The circular

Sickness: INPS changes the rules – sick notes may now be backdated

The INPS is partially revising its policy on the treatment of sick workers where the period covered by a medical certificate extends to the day before the date of issue

by Giuseppe Maccarone and Mauro Pizzin

5 September 2026

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3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

The INPS is partially revising the financial support to be provided to workers on sick leave when the cover of the medical certificate extends to the day prior to the date of issue. Factors contributing to the Institute’s change of stance include the current national social and healthcare context, characterised by a reduction in the number of general practitioners, the increase in organisational and care responsibilities for those currently practising, and the practice of scheduled appointments at clinics. As it was designed, the scheme penalised workers in terms of recognition of the first day of sick leave.

What is new?

Having received the Ministry of Labour’s approval, INPS in Circular 92/2026, published yesterday, by means of a ‘progressive interpretation’ of the 1963 regulation governing the procedure relating to an employee’s illness, has thus extended social security cover to the day immediately preceding the date of issue of the medical certificate, including cases previously excluded, outpatient consultations.

To better understand this change, please note that, under the pre-amendment rules, the start date of the illness was set to coincide with the date on which the medical certificate was issued and could not be backdated to the previous day, except in specific circumstances.

It is worth noting that the start date of the event is of crucial importance for the purposes of determining the first three days of sickness (known as the waiting period), which remain the employer’s responsibility, as well as the rates of compensation, the maximum period covered, and so on.

The approach adopted by INPS provided for the recognition of the day of sickness immediately preceding the date on which the electronic certificate was issued, only if that day was entered by the doctor in the field ‘Declares to have been unwell since…’ and, in any case, only for home visits.

The aim of this provision – which also applies to certificates confirming the continuation or relapse of an illness – is to ensure that the employee is not penalised in cases where the medical examination is not carried out on the day of the appointment with the attending doctor, particularly – as the social security body emphasised in its circular – in light of the option, provided for in the employment contracts of general practitioners, to carry out the home medical examination requested by the patient by 12 noon on the following day and only if deemed strictly necessary.

To avoid penalising workers, the Institute’s new interpretation – which also applies to certificates confirming the continuation or recurrence of an illness – recognises that, from 4 September, social security cover for an illness that began the previous day also applies to outpatient appointments. This entitlement does not apply if the certificate is backdated by more than one day.

Exceptions

However, the possibility of recognising the illness from the day prior to the date of issue of the medical certificate is, however, excluded if that preceding day is a public holiday falling on a weekday or falls on a Saturday or Sunday, since, in these circumstances, the worker would have had to use the out-of-hours medical service (formerly the ‘Guardia medica’).

For many employers who adopt the deferred calendar, the new arrangements for compiling the Single Employment Register (LUL) will come into full effect in October, when attendance data for September will be recorded.

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