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Italian sickness benefit: the day before the certificate counts, even without a home visit

With circular no. 92 of 4 September 2026, INPS has changed its position. The day immediately before the medical certificate is issued now falls within the sickness benefit paid by the State even where the worker was seen at the doctor’s surgery, and not, as previously, only where the doctor called at the worker’s home. The one-day limit remains, as does the exclusion of Saturdays, Sundays and midweek public holidays.

Anyone who falls ill in the evening, or on a day when their general practitioner sees patients by appointment only, will often obtain the certificate the following day. Until 4 September 2026 that first day counted towards the sickness benefit paid by INPS, the Italian national social security institute, only if the doctor had visited the patient at home: if the worker had gone to the surgery, the day was lost. From that date this is no longer so, and the difference is not merely one of principle.

The day on which the sickness event begins

The general principle is untouched: for social security purposes the sickness event runs from the date on which the doctor issues the certificate attesting, on the basis of the clinical assessment carried out, that the worker is temporarily unfit for work. This is the criterion the Institute has applied for more than forty years, consistently with circulars no. 134368 A.G.O./14 of 28 January 1981, no. 63 of 7 March 1991 and no. 147 of 15 July 1996.

The rule has a long-standing and non-legislative origin. The Regulation on cash benefits adopted by resolution of the Board of INAM, the former national sickness insurance institute, on 10 April 1963, ratified by decree of the Ministry of Labour and Social Security of 16 May 1963, provides in Article 2, paragraph 3, that the daily allowance is payable from the fourth day of sickness, and that the period runs from the day on which the doctor was called, as recorded in the certificate. Where the date of the call has been omitted, the period runs from the date of the first examination: thus INPS, citing INAM circular no. 52/ASS of 11 June 1963.

One point of wording, because the Institute is not consistent in its terms: the narrative part of the circular refers to the day before the certificate is “issued”, while the closing paragraph refers to the day before it is “drawn up”. Under the electronic system the two dates normally coincide, and it is on that date that the calculation is anchored; were they to diverge, the distinction would matter again.

The exception that already existed, and its two conditions

On that basis INPS did recognise, by way of exception, the day immediately before the certificate was issued, but only if the treating doctor completed two fields together. The first is the one in which the patient “declares having been ill since…”, giving the day immediately before the examination; the second is the one relating to a home visit. Both fields were already present in the old paper form OPM/1 and were subsequently carried over into the electronic sickness certificate, under the technical rules annexed to the interministerial decree of 18 April 2012, published in the Gazzetta Ufficiale of 4 June 2012. The criterion applies equally to certificates of continuation and of relapse.

The reason for the exception was organisational: the collective agreements governing general practitioners allow a home visit requested by the patient to be carried out by 12.00 noon on the following day, and only where it is considered strictly necessary. On this point the circular cites Article 43, paragraph 6, of the National Collective Agreement of 15 January 2026.

What changes from 4 September 2026

The second condition has gone. With the concurring opinion of the Ministry of Labour and Social Policy, circular no. 92 of 2026 declares the earlier administrative position superseded and extends cover to the day immediately before the certificate is drawn up even where the examination took place at the surgery.

The stated reason is the changed health and social context: the progressive fall in the number of general practitioners, heavier workloads and administrative duties, and the now common practice of scheduling surgery appointments so as to avoid crowded waiting rooms. In other words, a one-day delay is no longer read as a sign that the illness is slight: it is often the consequence of how primary care in the community is organised.

The change operates “from the date of publication of this circular”: the circular is dated 4 September 2026, and the Institute announced it on its portal on that same date. It says nothing further: in particular, it does not state whether the new reading applies only to certificates drawn up from that date, or also to events already under way or to claims not yet determined. As at 19 September 2026 the “Circolari, messaggi e normativa” archive on the Institute’s portal records no later measure on the point. The prudent reading confines the change to certificates drawn up from 4 September 2026; where a claim has already been determined under the previous criterion, each case is best considered on its own facts.

