Who signs you off and who monitors it
In Spain sick leave is signed by your GP (médico de familia), not by the oncologist, using the hospital's reports. It is classed as temporary incapacity (IT) for common illness. From then on it is monitored by your GP, the regional medical inspectorate and, depending on the case, your employer's mutual insurer (mutua), which can call you for check-ups but cannot discharge you for a common illness, and the INSS (the Spanish social security institute).
Since 2023 you no longer have to hand the certificates to your employer; they are sent electronically. For long processes such as cancer, your GP sets widely spaced reviews (every 35 days or more), not weekly ones.
How long it can last
- Up to 365 days, with the reviews your GP sets.
- At one year the INSS decides: extend by up to 180 more days (because recovery or the end of treatment is expected), discharge you, or open a permanent incapacity file.
- At 545 days (18 months) temporary incapacity must end: the INSS has to decide between permanent incapacity and discharge. There is an extra period of up to 3 months (6 in exceptional cases) while it decides; you keep being paid.
If you relapse with the same illness within 180 days of a discharge, the days are added to the previous period.
How much you receive
The benefit is a percentage of your contribution base (what you pay into the system, not your net salary): one percentage for the first days and a higher one from day 21. The percentages and ceiling are published by Social Security and updated. Many collective agreements top up the benefit to 100 % of salary for a period: check yours or ask HR or your union. The first three days are unpaid unless the agreement covers them.
While on leave you keep accruing contributions and holiday entitlement.
Self-employed workers
If you are self-employed (autónomo) you are entitled to IT; contributing for it has been compulsory since 2019. It is managed by your mutual insurer. You must file a declaration about your business activity (who takes over, or temporary closure) in the first days. Ask also about the contribution relief from the second month of leave and about regional support.
Two jobs and temporary contracts
With two jobs, the leave covers both (the base adds up both contributions). If your contract ends during sick leave, you do not lose the benefit: the INSS or the mutual insurer keeps paying it, and it is later processed as unemployment when appropriate. Get advice at that point.
Going back to work
Discharge is decided by your GP (or the INSS). If you do not feel able, say so before it happens: you can ask for adaptation of your post on health grounds (occupational risk prevention), reduced hours or, with a disability certificate, reasonable adjustments. Spain has no general "partial discharge", but a discharge with limitations that the employer must take into account through its prevention service.
You cannot be dismissed for being ill
Law 15/2022 bans discrimination on grounds of illness or health condition: a dismissal motivated by your cancer or your sick leave is void, not merely unfair. If you receive a dismissal letter while on leave or just after returning, see an employment lawyer or your union within days: the deadline to bring a claim is short (20 working days). Patient associations offer free legal advice services.
What to ask at your appointment (and at work)
- GP: how long do you expect the leave to last and how often will you review me? Will you record my limitations?
- GP: if I feel well between cycles, can I work some days without losing the leave? (No: IT is all or nothing; weigh it up.)
- Employer/HR: does my collective agreement top up the benefit? Until when?
- Employer: can my post or hours be adapted when I return?
- Hospital social worker: what support is there if the benefit is not enough?