With the Simplification Decree (law 182/2025) the sickness certificate can also be issued via tele-visit, legally equivalent to in-person visits. A turning point that promises simplification and accessibility, but raises questions about controls, fraud, medical liability and impact on INPS and employers
In Italy the sickness certificate for workers can be issued not only after the visit to the clinic or home, but also “remotely”, through tele-visit: this is provided by the package of rules contained in the recent Simplification Decree (law 182/2025) which legally equates the certification issued via telemedicine to the traditional one.
The innovation, which has attracted enthusiastic comments and cautious reservations in recent weeks, is not just a technological addition: it changes the way in which millions of certificates will be managed, transmitted and controlled with impacts on patients, doctors, employers and the INPS. In Italy the National Institute for Social Prevention records tens of millions of sickness certificates every year: suffice it to say that the theme of administrative simplification and efficiency was one of the drivers of the reform.
What does the law actually provide?
The central point is the article which authorizes the doctor (in particular the general practitioner/family doctor) to issue the certification even after a visit carried out via video call, provided that the procedure complies with the requirements of patient identification, traceability and digital signature of the document. Operational rules remain in force which will be detailed with implementing measures and, where required, with the State-Regions agreement to define methods, platforms and technical requirements.
The reasons behind the choice
Supporters (including many family doctors) talk about making clinics easier, reducing unnecessary access, and greater accessibility for those who are unable to move. In times of huge administrative burdens and waiting lists, televisit can give back clinical time to doctors and make life easier for patients.
The open nodes: controls, fraud and ethics
Formal equalization does not sweep away practical problems: relevant questions remain on INPS checks (how will remote visits be managed in inspection activities?), on the risk of certificates obtained without a real clinical assessment, and on tensions with pre-existing rules (for example some provisions of the Brunetta law which favor in-person visits for specific checks). Experts and specialists highlight that televisits can only work with secure platforms, precise identification procedures and clear rules on the categories of pathologies for which remote certification is admissible.
What technical and legal guarantees will be needed
According to commentators, for the reform not to remain a theoretical paper it will be necessary to:
1) a certified app or platform that ensures unique patient identification and digital signature;
2) clinical guidelines that define the cases in which televisit is appropriate;
3) tracking procedures and automatic integration with INPS flows to avoid delays or discrepancies;
4) effective sanctions against fraud and improper issuing of certificates. Without these pieces the risk is to shift burdens and uncertainty from the practical to the bureaucratic.
Impact on workers and employers
For the worker, the innovation means greater convenience: no queues at the clinic or home visits for minor ailments, possibility of obtaining supporting documents even in situations of logistical difficulty. For the employer, however, a period of adaptation is likely: the methods of receiving certificates (digital format, electronic signature), the verification processes and, potentially, the relationship with tax visits and random checks will change. Fraudulent behavior could also change: more digitalisation means more methods to divert any trace regarding new forms of abuse, which is why supervisory bodies will have to update tools and methodologies.
What doesn’t solve (and what could make it worse)
Televisit is not a magic wand: it does not reduce the need for in-person visits for complex conditions, it does not replace instrumental tests and can create legal inertia if the operating rules remain vague. Furthermore, if the digital platform became mandatory without adequate access standards, it would risk increasing the digital divide for segments of the population less accustomed to technology. Finally, the relationship between medical liability and the diagnostic limits of remote visits remains to be clarified.
The political weight and the calendar
The rule was approved in the context of the Simplifications Bill and applies from 18 December 2025, but many implementation measures require technical agreements (including between the State and the Regions). Translated: the law paves the way, but actual operation will depend on decrees and guidelines that have yet to be defined. Meanwhile, medical associations and trade unions have called for guarantees for clinical safety and the protection of personal data.
Who wins and who loses
Positive aspects: convenience for patients with logistical needs, a possible reduction in unnecessary access to clinics, and a potential administrative streamlining if digital flows were well designed.
Risk of losing: those who insist on an exclusively in-person visit model for each certificate; the most fragile patients if digital solutions are not easy to access; the system if the anti-fraud guarantees and clinical rules are not defined immediately.
A good start, but the journey is still long
The possibility of obtaining a sick certificate via televisit marks a logical turning point in the digitalisation of healthcare and the relationship with work: it is the formalization of practices already widespread informally. However, for this turning point to produce real benefits and not just formal simplifications, speed and concreteness in technical implementation, legal clarity and, last but not least, mutual trust between citizens, doctors and institutions will be needed. Without these ingredients, televisiting risks becoming a shortcut that leaves the usual problems unresolved: health production, job protection and fraud prevention.
