How to Appeal a Medical Discharge (Alta Médica) in Spain
You've been medically discharged from sick leave (alta médica) but still don't feel fit to return to work. A discharge can be challenged — but the route and the deadline depend entirely on who issued it. The regional health inspectorate, the INSS, or the labour court: each case has its own path. Miss the deadline by even one day and that route is closed.
Key principle: the route depends on who issued the discharge
A medical discharge (alta médica) is the official document ending a period of temporary incapacity (IT). Under art. 5 of Royal Decree 625/2014, it takes effect the day after it is issued. The correct appeal route is determined entirely by who signed it.
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What to do immediately
As soon as you receive the medical discharge, go back to your doctor and ask for a written medical report on your current health. Without it, any challenge is very weak. The report must clearly explain why you are not fit to return to work at this point.
Discharge issued by your GP or the Medical Inspectorate
- Get a written medical report from your doctor — without it, the challenge has no real foundation.
- File a written objection (escrito de disconformidad) with the Regional Health Inspectorate (Inspección Médica del Servicio Público de Salud) of your region. In Valencia: Conselleria de Sanitat Universal i Salut Pública; Madrid: SERMAS; Catalonia: CatSalut; Andalusia: SAS; Basque Country: Osakidetza.
- The deadline is 11 working days from the date of the discharge.
- The Inspectorate must respond within 7 calendar days. If no answer is received within that period, the challenge is deemed rejected.
- While the challenge is pending, the discharge remains in force. You must return to work. If you are unable to do so, ask your GP for a new sick note (parte de baja).
- If the Inspectorate overturns the discharge → sick leave continues and payments are restored.
- If the Inspectorate upholds the discharge → you have 20 working days to file a claim with the Labour Court (Juzgado de lo Social).
Discharge issued by a mutual insurance fund — workplace accident or occupational disease
- The deadline is 10 working days from notification of the discharge.
- Submit a request to the INSS under art. 4 of RD 1430/2009 (special review procedure). Attach your medical record or a copy of your request to the mutual fund for access to it.
- From the moment the request is submitted, the discharge is automatically suspended. Sick leave continues and the benefit keeps being paid (art. 4.3 RD 1430/2009). You do not need to return to work.
- The INSS must issue a decision within 15 working days of receiving the documents from the mutual fund (art. 4.6).
- If the INSS ultimately upholds the discharge, payments made during the review period may be treated as overpayments (art. 4.8).
- If the INSS upholds the discharge and you disagree → 20 working days to file a claim with the Labour Court (Juzgado de lo Social).
Discharge issued by a mutual insurance fund — ordinary illness (incl. self-employed)
The process is identical to that for a GP discharge: file a written objection with the Regional Health Inspectorate within 11 working days. The Inspectorate has 7 calendar days to respond. If it upholds the discharge, you have 20 working days to file a claim with the Labour Court.
Discharge issued by the INSS before day 365
- If the INSS Medical Inspectorate issued the discharge before day 365, do not use the 4-day disagreement procedure: that special route applies to INSS discharges when the 365-day period is exhausted.
- File a prior administrative complaint with the INSS within 11 working days of notification of the discharge (art. 71 LRJS).
- The INSS must answer within 7 days. If it does not respond, the complaint is deemed rejected.
- If the INSS upholds the discharge or stays silent → you have 20 working days to file a claim with the Labour Court.
Discharge issued by the INSS from day 365
From day 365 of sick leave, the INSS is the only authority empowered to issue a medical discharge (art. 170.2 LGSS). The maximum duration of temporary incapacity is 545 days; in exceptional cases the INSS may extend it to 730 days (art. 174 LGSS). Two routes are available against an INSS discharge — they can be used together.
- The deadline is 4 calendar days: Saturdays, Sundays and public holidays all count. This is an extremely short window — act immediately.
