Medical check-ups and the obligation to be available: what happens if the employee is not at home?

Sick leave: pay attention to the obligation to be available. In addition to promptly notifying the employer and sending the medical certificate, the employee has a third crucial duty: to be available during the time slots established by law. Ignoring this obligation can lead to financial and disciplinary sanctions, up to and including dismissal.

In this article, we analyze the relevant legal framework, how medical check-ups work, what the consequences are if the employee is not at home, and in which cases being away can be justified. We include practical examples and updated case law references.

For a broader perspective on illness and employee obligations, see also: “Medical check-ups and the obligation to be available: what happens if the employee is not at home?”

How medical check-ups work

A medical check-up is a home visit carried out by a doctor appointed by the Italian Social Security Institute ( “Istituto Nazionale della Previdenza Sociale” – “INPS”) to assess the health condition of an employee on sick leave. The visit can be:

• ordered by INPS on its own initiative;
• requested by the employer, who may seek confirmation of the legitimacy of the employee’s absence.

The employee has an obligation to be available, meaning they must be present at the address indicated on the medical certificate during specific time slots. It is therefore essential that the declared address corresponds to the actual location where the recovery period will take place. This is usually the employee’s residence, but if the illness occurs elsewhere (e.g., during a business trip or vacation), the employee must promptly inform both the physician and the employer.

As of 22 December 2023, the availability time slots have been standardized for both public and private sector employees (TAR Lazio ruling No. 16305/2023 and INPS message No. 4640/2023). The obligation applies:

• from 10:00 AM to 12:00 PM
• from 5:00 PM to 7:00 PM

every day, including Sundays and public holidays, as long as these fall within the period covered by the medical certificate. For instance, if the certificate covers from Wednesday to the following Monday, the employee must be available over the weekend as well.
What happens if the employee is not at home during the visit? Let’s find out in the next section.

What happens during a medical check-up (and if the employee is absent)

During the availability slots, the employee is required to be at the address listed in the medical certificate, unless exempt (e.g., hospitalization or high-risk pregnancy). This obligation is not merely formal; it is a safeguard for all parties involved:

• for the employee, who has an interest in demonstrating good faith and protecting their right to health;
• for INPS, which must verify the illness in order to provide the benefit;
• for the employer, who has a legitimate interest in monitoring employee absences;
• for the social security system, to ensure benefits are granted only to those truly entitled, and to prevent abuse.

The check-up is conducted by an INPS-appointed physician, who assesses whether the reported condition justifies absence from work. In some cases, the doctor may change the prognosis or suggest an early return to work.

If the employee is absent, the physician leaves a notice of summons for a follow-up in-office visit. This notice may be delivered in person or sent later via registered mail or certified email (PEC).

It is important to note that if the physician records the visit as having taken place during the designated hours but the employee disputes this, the burden of proof falls on the employee, who must provide evidence of the actual time of the visit or of a justified absence.

To avoid disputes, it is good practice to notify in advance any necessary medical-related movements, such as specialist appointments, trips to the pharmacy, or emergency room visits.

Absent during the medical visit? Here are the penalties

Unjustified absence during a scheduled check-up can result in serious financial penalties. Article 5 of Italian Decree-Law No. 463 of 12 September 1983 provides a graduated sanction system, as follows:

• First absence → full loss of INPS sick pay for the first 10 days of illness
• Second absence → 50% reduction of INPS pay for days beyond the 10th
• Third absence → total suspension of the INPS allowance for the entire illness period

In addition to losing INPS benefits, the employee may also lose any contractual top-up payments provided by the collective agreement, resulting in a significant (or total) loss of income during the sick leave period.
Furthermore, the employer may initiate disciplinary proceedings. Sanctions vary based on the seriousness of the violation and may include, in the most severe cases, termination of employment. To better understand how to respond, see our article: “How to defend against disciplinary charges”.

When is the absence justified (and when is it not)?

Failure to be available during the designated time slots, refusal to undergo the check-up, or failure to update your address are all considered violations of employment duties. If unjustified, they may lead to financial and disciplinary penalties.

Seemingly trivial excuses—such as not hearing the doorbell, not properly communicating the address, or not having your name on the doorbell—are typically regarded as unjustified, especially if repeated.

However, the seriousness of the absence must be evaluated on a case-by-case basis. If the employee shows good faith, cooperation, and no prior offenses, even an absence may not warrant extreme disciplinary action. This was confirmed by the Italian Supreme Court in Order No. 22484 of 18 July 2022, in a case where an employee missed the visit because they were in the shower. The Court stated:

“Not all behaviors relevant to social security relationships that may result in the loss of benefits necessarily lead to disciplinary liability. The latter requires verification of the substantive conditions under Article 2106 of the Italian Civil Code and the formal requirements under Article 7 of Law No. 300/1970. […] The duty of cooperation incumbent on an employee on sick leave […] cannot be stretched to include a ban on engaging in any ordinary domestic activity.“.

Conversely, in Order No. 24492 of 2019, the same Court deemed unjustified the absence of an employee who had left home to take their child to a non-urgent medical appointment. In that case, the employee failed to provide evidence that no one else could take the child, and did not inform the employer of their absence in advance. The Court upheld the sanction, ruling that no force majeure was involved.

In conclusion, each case must be carefully assessed. Even when employees act diligently, disciplinary issues may arise. That’s why seeking expert legal advice is always advisable—to prevent or effectively manage potential problems.