Sick Leave / Medical Certificate Form Chile

The Sick Leave / Medical Certificate Form Chile (Formulario de Solicitud de Licencia Médica) is a formal notification document used by workers in Chile to communicate a medically certified absence from work to their employer and to trigger the processing of the sick-leave subsidy (subsidio de incapacidad laboral, SIL) through the Comisión de Medicina Preventiva e Invalidez (COMPIN) for FONASA-affiliated workers, or directly through the worker's ISAPRE for private health insurance holders. The legal basis for medical leave in Chile is established by Article 195 of the Código del Trabajo (DFL No. 1/2003), Ley 18.469 (Ley de Salud) regulating healthcare access, and Decreto Supremo No. 3/1984 of the Ministerio de Salud, which governs the licencias médicas system.

A licencia médica in Chile is a certificate issued by a registered physician (médico tratante), dentist (cirujano-dentista), or midwife (matrona, for certain conditions) certifying that the worker is temporarily unable to perform their job duties due to illness, injury, mental health condition, or post-surgical recovery. The licencia médica is classified by type: Type 1 (enfermedad o accidente común — ordinary illness or accident); Type 2 (prórroga de licencia médica — extension of existing leave); Type 3 (licencia médica maternal — maternity leave under Articles 195–197 bis); Type 4 (enfermedad grave de hijo menor de un año — care for a seriously ill child under one year); Type 5 (accidente del trabajo o de trayecto — occupational accident under Ley 16.744); Type 6 (enfermedad laboral — occupational disease under Ley 16.744); and Type 7 (patología del embarazo — pregnancy-related conditions).

The sick-leave subsidy (subsidio de incapacidad laboral, SIL) is administered by the Superintendencia de Seguridad Social (SUSESO) and calculated based on the worker's average gross remuneration over the preceding 3 months (for FONASA affiliates) or 12 months (for ISAPRE affiliates in some cases). The daily subsidy rate is the average daily remuneration, subject to minimum and maximum limits established annually by SUSESO. Workers on occupational leave under Ley 16.744 receive their subsidy through the Mutual de Seguridad (ACHS, MUTUAL, or IST) rather than through COMPIN or ISAPRE.

The licencia médica electronic system (LME — Licencia Médica Electrónica) was introduced by SUSESO to digitalize the medical leave process. Since 2019, virtually all licencias médicas in Chile are issued electronically through the COMPIN online portal or the ISAPRE electronic platform. The treating physician issues the LME online, which is automatically forwarded to the employer through the Sistema de Autorización de Licencias Electrónicas (SALE). Workers submit the employer notification form to formally acknowledge receipt of the licencia médica number and to authorize the employer to manage the subsidy processing.

The Dirección del Trabajo (DT) and the SUSESO jointly supervise compliance with medical leave regulations. Employers who prevent workers from exercising their medical leave rights — including by requiring attendance during licensed periods or refusing to process subsidy applications — are subject to sanctions under Article 477 of the Código del Trabajo and the SUSESO enforcement regulations. Workers who experience employer interference with their medical leave rights may file denuncias administrativas at the Inspección del Trabajo or contact SUSESO's consumer protection service (Defensoría del Asegurado) for guidance.

A Sick Leave / Medical Certificate Form Chile is needed whenever a worker receives a licencia médica from a treating physician, dentist, or midwife and must formally notify their employer of the absence and authorize subsidy processing.

The form is required for Type 1 licencias médicas (ordinary illness or accident) — covering any temporary medical incapacity caused by illness, injury, infection, surgical recovery, mental health conditions including depression and anxiety disorders, chronic disease exacerbations, or other medical conditions that prevent the worker from performing their job duties. The Dirección del Trabajo has issued Ordinarios clarifying that mental health conditions (enfermedades de salud mental) fully qualify for licencia médica under Article 195 and Ley 18.469.