- Submit the disagreement notice to the Regional Health Inspectorate (Inspección Médica del SPS) of your region. You may also submit it at any administrative registry (art. 16.4 Ley 39/2015). Use the official INSS form (model C-061), available at sede.seg-social.gob.es.
- On the same day or the next working day, notify your employer in writing that you have filed the disagreement (art. 3 RD 1430/2009). Without this step, your absence may be treated as unauthorised.
- From the moment of submission, the discharge is suspended. Sick leave continues, payments are maintained and you do not have to return to work.
- The Regional Health Inspectorate (Inspección Médica del SPS) must issue its ruling within 7 calendar days. Silence means the challenge is rejected and the discharge takes effect.
- If the Inspectorate upholds the discharge → you must return to work; if you wish to continue challenging, file a court claim (20 working days).
A claim can be filed directly with the court — no prior administrative complaint (reclamación previa) is required. Routes A and B are compatible: you may first file the disagreement notice and, if the outcome is unfavourable, then pursue the court route.
Real cases: what the mistake cost
He missed one mutua appointment — the payments stopped the next day. A worker on sick leave failed to attend the check-up the mutua had set for 2 October 2023: he forgot, and was ill himself around those days. The following day he emailed the mutua, admitted he had forgotten and offered to come at any time; that same day a health centre treated him for a viral infection. It made no difference — his temporary incapacity benefit was cut off from 3 October. The first-instance court in Bilbao held that ending the payments was lawful.
What was not obvious. Missing the appointment does not automatically become a final loss of the benefit. A precautionary suspension starts from the next day, but the law gives 10 working days from the examination date to justify the absence. If the reason is accepted, the suspension is lifted and payment is restored from the date it was stopped. In this case the worker reacted the very next day and backed his explanation with medical evidence — that combination of facts is what the High Court ultimately treated as sufficient.
What the mistake cost: nearly a year and a half without the benefit, and two rounds of litigation. Only on 25 March 2025 did the Basque Country TSJ overturn the first-instance ruling and order payment of everything withheld since 3 October 2023. A separate claim for €7,501 in damages was dismissed, and the judgment is not final — an appeal to the Supreme Court remains open.
The current rule is explicit: art. 9.4–7 RD 625/2014 provides for suspension from the next day and 10 working days to justify the absence; extinction follows only if sufficient justification is not provided in that period. Art. 174.1 LGSS ties extinction to an unjustified failure to attend. Acting immediately is useful, but the legal window is not measured in “hours”. The High Court judgment described here was not final and remained open to cassation.
Basque Country High Court, Social Chamber — court press release · 25.03.2025
The guide above sets out the ordinary appeal route. What to check is not the deadline itself, but who issued your discharge and how you covered a missed appointment, if there was one.
Check my situationWhat to do while the challenge is pending
In most cases you will need to return to work — challenging the discharge does not suspend its effect. There are only two exceptions:
- Mutual insurance fund, occupational contingencies → submitting the request to the INSS automatically suspends the discharge.
- INSS from day 365, Route A (disagreement procedure) → the discharge is suspended from the moment of submission.
In all other cases the discharge is not suspended. If you are physically unable to work, see your GP: if there is clinical justification, they can issue a new sick note. Otherwise, your employer may treat your absence as unauthorised.
Do you need a lawyer?
At the administrative stage — filing an objection with the Health Inspectorate or a request with the INSS — legal representation is not required. Nor is it mandatory at first instance in court: art. 21.1 LRJS states expressly that legal assistance is optional (carácter facultativo).
A lawyer is only compulsory for a second-instance appeal (recurso de suplicación), but in medical discharge cases a merits appeal is not available (art. 191.2.g LRJS) — the first-instance judgment is final.
What to submit and where
There is no prescribed form for the written objection to the Health Inspectorate — a plain document is sufficient. For an INSS discharge before day 365, file a prior administrative complaint with the INSS; for Route A with the INSS (from day 365), use the official INSS form C-061. All submissions should include:
- Your details: name, identity document number (DNI/NIE), address, Social Security affiliation number.
