Sick Leave in Italy (2026): Rules, Pay and Procedure for Employers

Last updated: October 2026 · Written by the Peoitaly team, Employer of Record and payroll specialists in Italy.

Sick leave is one of the questions we hear most often from companies hiring in Italy. Who pays the employee when they are ill? For how long? Can you end the employment relationship during a long absence? And what does the employee actually have to do on the first day of illness?

The short answer: sick leave in Italy is partially paid by INPS, employees can be on paid sick leave for up to 180 days and their employment cannot be terminated during this period. This guide explains the rules, the procedure and the pay, including how it works when you employ people through an Employer of Record such as Peoitaly.

How sick leave works in Italy

When an employee falls ill and cannot work, they are entitled to stay at home and keep receiving an income. That income is made up of two parts:

• An allowance paid by INPS (indennità di malattia), which starts from the 4th day of illness.
• A top-up paid by the employer (integrazione), set by the applicable collective agreement (CCNL), which covers the first three days in full and raises the INPS allowance to a higher percentage of salary.

The employee’s job is protected for a maximum period called the periodo di comporto. Under the collective agreement for staffing agencies (CCNL Somministrazione), which applies to Peoitaly’s EOR employees, this is 180 days in a calendar year. It can be extended by a further 120 days if the employee presents regular medical certificates; the days beyond 180 are treated as unpaid leave (aspettativa senza retribuzione). During the comporto, the employment cannot be terminated because of the illness.

Employment cannot be terminated during sick leave, as long as the absence stays within the protected period.

What the employee must do: step by step

The procedure is simple, but the deadlines matter: missing them can turn a sick day into an unjustified absence.

• 1. Inform the employer immediately. The employee must tell the employer they are sick as soon as possible. If this is not done within one day from the start of the absence, the absence is considered unjustified and may lead to a formal complaint to the worker or a sanction.
• 2. See their own doctor. Once the absence has been communicated, the employee visits their personal doctor (medico di base), who issues the medical certificate.
• 3. Send the certificate number to the employer. Within one day, the employee communicates the number of the certificate to the employer. In case of hospitalisation, the certificate is issued by the hospital.
• 4. The doctor sends the certificate to INPS. The certificate is transmitted electronically by the doctor directly to INPS: the employee does not need to send any paper document.
• 5. Stay available for home checks. During sick leave the employee must be at the home address stated on the certificate during the availability hours.

Sick pay: who pays what

Under an EOR, the economic treatment during sick leave follows the collective agreement for staffing agencies (CCNL Somministrazione), not the client company’s CCNL:

Percentages refer to the normal daily pay the employee would have received if working. As the employer, Peoitaly advances the INPS allowance together with its own top-up in the monthly payslip, so the employee is paid as usual. See how the Italian wage structure and statutory benefits work.

Short, repeated sick leaves. Some collective agreements reduce the employer’s top-up for the first three days when an employee has several short illnesses in the same calendar year. For example, under the CCNL Commercio the first 3 days are paid at 100% only for the first two occurrences, then at 66% for the third, 50% for the fourth and not at all from the fifth. These reductions do not apply under the CCNL Somministrazione: for EOR employees, the first three days are always paid at 100%. If your employee’s payslips do not follow these rules, see how to switch your EOR provider in Italy without losing your employee.

Home checks during sick leave (visite fiscali)

Employers have the right to request checks to ensure that employees are at home during sick leave. The check is carried out by a doctor sent by INPS, at the employer’s request or on INPS’s own initiative.

For this reason, the employee must be at the home address stated on the certificate during the availability hours: 10:00 – 12:00 and 17:00 – 19:00, every day of the sick leave, including weekends and public holidays. If the employee needs to be away during these hours, for example for a medical appointment, they should inform the employer in advance and be ready to justify it. An unjustified absence from a home check can lead to the loss of the INPS allowance for the days concerned and to disciplinary action.

Sick leave, probation and holidays

• During probation: an absence for illness suspends the probation period, which is extended by the same number of days.
• During annual leave: if an employee falls ill while on holiday and sends a regular medical certificate, the illness interrupts the holiday; the days not used are taken later.
• Long illness: once the protected period is used up, the employee can ask for the extension of 120 days of unpaid leave; after that, the job protection ends.

Frequently asked questions