutua |
| Cover for ordinary illness | Included in your regime | Compulsory, via a mutua |
| Contributions must be up to date | Employer's responsibility | Yours |
| Extra form to file | None in the normal case | Declaración de situación de la actividad |
| Who tells the employer | INSS notifies the company electronically | Not applicable |
| Contributions during the absence | Handled through payroll | Your cuota still applies |
Note the two rows that cause the self-employed the most trouble: being up to date with contributions and the extra declaration. Neither applies to an employee, and neither is intuitive if your working life so far has been on a payroll.
Sources: Seguridad Social — Regímenes Especiales (RETA); Seguridad Social — Reconocimiento del derecho y pago.
This is where most expats get caught out — partly because the rules changed in recent years, partly because much English-language advice online is simply old.
Social Security states that cover for the temporary incapacity benefit arising from common contingencies is compulsory in the RETA scheme and must be formalised with a mutua colaboradora, which is obliged to accept any proposal put to it. Cover for professional contingencies has also been compulsory since 1 January 2019, with limited exceptions, and goes with the same mutua. Particular rules apply to the agricultural self-employed system, to TRADE workers, and to people in pluriactividad.
For the special regimes, Social Security sets two general requirements: being registered (en alta) or in an equivalent situation, and being up to date with the contributions for which you are directly responsible. It also sets out what happens if you are not, including the invitación al pago mechanism.
Most autónomos must also file a declaration with the INSS or their mutua, on an official form, stating who is directly running the business while they are off — or that the activity has ceased temporarily or permanently. Social Security gives the deadline as within 15 days of the baja, and adds that during a long absence you may have to file it again every six months.
The consequence of missing it is stated plainly: failure to present the declaration in time "producirá la suspensión en el inicio del pago de la prestación". The money does not start. This one form is probably the most common reason a self-employed person in Spain is signed off and then finds nothing has been paid.
Even with everything filed correctly, being autónomo and ill is harder. Your contribution obligation does not disappear, your clients do not pause, and a benefit calculated from your contribution base may be far from what your business normally brings in. That is why many self-employed people hold private cover alongside their public entitlement: not because it pays them while ill, but because being seen and treated faster shortens the absence. See health insurance for autónomos in Spain, or if you are on a nomad route, digital nomad visa health insurance.
Sources: Seguridad Social — Régimen Especial de Trabajadores por Cuenta Propia o Autónomos; BOE — Ley General de la Seguridad Social.
An absence is not open-ended. Social Security states that in the case of accident or illness, whatever the cause, the benefit lasts 365 days, extendable by a further 180 days where it is presumed the worker may be medically discharged as recovered during that period — "365 días prorrogables por otros 180 días".
The 365-day mark is a genuine turning point. From there, Social Security states that the INSS medical inspectorate becomes the sole competent authority to issue the discharge — for recovery, for improvement allowing a return to work, with a proposal for permanent incapacity, or for unjustified failure to attend an examination it has convened. Your own family doctor no longer decides.
If no discharge has been issued once that period is exhausted, the worker is understood to be in the extension situation, with medical control passing to the INSS inspectorate. Where the estimated time to recovery goes beyond the extension window, Social Security explains that the extension does not proceed and a permanent incapacity file is opened instead.
Relapse and observation periods are generally counted towards the maximum duration, so a series of related absences may not reset the clock. And where the INSS issued the discharge, it is also competent to issue a new baja for the same or a similar condition within the period set out in the rules — you cannot simply go back to your GP and start again.
Source: Seguridad Social — Nacimiento del derecho / Duración / Prórroga / Extinción.
The parte de alta ends the absence. Normally the same public doctor who has been reviewing you issues it, and you return on the date it states. You do not need your employer's agreement, and your employer cannot extend it.
Sometimes the discharge is a surprise — you are discharged while you still feel unable to work, or a mutua proposed it and the public system agreed. Spain has formal channels rather than argument: Social Security describes a procedure for objecting to a discharge issued by the managing body after the 365-day point, and a separate procedure for reviewing discharges issued by mutuas or collaborating companies. Deadlines apply, and they are short.
Discharge from work is not the same as being finished with treatment — many return while still having physiotherapy, follow-up scans or specialist reviews. This is one place private cover genuinely earns its keep, because continuing rehabilitation and follow-ups are exactly the planned, non-urgent care where public waiting times tend to be longest.
Sources: Seguridad Social — Gestión y control / Impugnaciones; BOE — Real Decreto 625/2014.
We sell private health insurance, so we want to be very clear about where it fits — the wrong expectation causes real harm.
Its value here is speed, and speed matters when you are on a fraction of your income and every week off work costs you money.
That is the honest case for private cover here — not that it replaces the state system, but that it can shorten the time you spend needing it. Cover varies by plan, so always check your particular policy details — or ask us for a plan that includes it. Our comprehensive health insurance page sets out what fuller policies typically include. And to be equally clear about the other end of the scale: in a genuine emergency you go to urgencias or call 112, and private insurance neither speeds that up nor is required for it.
Everything on this page is general information about how the system is structured. It is not employment-law advice, benefits advice or medical advice, and it cannot tell you what applies to your contract, your regime, your contribution history or your medical situation. For that you need someone who can look at your file.
In Spain that is usually a gestoría for administrative and Social Security paperwork, a graduado social or asesor laboral for employment matters, and an employment lawyer where there is a genuine dispute. Many expats already have a gestor for tax and autónomo filings; that person is often the right first call.
The official sources are more usable than their reputation suggests: Social Security's own pages on incapacidad temporal are detailed, available in English as well as Spanish, and authoritative, and the underlying law is published in the Boletín Oficial del Estado.
Private cover will not sign you off or pay your wages — but it can get you seen, scanned and treated faster. Tell us your age, your region and whether you are employed or autónomo, and an English-speaking Sanitas adviser will talk you through the options.
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