- Employer's details and, if applicable, the mutual fund's details.
- Date and reference details of the medical discharge you are challenging.
- Statement: diagnosis, course of treatment, reasons why the discharge is premature.
- Specific grounds for the objection.
- Request: annulment of the medical discharge and reinstatement of sick leave.
Attachments: copy of the medical discharge; written medical report; medical records; copy of identity document (DNI/NIE).
Where to submit (by route)
- Routes 1, 3 and the INSS disagreement procedure from day 365: Regional Health Inspectorate of your autonomous community (Conselleria de Sanitat in Valencia, SERMAS in Madrid, CatSalut in Catalonia, etc.) — in person, by registered post or via the electronic registry.
- INSS discharge before day 365: prior administrative complaint to the INSS, through the electronic office, an administrative registry or an INSS office.
- Mutual fund, occupational contingencies route: Any INSS office or via the Social Security Electronic Headquarters (sede.seg-social.gob.es).
Quick-reference: deadlines and routes
| Who issued the discharge | Type / period | Deadline | Where | Suspended? | Work? |
|---|---|---|---|---|---|
| GP (médico de cabecera) | Ordinary illness, ≤365 days | 11 working days | Regional Health Inspectorate (SPS) | No | Yes |
| Mutual insurance fund (mutua) | Occupational (AT/EP) | 10 working days | INSS — special review procedure | Yes | No |
| SPS Inspectorate / Mutual fund (ordinary) | Ordinary illness, ≤365 days | 11 working days | Regional Health Inspectorate (SPS) | No | Yes |
| INSS | Before day 365 | 11 working days | INSS — prior administrative complaint | No | Yes |
| INSS — disagreement procedure | From day 365 | 4 calendar days | Regional Health Inspectorate (SPS) + notify employer | Yes | No |
| INSS — direct court claim | From day 365 | 20 working days | Labour Court (Juzgado de lo Social) | No | Yes |
| After day 545 of sick leave, the next step is no longer challenging the discharge but claiming permanent disability (incapacidad permanente). | |||||
Official sources
- BOE — RD 625/2014: how a sick-leave process is managed and controlled in its first 365 days: who may review the case and issue a discharge, and when.
- BOE — Ley 36/2011 (LRJS), art. 140: how discharge challenges are heard, with priority deadlines.
- BOE — Ley 36/2011 (LRJS), art. 191.2.g: the first-instance judgment is final; no appeal on the merits (suplicación).
- BOE — RDLeg 8/2015 (LGSS), art. 170: who runs a temporary-incapacity process and who may issue the discharge.
- BOE — RDLeg 8/2015 (LGSS), art. 174: the grounds on which the right to the benefit ends, discharge included.
- BOE — RD 1430/2009, arts. 3 and 4: the disconformidad procedure against a discharge issued by the INSS and the administrative review of one issued by a mutua — the appeal route itself and its deadlines.
- Seguridad Social (INSS): filing and booking an appointment.
Received a medical discharge you disagree with — tell us your situation
Let us know who issued the discharge, how many days of sick leave you've had and what your diagnosis is — and you'll get a concrete plan: which route applies to you, what to submit, where and by when.
Describe my situation →Based on: RD 1430/2009, RD 625/2014, LGSS (RDLeg 8/2015), Ley 36/2011 (LRJS). For information purposes only. Updated June 2026.
Prefer to handle it yourself?
You can also use the official channels directly, often at no cost: Banco de España for bank complaints, DGSFP for insurance, OMIC or consumer services for consumer claims and Defensor del Pueblo for problems with public administration. Or go through the claim with RightNOW: we prepare the text, evidence and action path, then accompany the case through to the result.
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This guide is general information about Spanish law, not a legal opinion on your case. Rules change and outcomes depend on your own facts and documents — check your situation before you act on it.