Skip to content Workers who fall ill during a temporary stay abroad retain the right to economic compensation under Italian law. However, they must submit a medical certification that includes all the data required by Italian law, but also complies with the regulations of the host foreign state.
Therefore, it is of paramount importance to be informed of the rules and procedures to be followed in the case of the onset of illness abroad, to be able to properly take advantage of the allowance provided by the Italian state.
Entitlement to social security protection
The Italian state provides a system of compulsory social insurance. Its purpose is to protect both employees and self-employed and freelance workers in case of illness, retirement and other events.
This system is based on the right enshrined in Article 38 of the Italian Constitution, according to which workers have the right that adequate means be provided and insured for their living needs in case of accident, illness, disability and old age, and involuntary unemployment. […] The tasks provided for in this article are provided for by organs and institutions arranged or supplemented by the State.
To date, the management of compulsory social security is entrusted in part to INPS (Italian national social security institution), which insures most employees in the public and private sectors, and in part to the welfare institutions of self-employed people.
These institutions are then flanked by voluntary forms of supplementary insurance (pension funds), which have developed on the expectation that mandatory pensions will become lower and lower over time, due to the gradual increase in average life expectancy and average wages earned.
Another important form of insurance related to the world of work is the compulsory insurance against occupational accidents and diseases, under INAIL, a public body whose task is to ensure support in the event of an accident that happens to employees who carry out activities considered to be at risk and to carry out activities in the field of prevention and safety.
Compensation in case of illness
According to the principle of social security protection, during sick leave, the law guarantees job retention for a given period. The length of this period, during which dismissal is prohibited, is determined by the relevant collective bargaining agreement and is generally 180 days per calendar year.
In addition, employees who must be absent from work due to illness are still entitled to receive pay. The extent and duration of remuneration are determined by the relevant collective bargaining agreement. Furthermore, depending on the case, such remuneration will be borne entirely by the employer or by INPS.
Illness certificate and on-call address
To avail of the right to protection in case of illness, the worker must promptly notify the employer of absence due to illness and provide an on-call address. In addition, the worker is obliged to have the illness certificate issued by his or her attending physician, who then transmits it electronically to INPS, for the purpose of disbursement of sickness benefits.
During the entire period of illness, the employee must be on call at the usual address or domicile communicated to the employer. The worker must remain on call during all the days reported on the illness certificate, including Saturdays, Sundays, and holidays, from 10:00 a.m. to 12:00 p.m. and from 5:00 p.m. to 7:00 p.m. (unless otherwise defined according to the applicable collective bargaining agreement). During this period, it is possible to receive a visit from the fiscal physician. This visit that can be arranged either ex officio or at the request of the employer. If, upon the arrival of the doctor, the employee is absent without justification, they may be subject to disciplinary sanctions.
Travel during sick leave
If the worker wants to travel abroad during sick leave, they must first notify INPS, so as not to lose the right to social security protection.
INPS usually conducts a medical evaluation, possibly summoning the worker for an outpatient visit, to ensure that the trip does not worsen the worker’s condition. In cases of travel to non-EU states, INPS may issue travel authorization after assessing that in the destination state the applicant will be able to receive adequate medical care.
Finally, an address abroad should be communicated in advance to the relevant INPS office to allow for possible medical checkups.
Illness occurred in an EU state
Workers who fall ill while traveling abroad must first submit an illness certificate.
This certificate must contain all the data required by Italian regulations, such as:
- Header
- Biographical data
- Prognosis
- Diagnosis of inability to work
- On-call address
- Date
- Doctor’s stamp and signature
In addition, the worker must comply with the legislation of the place, to allow for follow-up medical examinations.
Illness in an EU, EEA, or Swiss state
Posted workers are usually required to hold an A1 certificate to prove the applicable social security legislation. Depending on the situation, an S1 form may also be relevant for healthcare coverage.
Therefore, to obtain economic allowance in the event of illness occurring abroad, a doctor in the host foreign state must be consulted on the first day of illness to request certification of the condition of absolute and temporary inability to work, as verified by the doctor.
Issuing the illness certificate
If the doctor in the host foreign state cannot issue the certificate of inability to work according to local laws, the competent institution in that country must be contacted.
The competent institution will instruct a doctor to verify the inability to work, compile the certificate and transmit it to INPS in Italy via the electronic exchange of data EESSI, in accordance with the provisions of the European coordination of social security systems.
According to EU regulations, it is not necessary to translate into Italian the certificate issued in the language of the foreign country where you are staying.
How to send the sickness certificate
The worker must send the complete sickness certificate to the competent INPS office within two days of its issuance and, within the same deadline, send the employer the sickness certificate without any details relating to the diagnosis. If the deadline falls on a public holiday, it is extended to the next non-public holiday.
To meet the transmission deadline, the certificate may be sent in advance by PEC, email or fax, according to the methods allowed in the specific case. It is always advisable to verify the operational requirements of the competent INPS office and to keep the original certificate where required.
To meet the deadline, the certificate can be sent in advance by PEC, e-mail or fax. However, the original certificate must still be submitted.
Illness occurred in a non-EU state
On the other hand, the procedure to be followed in the event of illness occurring during a stay in a non-EU state changes depending on whether Italy has signed bilateral agreements with the foreign country or not.
Illness in a non-EU contracted state
Italy has bilateral social security conventions and agreements with several non-EU foreign states. INPS provides a dedicated page listing all of the non-EU contracted states, which can be consulted online. For each of the contracted states, in-depth fact sheets on the individual conventions or agreements can be consulted.
In states with bilateral agreements or conventions with Italy, the procedure to follow is the same as for EU states. In addition, the legalization of the illness certificate is not required.
Illness in a non-EU state without an agreement
In the case of illness arising while staying in a non-EU state without specific agreements with Italy, the procedure for applying for a certificate is the same as for EU states. However, sickness benefits are paid only after the original, duly legalized certificate is submitted to INPS.
Legalization or Apostille confirms the authenticity of the signature, the capacity of the public official, or the authority that issued the medical certificate. It does not certify the medical content of the document.
A sworn or certified translation, on the other hand, only confirms the linguistic conformity of the translated text to the original document. Therefore, it does not replace the legalization or Apostille of the medical certificate, where such formalities are required.
Timeframe for the certificate legalization
The timeframe for obtaining legalization varies from country to country and it can take several weeks. Furthermore, the legalization procedure changes depending on whether the relevant countries have signed the Hague Apostille Convention or not. In fact, the apostille is a simplified procedure that certifies the validity of the signature on the document.
In case you fail to legalize the document in time and, therefore, the health certificate is not legalized when you return to Italy, you can regularize the legalization later, if it is within the 1-year deadline.