Knowledge & Insights

Medical Appointments During Working Hours

By Lexellent , Suciu
05 May, 2026 News

1. Balancing Employees’ Health Needs with Business Continuity


ROMANIA

Employee health is protected under Romanian labor and individual legislation, with employers required to ensure workplace safety, including occupational health services. Employees have the right to access medical care without fear of retaliation. At the same time, companies must maintain business continuity, especially during critical periods or in small teams, through careful scheduling of appointments and clear internal policies.

ITALY

Workers’ health is expressly protected by Italian legislation, in particular by Article 2 of the Constitution, Article 2087 of the Civil Code, and Legislative Decree no. 81/2008 (“Consolidated Act on Health and Safety in the Workplace”).

Article 2 of the Constitution safeguards health as a fundamental right of the individual; it is a general provision that forms the basis of other rules of interest in the field of labour law.

More specifically, Article 2087 of the Civil Code establishes the employer’s general duty of protection towards employees, which translates into the obligation to adopt all necessary measures to safeguard workers’ physical integrity.

At the same time, Legislative Decree no. 81/2008 makes the protection of health and safety in the workplace an integral part of a company’s strategic organization. In this perspective, a safety management system is envisaged, relying on the contribution of various roles, each subject to specific obligations. Among these is the company doctor (see below), a physician specialized in occupational medicine, appointed by the employer to protect workers’ health and safety in relation to the risks associated with their work activities.

All these principles and values must then be reconciled with the need for business continuity, which can be ensured through early and well-organized scheduling of medical examinations, whether they are carried out by the company doctor or by the employee’s trusted doctor.

2. Key Distinctions: different kinds of medical appointments and how they are distinct from sick leave.

ROMANIA

It is essential to distinguish between a medical consultation and sick leave. Consultations with an occupational health physician or other specialists are often brief and do not require a medical certificate, whereas sick leave, supported by a medical certificate, is regulated by the Labor Code and protects employees who are unable to work due to health reasons.

This distinction affects how absences are managed in practice: preventive medical consultations can be approved internally, while sick leave requires submission of a medical certificate and official recording in the company’s attendance records.

ITALY

In Italy as well, it is essential to distinguish between medical appointments and sick leave.

As for medical appointments, these involve absences of only a few hours and may be carried out:

  • at the company doctor’s office, as part of “health monitoring” (see below), during working hours;
  • as an individual need of the employee, with a personal doctor chosen by the employee himself/herself. This appoinments happen outside working hours, by using time-off (paid or unpaid) provided for by collective bargaining agreements or company practices. If the employee uses paid time-off, they are generally required to provide a medical certificate confirming the appointment and its timing.

Sick leave, on the other hand, is a prolonged absence due to a physical or psychological condition that prevents the employee from performing their work duties. During this period, the employee retains both their job and their right to remuneration, in accordance with the applicable collective labour agreement (NCBA). In the event of illness, the employee must promptly inform the employer and undergo a medical examination in order to obtain a certificate stating the diagnosis and prognosis. The employee must also ensure their availability to allow for possible checks by a doctor from the public health authority.

3. Understanding the Legal Landscape

ROMANIA

Romanian law requires employers to provide access to occupational health services, and mandatory medical examinations cannot be refused. Government Decision No. 355/2007 sets exams at hiring, adaptation, periodically, and upon returning to work based on professional risks. 

The Labor Code governs sick leave but does not explicitly cover absences for non-mandatory preventive consultations.Therefore, employers must set clear internal procedures for managing such absences, including attendance recording and salary entitlements.

ITALY

In Italy, employers are required to ensure health monitoring of employees through the company doctor.

Health monitoring is carried out through different types of medical examinations aimed at verifying an employee’s fitness for their duties. These examinations may be:

  • pre-employment (before hiring);
  • periodic (during the employment), aimed at monitoring workers’ health and identifying over time any conditions that may affect their fitness for the role;
  • at the employee’s request (when occupational risks may affect their fitness for the role);
  • upon a change of duties;
  • following an absence due to health reasons lasting more than 60 consecutive days.

On the other hand, about private medical appointments in Italy, if employees need to attend them, they usually do so by using time-off, depending on what’s available to them. There isn’t a general rule that automatically covers this type of absence, as everything depends on the provisions set out in the applicable CCNL and any internal company policies. In practice, these absences also need to be balanced with the company’s operational needs, so employees are expected to give advance notice and coordinate with their employer to avoid disruptions to work continuity.

4. Are All Medical Appointments the Same?

ROMANIA

In Romania, not all medical appointments are treated equally: 

  • Occupational health appointments are legally mandatory, take place during working hours and are considered time worked without negative consequences for the employee,.
  • Preventive or specialist consultations are generally optional and typically take place outside working hours. If exceptionally scheduled during working hours, company policies may require employees to use annual leave, particularly where examinations last several hours. In practice, some employers grant a limited number of paid days off per year for more complex medical investigations; however, the scope and limitations of such benefits should be expressly regulated by internal policies.
  • Chronic conditions or medical emergencies require immediate attention and are typically covered by justified sick leave.
    This distinction helps employers manage absences efficiently while balancing organizational needs with employees’ right to health protection.

ITALY

Medical examinations carried out by the company doctor:

  • are arranged and paid for by the employer;
  • are organized by the employer;
  • are mandatory for both the employer and the employee, neither of whom may refuse them (see below);
  • take place during working hours and are considered working time for all purposes. 

