Medical leave in Peru: who pays the first 20 days, and when does EsSalud's sickness benefit start?

Who pays what: the first 20 days and from day 21

When a doctor signs you off work, your pay comes in two stages. Article 12, literal a.3, of Ley 26790 says:

“El derecho a subsidio se adquiere a partir del vigésimo primer día de incapacidad. Durante los primeros 20 días de incapacidad el empleador o cooperativa continúa obligado al pago de la remuneración o retribución. Para tal efecto, se acumulan los días de incapacidad remunerados durante cada año.”

(The right to the benefit starts on the 21st day of incapacity. For the first 20 days, the employer must keep paying your salary. For this purpose, paid sick days add up over each year.)

The benefit lasts “mientras dura la incapacidad del trabajador, hasta un máximo de 11 meses y 10 días consecutivos” (while the incapacity lasts, up to 11 months and 10 consecutive days).

The 20 days count per year, not per leave

This is where most people go wrong. The 20 days your employer covers do not restart with each certificate. The regulation (D.S. 009-97-SA, art. 15) says:

“Para tal efecto, se acumulan los días de incapacidad remunerados durante cada año calendario.”

(For this purpose, paid sick days add up over each calendar year.)

Our reading: if your employer paid for sick leave in March and you fall ill again in August, the March days count. Once the year’s total reaches 20, what follows is EsSalud’s benefit.

The same article adds a condition: the benefit is paid “en tanto no realice trabajo remunerado” (as long as you do no paid work). If you do paid work during the leave, you put the benefit at risk: EsSalud’s page lists it among the reasons the benefit ends, is lost or is suspended.

How the benefit is calculated

Ley 28791 changed the formula in article 12 a.2. It now reads:

“El subsidio por incapacidad temporal equivale al promedio diario de las remuneraciones de los últimos 12 meses calendario inmediatamente anteriores al mes en que se inicia la contingencia. Si el total de los meses de afiliación es menor a 12, el promedio se determinará en función a los que tenga el afiliado.”

(The benefit equals the daily average of your pay over the 12 calendar months before the month the incapacity began. If you have been affiliated for fewer than 12 months, the average uses the months you have.)

So it is not necessarily last month’s salary. The original regulation used a four-month average; the law now says twelve.

Who qualifies: contributions and employment

The benefit goes to “afiliados regulares en actividad” (employed regular members) who meet the first paragraph of article 10 (art. 12 a.1). That paragraph, as amended by Ley 31469, requires:

”[…] tres meses de aportación consecutivos o con cuatro no consecutivos dentro de los seis meses calendario anteriores al mes en que se inició la contingencia […]. En caso de accidente basta que exista afiliación.”

(Three consecutive months of contributions, or four non-consecutive ones, in the six calendar months before the month the incapacity began. For an accident, being affiliated is enough.)

The law also requires your employer to have reported and paid (or be on a current payment plan for) the contributions for the twelve months before those six. And it says contributions the employer reports late “no surten efectos retroactivos para determinación del derecho de cobertura” (do not count backward to give you coverage).

EsSalud adds a condition on its official page: “El trabajador debe tener vínculo laboral en el momento del goce de la prestación (al inicio y durante el periodo a subsidiar).” (You must be employed at the start of and during the period of the benefit.) If your job ends, the benefit ends.

If your employer has an EPS plan, see EsSalud vs EPS for who covers the cash benefits.

The CITT and private clinic certificates

The CITT is EsSalud’s Certificado de Incapacidad Temporal para el Trabajo. According to EsSalud’s page on gob.pe, sick days are backed “en base a CITT o certificados médicos particulares” (by a CITT or private medical certificates). But there is a rule for leave beyond 20 days:

“Si cuenta con certificados médicos particulares que sustenten la incapacidad que haya superado los 20 primeros días, deberán ser validados o canjeados por el CITT.”

(Private certificates for incapacity beyond the first 20 days must be validated or exchanged for a CITT.)

You ask for validation at the Cevit Central office, on the VIVA platform, or with the médico de control at an EsSalud facility. Asking for it “suspende el plazo de prescripción del derecho” (pauses the deadline) to claim the benefit, which restarts when EsSalud issues the CITT.

Some private clinics have an agreement with EsSalud to issue the “CITT Digital Cero Trámite”, which gets you a CITT “sin necesidad de realizar el trámite de validación” (with no validation step). Ask your clinic whether it issues one; the system is explained on EsSalud’s page.

Who files, and the deadline

If you are on the payroll, your employer normally handles it. EsSalud’s official page says:

“El empleador, en caso de asegurado regular y agrario dependiente, es quien paga al asegurado el subsidio en la misma forma y oportunidad en que percibe su remuneración, luego solicita reembolso a EsSalud.”

(For regular employees, the employer pays the benefit in the same way and at the same time as your salary, then claims it back from EsSalud.)

The claim is filed with EsSalud using Form 1040 (Formulario N.° 1040) and the CITT. The deadline is short. The law says:

“El derecho a subsidio prescribe a los seis meses contados desde la fecha en que dejó el período de incapacidad o el período máximo postparto.”

(The right to the benefit expires six months after the incapacity ends.)

EsSalud’s page repeats it: “El plazo para presentar la solicitud de subsidio es de 6 meses contados desde la fecha en que finaliza la incapacidad.”

If your employer reported the leave days as worked on the payroll, EsSalud “notificará al solicitante sobre la observación, otorgándole un plazo de siete días para subsanar la situación” (will notify the applicant and give seven days to fix it). If it is not fixed, only the days correctly reported as not worked are paid, and EsSalud issues a decision you can appeal.

When the benefit ends

According to EsSalud’s official page, the benefit ends, is lost or is suspended if you lose your job, do paid work during the benefit, recover or are declared permanently disabled, or abandon or do not follow your treatment.

If your employer does not pay

The first 20 days are salary: your employer “continúa obligado” (remains obliged) to pay them (art. 12 a.3). And if you are on the payroll, your employer must hand you the benefit from day 21 with your salary, then claim it from EsSalud.

If you are not paid, ask in writing and keep your certificates, payslips and proof that you handed in the leave. If there is no answer, you can complain to SUNAFIL; the steps are in how to file a complaint with SUNAFIL.

If the problem is that your employer was not paying your contributions, the law says EsSalud must cover the benefit and then bill the employer (art. 10). We found no rule that says in those words how this applies to the sickness benefit. See also what to do if your employer does not register you with EsSalud.

What this page does not cover

We do not cover the maternity or breastfeeding benefits, or the rules for domestic workers, port workers, fishers, independent farm workers or the public sector, which have their own procedures. We also do not cover work accidents under SCTR, dismissal during sick leave, or what happens when the 11-month-and-10-day maximum is reached. We did not review EsSalud’s internal CITT directive or decisions of EsSalud’s tribunal.