The limits that remain

Two exclusions remain, and it is these that decide most cases in practice.

The first is quantitative: cover is lost if the date entered in the “declares having been ill since…” field is more than one day earlier than the certificate. INPS justifies this as a matter of logic: beyond that limit the date can no longer refer to the day on which the doctor was called. The consequence is stark: it is not merely the excess day that is lost, but the backdating as a whole.

The second concerns the calendar: cover is lost if the immediately preceding day is a midweek public holiday or falls on a Saturday or a Sunday, because on those days the worker has access to the out-of-hours medical service, which can issue the certificate. There also remains, as the circular states, “the maximum period of cover laid down by law”: backdating moves the start of the event; it does not extend the duration of the benefit. It should be noted, for accuracy, that the closing paragraph of the circular expressly restates the calendar condition alone. That the one-day limit and the need to complete the declaration field survive as well is the sounder reading, but a reading it remains.

There are two points the circular does not address at all. The first is the duty to be available at home for check-ups: nothing is said as to whether and how it bears on the backdated day, on which the worker did not yet hold a certificate. The availability hours, the Institute notes, run from 10.00 to 12.00 and from 17.00 to 19.00 on every day covered by the certificate, Saturdays, Sundays and public holidays included; for that particular day, however, there is no guidance.

The second is the field relating to the home visit, which the circular neither abolishes nor could abolish: the layout of the certificate is fixed by the technical rules annexed to the 2012 interministerial decree, and a circular cannot amend it. The field therefore remains on the form and must be completed where the visit was in fact made at home; what has fallen away is its role as a condition of cover.

Who is actually entitled to the benefit

The change does not affect everyone in the same way. INPS sickness benefit is not payable to every employee: the dividing line is not the grade held, but whether the sector in question carries a contribution obligation for sickness insurance. Outside it, according to the Institute, are domestic workers, building caretakers, middle managers in industry, craft trades and agriculture, white-collar employees in industry, and senior executives. For all of these, pay during sickness falls on the employer, under the collective agreement and, for white-collar employees, under the statutory rules on private-sector employment as well: circular no. 92 does not concern them.

Within the scheme are, among others, manual workers in industry and the craft trades, manual and white-collar employees in the tertiary, services and retail sectors, agricultural labourers, workers in the entertainment industry, and unemployed or laid-off workers who meet the conditions. Apprentices are covered as well: Article 1, paragraph 773, of Law no. 296 of 27 December 2006 extended to them, from 1 January 2007, the general rules on daily sickness benefit.

A separate regime applies to workers engaged under coordinated and continuing collaboration contracts and registered with the Gestione separata, the INPS scheme for self-employed and para-subordinate workers — the provision still speaks of “project workers” — who are neither in receipt of a pension nor registered with another compulsory scheme. For them the cover has a statutory basis of its own, Article 1, paragraph 788, of Law no. 296 of 2006, and rules of its own. It does not extend to everyone registered with the Gestione separata: self-employed professionals, in particular, fall outside it.

The benefit may not exceed one sixth of the total duration of the engagement and is in any event not less than twenty days in the calendar year, and episodes lasting fewer than four days are excluded altogether. Nor is the amount calculated by reference to pay: according to the Institute it equals 8, 12 or 16 per cent of the figure obtained by dividing the year’s contribution ceiling by three hundred and sixty-five, according to the months of contributions credited in the preceding twelve.

It is precisely the exclusion of episodes under four days that makes the question anything but academic for this group, since a single day of backdating may carry the episode over the four-day threshold. The same provision refers, for the certification and notification of sickness, to Article 2 of Decree-Law no. 663 of 30 December 1979; the circular, however, speaks simply of “the worker” and does not say whether the new criterion applies here.

Why that day counts for more than it seems

The first day of the event is no ordinary date. It is INPS itself that points out that the calculation of the waiting days turns on it — the first three days, which the Institute does not pay. So do the rates of benefit, the maximum period of cover and any penalties, among them the penalty for failing to attend a check-up.