Other aspects to keep in mind regarding health monitoring:

  • at the end of the examination, the doctor may issue a judgment of fitness or unfitness for the job, either partial or permanent;
  • a copy of this judgment is provided to both the employee and the employer, but the latter may not be informed of any specific illness affecting the employee;
  • the judgment of the company doctor may be challenged before a specific commission.

About private medical appointments carried out by the personal doctor chosen by the employee:

  • they are arranged directly by the employee, who decides if and when they’re needed based on personal health concerns;
  • from the employer’s side, there are clear privacy limits: they can’t ask what kind of visit it is or know anything about the outcome: what matters is simply managing the absence;
  • if the visit reveals a health condition that could affect the employee’s ability to work, the employee can communicate this condition to the company doctor during the health monitoring.

5. Can Employers Refuse Such Absences due to medical appointments? Can employees refuse to attend a medical examination with the medical doctor? 

ROMANIA

In Romania, absences for mandatory occupational health examinations cannot be refused. For preventive or other non-mandatory medical appointments, refusal is only permissible for objective reasons, such as critical periods of activity or the impossibility of rescheduling, but any decision must be non-discriminatory and properly documented.

Unjustified refusals may be considered abusive and could lead to harassment complaints. Therefore, clear internal policies and open communication are essential to prevent conflicts.

ITALY

For the employer:

  • The employer may not obstruct or deny medical examinations carried out by the company doctor; doing so may expose the company to liability for breach of the duty of protection.
  • As regards non-mandatory medical appointments carried out by the employee with their own trusted doctor, the employer may require prior scheduling in order to avoid organizational disruption. Only in rare cases can time-off for medical appointments be denied, and only where there are significant and proven organizational needs, provided that the principles of fairness, good faith, and non-discrimination are respected.

For the employee:

  • An employee may not refuse a medical examination with the company doctor. Such conduct is relevant from a disciplinary perspective and may even lead to dismissal. It is considered a serious breach, as it prevents the employer from fulfilling its duty of protection.

6. How Employers Handle absences due to medical appointments in Practice. 

ROMANIA

Internal policies thus provide flexibility for employees while minimizing the risk of abuse and giving managers clarity for planning work. In practice, approaches to medical absences vary:

  • Flexible policies: employees notify their manager/superiors and take the necessary time for appointments without complex procedures.
  • Strict policies: require prior approval, reporting of the absence, and justification according to internal rules (through documents submitted before or after the appointment). 
    In practice, the same procedures are often applied to other personal situations as well, such as appointments with public institutions, school-related meetings for the employee s children, or other personal matters that cannot be addressed outside working hours.

Internal company rules dictate how these intervals are recorded and compensated, with approaches ranging from full salary preservation to time recovery mechanisms or using the annual leave for this purpose (if the medical absents last several hours).

For mandatory occupational health examinations, appointments are scheduled by the Employer. Employee attendance is mandatory, and any unjustified absence may be considered disciplinary misconduct.

ITALY

Two measures are relevant:

  1. the adoption of company regulations to govern the employee’s reporting obligations towards the company (for example, to set deadlines for submitting requests for time-off for specialist medical examinations or deadlines for reporting sickness absence);
  2. the engagement of a private investigation agency to verify that the employee is properly using time-off for medical appointments. This measure may only be used where there is a serious suspicion that the employee is misusing such time-off, i.e., using it for purposes other than those declared.

7. When Flexibility Turns Into Risk: Managing Potential Abuse

ROMANIA

Risks arise when flexibility is perceived as an opportunity for abuse. Examples include accumulating unjustified time off through medical appointments or the improper use of medical documents.

Preventing abuse requires clear internal policies, setting limits on hours for preventive consultations, requesting official proof for absences, and maintaining open communication with employees. This way, flexibility can be preserved without compromising discipline or productivity.

ITALY

If the employer becomes aware (for example, through a private investigation agency) that the employee is improperly using time-off for medical appointments, a disciplinary procedure may be initiated and a sanction may be imposed, including dismissal. 

CONCLUSION

While national legal frameworks differ in structure and level of detail, they consistently distinguish between mandatory occupational health monitoring and other types of medical consultations, which allow for greater flexibility and rely more on internal regulation. In this context, employers are expected to establish clear internal policies for requesting and documenting medical absences, helping to reduce uncertainty and prevent potential abuse, while employees are expected to act in good faith and respect both organizational needs and legal obligations, particularly regarding occupational health examinations.

Ultimately, managing medical absences effectively goes beyond formal rules and procedures. It requires a workplace culture built on clarity, consistency, and open dialogue, where flexibility is applied responsibly, employee well-being is respected, and organizational efficiency and business continuity are maintained.

AUTHORS:

Chiara D’Angelo is an associate at Lexellent, the Italian member of Ellint, and based in Milan. She is a graduate of the University of Siena and a member of the Milan Bar Association. She provides assistance, both in and out of court, in employment law matters, with particular reference to personnel management, employment and self-employment relationships and individual dismissals. She is also involved in research and updating activities for the publication of juridical articles and articles of general interest.

Georgia Vasiu is as senior associate at Suciu Employment Law, having acquired her expertise in employment law advisory and litigation in renowned local law firms.

During her 15+ years of activity as an employment lawyer, Georgia has experienced a high level of responsibility, with a focus on restructuring and redundancies, collective bargaining, harassment at work, disciplinary dismissals and employment litigations. Georgia's expertise also covers corporate and commercial matters.