The form is needed for Type 4 licencias médicas — when the worker must care for a child under one year who has a serious illness. Article 199 of the Código del Trabajo grants the mother or father (alternately) the right to a licencia médica when their child under one year is hospitalized or diagnosed with a serious illness requiring home care.

The document is required for Type 7 licencias médicas — pregnancy-related conditions (patología del embarazo) that incapacitate the worker before the standard prenatal leave period begins at 6 weeks before the expected delivery date under Article 195. These pathological pregnancy licencias can be extended multiple times and run consecutively until the prenatal leave begins.

The form is necessary for extensions (prórrogas, Type 2) of any existing licencia médica. When a treating physician determines that the worker requires additional recovery time beyond the original licencia médica period, a new licencia médica is issued as a prórroga and must be notified to the employer using this form.

The notification form is also needed when the worker's licencia médica is processed by the Mutual de Seguridad (ACHS, MUTUAL, or IST) for occupational accidents (Type 5) or occupational diseases (Type 6) under Ley 16.744 — to separately notify the employer of the absence and the Mutual claim number, even though the subsidy is administered by the Mutual rather than COMPIN or ISAPRE.

A complete Sick Leave / Medical Certificate Notification Form Chile under the SUSESO licencias médicas system must contain the following essential elements to ensure valid employer notification and timely subsidy processing.

Worker Identification: Full legal name, RUT (Rol Único Tributario), cédula de identidad number, and contact information (telephone and email). The worker's AFP affiliation (AFP Habitat, AFP Provida, AFP Capital, AFP Cuprum, AFP Modelo, or AFP Uno) and health insurance provider (FONASA or ISAPRE, specifying the ISAPRE name) must be stated.

Employer Identification: Full legal name (razón social), RUT, address, and the name and position of the human resources representative or direct supervisor receiving the notification. For COMPIN processing purposes, the employer's sector classification (whether the employer is a regular private employer, the State, a municipality, or a university) affects which COMPIN jurisdiction processes the subsidy.

Job Title and Department: The worker's position (cargo) and department (departamento o área) within the organization. This information helps the employer plan for coverage during the absence and is required by the COMPIN/ISAPRE for benefit administration.

Licencia Médica Details: The LME (Licencia Médica Electrónica) number assigned by the COMPIN or ISAPRE electronic system. The licencia médica type (Type 1 through 7), the diagnosis (diagnóstico), the ICD-10 code (Código CIE-10) from the Clasificación Internacional de Enfermedades, the name and RUT of the issuing physician, the issuance date, and the start and end dates of the rest period.

Absence Period: The exact start and end dates of the medical leave. If the licencia médica is a prórroga (extension, Type 2), reference to the original licencia médica number must be included.

Subsidy Authorization: The worker's declaration authorizing the employer to forward the licencia médica to the COMPIN or ISAPRE for subsidy processing, and an acknowledgement that during the leave period the employer pays no salary — the SIL subsidy from COMPIN/ISAPRE substitutes the remuneration. Workers should understand that the SIL subsidy may be less than their full salary if their remuneration includes variable components not fully captured in the 3-month average used by FONASA/COMPIN.

Contact During Leave: The worker's contact address and telephone number during the leave period, required by COMPIN and ISAPRE for home visit verification (visita domiciliaria) if the licencia médica duration exceeds 11 days.

Occupational Accident / Disease Declaration: If the medical condition results from a work accident or occupational disease, the worker must declare this fact on the form and identify the relevant Mutual de Seguridad (ACHS — Asociación Chilena de Seguridad, MUTUAL DE SEGURIDAD, or IST — Instituto de Seguridad del Trabajo). Occupational accident and disease licencias are processed under Ley 16.744 by the Mutual, not by COMPIN or ISAPRE.

Forms-legal.com provides this Sick Leave Medical Certificate Form Chile template as a reference. Workers should complete the official LME notification through the COMPIN or ISAPRE electronic portal and retain a copy stamped by the employer as proof of timely notification.