The practical effects are real ones. The rates change as the episode goes on: according to the Institute, from 50 per cent of average daily pay between the fourth and the twentieth day, to 66.66 per cent from the twenty-first to the one hundred and eightieth. The ceiling is one hundred and eighty days in the calendar year — not fixed by any statute dealing with the cash benefit, but by the 1963 regulation and by the Institute’s settled practice, notwithstanding that the circular speaks of “the maximum period of cover laid down by law”.

For fixed-term engagements, however, a second limit applies, and this one is statutory: Article 5, paragraph 1, of Decree-Law no. 463 of 12 September 1983, converted by Law no. 638 of 11 November 1983, confines the benefit to the period actually worked in the twelve months immediately preceding the onset of illness. For a worker who cannot show more than thirty days of work in those twelve months, paragraph 3 caps the benefit at thirty days in the calendar year, paid by INPS directly once the employer has given notice.

As to the forfeiture laid down by Article 5, paragraph 14, of the same decree-law for a worker absent from a check-up without good reason, it too is measured from the start of the event. Entitlement to the benefit is forfeited in full for the first period, of up to ten days, and by one half for the remainder. Days spent in hospital, and days already verified at an earlier check-up, are excluded. The halving does not, however, follow from a single absence: it presupposes a second check-up, because the Corte costituzionale, the Italian Constitutional Court, by judgment no. 78 of 14-26 January 1988, struck the provision down in so far as it did not require one.

The employment relationship remains a separate question

This is where the misunderstandings arise, and a caution is called for. It applies first of all to employees: Article 2110 of the Civil Code and the job-retention period presuppose a contract of employment. For self-employed workers engaged on a continuing basis by a client, the position is governed instead by Article 14 of Law no. 81 of 22 May 2017, under which sickness does not bring the engagement to an end: performance is suspended, at the worker’s request and without any right to payment, for no more than one hundred and fifty days in the calendar year, unless the client ceases to have an interest in it.

Where sickness then prevents the worker from working for more than sixty days, payment of contributions and premiums is suspended for the whole of the episode, up to a maximum of two years: suspended, not written off, since the accrued amount must afterwards be paid in monthly instalments numbering three times the months of suspension.

Whether the absence is justified as against the employer, and whether the employer must top up the benefit, continue to be governed by Article 2110 of the Civil Code, by the statutory rules laid down for particular categories, and by the collective agreement in force. It remains the case, by the express terms of the third paragraph of that article, that absence through sickness counts towards length of service.

The three waiting days fall on the employer where the collective agreement so provides: for manual workers and for employees in the tertiary sector, that is where to look. It would be wrong, however, to conclude that the law is silent altogether.

For white-collar employees in the private sector, Article 6 of Royal Decree-Law no. 1825 of 13 November 1924, converted by Law no. 562 of 18 March 1926, still provides, failing a more favourable collective agreement, that the post is held open for a period geared to length of service. Pay varies with length of service too: up to ten years, full pay for the first month and half pay for the two following; beyond ten years, full pay for the first two months and half pay thereafter. The employer retains the right to deduct whatever the employee is entitled to receive under welfare arrangements established by the employer itself.

Where the event is not ordinary sickness but an accident at work, which follows rules of its own, the law itself provides: Article 73 of the consolidated act approved by Presidential Decree no. 1124 of 30 June 1965 places on the employer the whole of the pay for the day of the accident and 60 per cent of it for the waiting days.

The practical consequence is a clear one: the day in question may be paid by INPS and, at the same time, not be treated by the employer as a day of sickness. Whether the absence is justified turns on what the worker actually did that day and on how they met the notification duties laid down by the collective agreement. Where the two diverge, the matter is not resolved on the payslip: it must be settled beforehand, between worker and employer.

There is also an effect that runs the other way: one more day of sickness is also one more day capable of counting towards the job-retention period, the period for which the post is held open. For a worker with a history of repeated absence, the social security gain of a single day may be worth less than the risk that day brings with it.

