The German government is planning significant changes to the rules on sick leave. Under the coalition government’s proposals, employees would be required to provide a medical certificate of incapacity for work (Arbeitsunfähigkeitsbescheinigung, or AU) from the very first day of illness. At the same time, telephone sick notes would be abolished, and measures to combat the misuse of sick leave certificates would be strengthened.
These proposals form part of the coalition agreement, “A Programme for Economic Growth and Employment,” and are intended to reduce Germany’s high level of sick leave while reinforcing confidence in the country’s continued salary payment system during illness.
For now, however, these are political proposals only. Until new legislation is enacted, the current legal rules remain fully in force.
Sick Leave in Germany: What Are the Current Rules?
Under current German law, employees must inform their employer immediately if they are unable to work and indicate how long the illness is expected to last.
According to Section 5 of the Continued Remuneration Act (Entgeltfortzahlungsgesetz), a medical certificate is generally required only if the incapacity for work lasts more than three calendar days. In practice, this means the certificate must be submitted no later than the fourth day of illness.
However, employers already have the legal right to require employees to provide a medical certificate from the first day of illness. Although this option exists, it is currently used relatively infrequently.
Medical Certificate Required from the First Day?
Under the government’s proposals, the legal requirement would be brought forward so that employees must provide a medical certificate starting on the first day of illness.
Employees would therefore need to arrange a medical assessment immediately after becoming unable to work.
According to the government’s current statements, the aim is to improve the monitoring of sickness absences and reduce abuse of the system.
Whether this change would actually reduce sick leave or simply lead to a significant increase in doctor visits cannot yet be predicted. Much will depend on the final wording of the legislation.
Telephone Sick Notes Could Be Abolished
Alongside the earlier certification requirement, the government also intends to abolish telephone sick notes.
Since the end of 2023, people covered by Germany’s statutory health insurance have, under certain conditions, been able to receive an initial sick note by telephone.
This is currently possible only if:
- the patient is already known to the medical practice,
- no serious symptoms are present,
- and the treating physician considers a telephone consultation sufficient.
An initial telephone sick note is currently limited to a maximum of five calendar days.
Contrary to a common misconception, however, patients do not have a legal right to receive a telephone sick note. The decision rests entirely with the treating physician.
If the employee remains unable to work after the initial certificate expires, a follow-up certificate generally requires an in-person medical examination.
Under the government’s proposals, the option of obtaining a sick note by telephone would be abolished altogether, meaning employees would once again have to visit a doctor in person in most cases.
Backdated Sick Notes Would Remain the Exception
German doctors are already permitted to issue backdated medical certificates, but only under very limited circumstances.
According to the Incapacity for Work Directive issued by Germany’s Federal Joint Committee (Gemeinsamer Bundesausschuss), a sick note may generally be backdated by no more than three days, and only after careful medical assessment.
Backdated certificates are intended to remain the exception rather than the rule.
Why Are Stricter Rules Being Proposed?
The proposed reforms are largely being justified by Germany’s high rate of sickness absence.
According to the health insurer DAK-Gesundheit, employees took an average of 19.5 sick days per person during 2025.
Germany’s Techniker Krankenkasse reported an average of 18.6 days of absence per insured employee.
The most common causes of sick leave include:
- respiratory illnesses,
- mental health conditions,
- musculoskeletal disorders, such as back pain.
Together, these three categories account for roughly half of all sickness-related absences.
However, a high sickness rate does not automatically mean employees are abusing sick leave.
The Scientific Institute of the AOK points out that, since the introduction of Germany’s electronic sick note system (eAU), short-term illnesses are now recorded much more comprehensively than before. As a result, official statistics show higher absence rates even though the actual number of sick employees may not have increased.
Medical Certificates Would Remain Strong Evidence
Even if the reform is implemented, the medical certificate would continue to play a central role in German employment law.
A properly issued certificate generally creates the legal presumption that the employee is genuinely unable to work.
This presumption can be challenged in exceptional cases, for example if:
- there are significant inconsistencies,
- the employee displays suspicious behaviour,
- the illness begins immediately after receiving notice of dismissal,
- or other unusual circumstances cast doubt on the claimed incapacity for work.
Frequent sick leave alone, or a generally high level of sickness absence, is usually not sufficient to overcome this legal presumption.
According to the current proposals, this fundamental principle would remain unchanged.
Tougher Penalties for False Medical Certificates
The government also plans to impose stricter penalties for issuing false medical certificates.
Under current law, Section 278 of the German Criminal Code (Strafgesetzbuch) already makes the issuance of false health certificates a criminal offence.
The current maximum penalty is two years’ imprisonment or a fine.
Exactly how these penalties would be strengthened remains to be determined during the legislative process.
Impact on Continued Salary Payments
A legal obligation to provide a medical certificate from the first day of illness would also affect Germany’s rules on continued salary payments during sickness.
Even under current law, employers may refuse continued salary payments until employees comply with their notification and documentation obligations.
Employees should therefore always:
- notify their employer immediately that they are unable to work,
- indicate the expected duration of their illness,
- and obtain a medical certificate in good time whenever required by law or by their employment contract.
For employees covered by Germany’s statutory health insurance, medical certificates are now generally transmitted electronically via the electronic certificate of incapacity for work (eAU).
To retrieve the certificate, employers need key information such as the start date and expected duration of the illness.
Simply informing the employer that you have visited a doctor is generally not sufficient.
What Employers Should Consider
The proposed reform would also have practical implications for employers.
Businesses should consider:
- reviewing their internal sickness reporting procedures,
- preparing HR departments for possible legal changes,
- informing employees about any new documentation requirements,
- ensuring that their systems can retrieve electronic sick notes (eAU) correctly.
At the same time, employers should not refuse continued salary payments too quickly.
Delays in accessing the electronic certificate may result from technical or administrative issues rather than employee misconduct.
Employers should also assess whether an employee was actually responsible for any delay.
For example, an employee receiving hospital treatment or suffering from a serious illness may be judged differently under employment law than someone who simply forgot to report their illness.
What Are the Rules Until the Reform Is Introduced?
At present, nothing has changed.
The announced measures remain political proposals and have not yet become law.
Until any new legislation is enacted:
- employees must continue to report their incapacity for work immediately,
- a medical certificate is generally required only from the fourth day of illness,
- employers may already require a certificate from the first day if they choose,
- telephone sick notes remain available under the current legal conditions.
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