The assessment of disability in Italy is a complicated procedure, especially because, in most of the country, it consists of two phases based on the involvement and coordination of two institutions, the Local Health Authority (ASL) and National Social Security Institute (INPS). This article describes this procedure in Iglesias (South Sardinia), which reflects the modalities and times observable in most of the Italian regions. The assessment of disability in Italy is divided into five areas: civil invalidity (law no. 118/1971 and subsequent amendments), blindness (law no. 382/1970 and subsequent amendments), deafness (law no. 381/1970 and subsequent amendments), handicaps (law no. 104/1992), and the targeted job placement of disabled people (law no. 68/1999). Civil invalidity, which is determined by a commission of doctors only, provides for the granting of economic and non-economic benefits proportionate to the disability caused by all the health conditions (disorders and diseases), and it is measured based on three parameters: a permanent reduction in working capacity in subjects aged 18–65 years, derived from the percentage measures of health disorders and diseases indicated in the table provided by the Ministerial Decree of 5 February 1992; persistent difficulties in performing age-related tasks and functions in subjects under 18 years old and over 65 years old; dependence on third parties in walking and/or daily life in all age groups [
1]. The civil invalidity of people of working age is expressed as percentage measures of the incapacity to work: 0–33%, not disabled; 34–73%, disabled with the right to non-economic benefits only (for example, targeted job placements for civil invalidity ≥46%); 74–100%, disabled with the right to economic benefits. The civil invalidity of minors/elderly is not linked to the percentage measurement of the diseases in the table and can only concern the two possibilities of granting or not granting an economic benefit. Independent financial compensation is guaranteed for disability caused by visual impairment [
2] and prelingual deafness [
3]. The normative discipline of the handicap, which is determined by a commission of doctors and social workers, identifies the nature of the handicap in a person who has a physical, psychological, or sensory impairment, stabilized or progressive, that is the cause of difficulties in learning, in relationships, or in work placements, to determine potential social disadvantages or marginalization. The nature of the disability for a handicap can be quantified in a binary fashion, as not severe or severe, according to whether it reduces personal autonomy and necessitates permanent and global assistance in the individual or relational sphere [
4]. The recognition of a person with a disability qualified as a handicap entails the right to a wide range of mainly non-economic benefits (insertion and social integration, personal assistance services, school insertion and integration, various services, and paid absences from work for individuals with disabilities and their caregivers). The law on targeted job placements, the eligibility for which is determined by a commission of doctors and social workers, is aimed at promoting the job integration of disabled people including those in various categories, such as civil invalidity ≥46%, blindness, deafness, invalidity for work ≥33%, and receivers of social security for invalidity [
5]. Every citizen can apply for the recognition of all five types of disabilities. There are often double applications for civil invalidity and handicaps, which have different purposes, the first being aimed at determining whether economic benefits should be granted and the second focused on the objective of inclusion and social integration. The rare occurrence of multiple and simultaneous economic requests for civil invalidity, blindness, and deafness can fall into the category of people with multiple disabilities, whose legal status, provided for by the sentence of the Constitutional Court no. 346/1989 and by art. 2 law no. 429/1991, admits the receipt of the various economic benefits [
6]. In all areas of disability, each disease reported in the final diagnosis of each report is classified with the code of the International Classification of Diseases (ICD) [
7]. The INPS plays a central role in the assessment of disability in Italy, in all the different ways of carrying out the procedure. The first-instance application for the required providence, accompanied by a preparatory medical certificate, is submitted online by the citizen to INPS. The operational flow takes place entirely online [
8]. The evaluation of each instance, pursuant to article 20 law no. 102/2009, provides, in most of the national territory, a two-phase procedure: the first phase is an evaluation carried out by the ASL; the second phase is a final verification and evaluation carried out by INPS. In this manner, the visit is carried out by the ASL medical commission integrated by the INPS doctor (Integrated Medical Commission = IMC), and its opinion is subsequently verified by the competent INPS medical office (MO). The report drawn up by the IMC is validated by the MO or, in cases of disagreement, is suspended, and the evaluation of the application is repeated with a direct visit by the MO. The tacit consent rule, established by article 1 law no. 295/1990, dominates the procedure, so ASL opinions formulated by the IMC, that are not verified by the INPS MO within 60 days of their inclusion in the INPS database, are automatically confirmed. The INPS also carries out the assessment by itself from start to finish for first-instance visits in a limited part of the national territory, pursuant to article 18 law no. 111/2011, and for review visits throughout the national territory, pursuant to article 25 law no. 114/2014. Cases of disability applications are presented and examined in the year 2021 (January–September) at the INPS MO in Iglesias, in which the first-instance assessment procedure maintained the biphasic ASL–INPS organization.