Two situations the circular does not resolve

The circular is silent on two situations that arise at once in practice: the gap has to be filled by the ordinary law of the employment relationship.

The first is that of a worker who in fact worked normally on the day later given as the start of the illness. Here there is no absence to justify, no lost pay to make good and nothing to count towards the job-retention period: backdating serves no purpose and indeed creates an inconsistency between the certificate and the attendance records. The date entered in the “declares having been ill since…” field is the worker’s own declaration, and it must be true. If instead the worker fell ill during the day and left early, how that day is treated is as a rule governed by the collective agreement in force.

The second is that of a worker who did not attend that day and gave no notice. A certificate placing the onset of incapacity on the previous day goes to the reason for the absence. It does not go to the duty to notify the employer of the absence without delay, which collective agreements impose in their own right: that duty answers a real interest of the business, namely arranging a replacement and allowing checks to be made.

The duty to notify retains its own weight even where the illness was genuine: its basis lies in the general rules of Articles 1175 and 1375 of the Civil Code, which require fair dealing and good faith in the performance of a contract. For the worker the practical consequence is one only: notify at once, even before the certificate is to hand. And if the day had already been recorded as annual leave or time off, reclassifying it is a matter for agreement with the employer and does not follow from the certificate alone.

In practice

For the worker there is only one point: backdating is not automatic, it is not obtained from INPS and it is not a favour granted by the doctor. What the worker must do is state accurately both when they began to feel unwell and when they contacted the doctor, bearing in mind that it is that second moment that the Institute treats as the date to be entered in the declaration field. The certificate reference number, the numero di protocollo, should then be noted, and the sickness notification checked in the worker’s own social security file without delay.

One misunderstanding surrounds the sickness notification. Under the electronic certificate system the worker no longer has to deliver it to the employer, who obtains it directly through the Institute’s services. The duty to send it within two days of issue, which Article 2 of Decree-Law no. 663 of 30 December 1979, converted by Law no. 33 of 29 February 1980, still lays down in its literal terms, revives in one case only. Electronic transmission must have proved impossible, and the doctor must have issued certificate and notification on paper.

Even then, delay admits of justification: the Corte costituzionale intervened by judgment no. 1143 of 15-29 September 1988, striking the provision down in so far as it did not allow the worker to plead and prove good reason for the late sending of the certificate to the Institute.

For the business, and for whoever runs its payroll, the checks shift to the dates: the date of issue and the declared date of onset no longer necessarily coincide, and the waiting days and the benefit rates are calculated from the date recognised for social security purposes. The job-retention period, by contrast, does not follow the start date fixed by INPS: it remains tied to the actual absence from work, to Article 2110, second paragraph, of the Civil Code and to the collective agreement in force.

The benefit is as a rule advanced by the employer, under the collective agreement, and then set off against contributions, so that moving the first day means recalculating the waiting days and the rate bands, on payslips already closed as well. Where payment is instead made directly by the Institute — fixed-term agricultural labourers, unemployed or laid-off workers, employees of businesses in difficulty and seasonal workers whose collective agreement makes no provision for an advance, among others — the recalculation is INPS’s to make. In either case the sickness notification should be kept, with its reference number, together with the recalculation schedule. If the benefit is refused, an appeal lies to the INPS provincial committee, to be brought within ninety days of notice of the refusal.

Frequently asked questions

If I fall ill on a Saturday and see the doctor on Monday, do I recover the Saturday?

No. Cover extends only to the day immediately before the certificate: where the certificate is issued on a Monday, that day is the Sunday, and it is excluded precisely because it is a Sunday, a day on which the out-of-hours medical service is available. The Saturday, all the more so, is more than one day earlier and falls outside. If the illness began on the Saturday, the worker should go to the out-of-hours medical service.

Can the certificate give the start of the illness as two days before the examination?

Yes, if the doctor so finds, because a doctor certifies what they ascertain. For INPS benefit purposes, however, cover for the earlier day is lost where the declared date is more than one day before issue. The event is then calculated, for social security purposes, from the date of the certificate: it is not a single day that is lost, but the backdating as a whole.

Must the employer treat that day as a justified absence?

No, not automatically. Whether the absence is justified, and whether any top-up is due, depend on Article 2110 of the Civil Code and on the collective agreement in force, not on the circular. A certificate placing the onset of incapacity on the previous day is a point in the worker’s favour, not a guarantee. It remains the case that the absence had to be notified to the employer that day, in the manner and within the time laid down by the collective agreement, and that the employer may ask for the illness to be verified.

Sources

INPS, circular no. 92 of 4 September 2026, “Data di inizio della prognosi riportata nel certificato di malattia. Riconoscimento della prestazione previdenziale”, prepared by the Direzione centrale Ammortizzatori sociali (Central Directorate for Social Safety Nets) and by the Coordinamento generale medico legale.

INPS, institutional notice “Nuove indicazioni per il riconoscimento della prestazione di malattia”, published on 4 September 2026.

Regulation on cash benefits adopted by resolution of the Board of INAM of 10 April 1963, ratified by decree of the Ministry of Labour and Social Security of 16 May 1963, Article 2, paragraph 3; INAM circular no. 52/ASS of 11 June 1963, letter C, both as cited in circular no. 92 of 2026.

INPS, circulars no. 134368 A.G.O./14 of 28 January 1981, no. 63 of 7 March 1991 and no. 147 of 15 July 1996.

Article 2, paragraphs 1, 2 and 6, of Decree-Law no. 663 of 30 December 1979, converted by Law no. 33 of 29 February 1980, text in force at 19 September 2026 (Normattiva), and Corte costituzionale, judgment no. 1143 of 15-29 September 1988.

Article 46, paragraph 1, letter f), and paragraph 5, of Law no. 88 of 9 March 1989, text in force at 19 September 2026 (Normattiva), on appeals to the provincial committee.

Article 14, paragraphs 1 and 3, of Law no. 81 of 22 May 2017, text in force at 19 September 2026 (Normattiva), on the suspension of a continuing self-employment engagement in case of sickness.

Article 5, paragraphs 1, 3 and 14, of Decree-Law no. 463 of 12 September 1983, converted by Law no. 638 of 11 November 1983, text in force at 19 September 2026 (Normattiva), and Corte costituzionale, judgment no. 78 of 14-26 January 1988, in Gazzetta Ufficiale, first special series, no. 5 of 3 February 1988.

INPS, circular no. 117 of 9 September 2011, on the worker’s exemption from sending the sickness notification to a private-sector employer.

Articles 1175, 1375 and 2110 of the Italian Civil Code.

Article 6 of Royal Decree-Law no. 1825 of 13 November 1924, converted by Law no. 562 of 18 March 1926, text in force at 19 September 2026 (Normattiva).

Article 73 of the consolidated act on compulsory insurance against accidents at work and occupational diseases, approved by Presidential Decree no. 1124 of 30 June 1965, text in force at 19 September 2026 (Normattiva).

Interministerial decree of 18 April 2012, published in the Gazzetta Ufficiale, general series, no. 128 of 4 June 2012, and the technical rules annexed to it, on the electronic sickness certificate.

National Collective Agreement governing relations with general practitioners, 15 January 2026, Article 43, paragraph 6, as cited in circular no. 92 of 2026.

Article 1, paragraphs 773 and 788, of Law no. 296 of 27 December 2006, text in force at 19 September 2026 (Normattiva), on the extension of cover to apprentices and on the benefit for those registered with the Gestione separata respectively.

INPS, information sheet “Indennità di malattia/degenza ospedaliera e visite mediche di controllo”, updated to 29 January 2026: a source of administrative practice, not of law, for rates, maximum duration, payment arrangements, availability hours and the scope of entitlement.