Example of a sick note in Germany. Source: AllAboutBerlin
When you fall sick as an employee, you can take paid sick leave. Your employer can request or a demand a proof of incapacity (Krankschreibung or Arbeitsunfähigkeitsbescheinigung). Most of this guide is written on the assumption that you are in public health insurance.
What is a sick note?
Krankschreibung, Arbeitsunfähigkeitsbescheinigung or AU-Bescheinigung provides confirmation that you are sick. Only a Doctor may issue it, usually on the first day of sickness; or within 3 days of sickness retroactively in certain cases.
Example of a sick note in Germany. Source: AllAboutBerlin
There are four copies. This is for:
you
your employer (in 2023, you don't have to send this copy to your employer anymore if you have public health insurance.)
your health insurance (also transmitted to the health insurance digitally)
your doctor's records
Update in 2024: A few people have told me that they no longer receive any copies for sick notes and they are transmitted to your insurance & employer electronically. If you want a copy for yourself, please ask your doctor's office. My insurance TK provides an option to download it (it looks pretty different) on their platform.
What is present in a sick note?
Your insurance provider's name (Krankenkasse bzw. Kostenträger)
Your full name, address, and date of birth (Name, Vorname des Versicherten; geb. am)
Cost unit identifier (Kostenträgerkennung)
Your insurance number (Versicherten-Nr.)
Your Doctor's number- Whether illness, or injury is a result of work (Arbeitsunfall, Berufskrankheit)
Important information about how long you can take paid sick leave:
Incapacity for work since (Arbeitsunfähig seit)
Expected date of recovery, including the last day (voraussichtlich arbeitsunfähig bis einschließlich oder letzter Tag der Arbeitsunfähigkeit)
Issued date of sick note (festgestellt am)
Your copy and your health insurances' copy will include diagnosis in the sick note, with ICD codes. Employer's copy is shorter than the other copies. It does not include the diagnosis.
On the top right side, it specifies
if this is a first issuance (Erstbescheinigung)
or a renewed issuance of an existing one (Folgebescheinigung)
Read about my wisdom teeth removal experience in Germany
Things to do when you fall sick in Germany
Inform your employer
When you're sick, you must notify your employer at the start of the first day of sickness. If you know when you are likely to recover, you can choose to let your employer know; you don't need to. You do not need to reveal your illness, or reasoning for sick days off.
You can do this by email, phone, fax (read how to send a fax in Germany) or SMS.
Submit a Sick Note
If you are sick for at least three consecutive work days, you must submit a doctor's note to your employer. This is a medical certificate that allows you to take days off from work. In 2023, this is transmitted digitally to your employer only for public health insurance companies. For private health insurance, you must still submit it.
Your employer can request or demand a sick note even from day 1. This varies based on the employer.
How is it counted over weekend?
If you fall sick on a Thursday to Monday, the number of days you have been sick is 5. Sick days are counted for calendar days and not just work days. They do not reset over the weekend or holidays, so you will need to provide a sick note.
Getting a sick note
Go to a doctor's, tell them your symptoms, and if necessary, the doctor can write you a sick note (Krankschreibung) and recommend rest.
Once you receive yours (4 copies are present as mentioned above), submit the employer's copy to your employer via email, in-person or via fax. And the health insurance's copy to your health insurance. A copy of a sick note is enough. Keep your original with you, in case it's required by your health insurance, or your employer.
From July 2022, your employer and health insurance will receive the digital copies automatically, from your doctor's office.
Update in February 2023: Unfortunately, it looks like the system does not work properly always. You might still have to send a copy to your employer by hiding out sensitive information from your copy.
Who pays my salary on sick leave?
Your employer will pay 100% of your salary for up to six weeks of sick leave (Entgeldfortzahlung). After that, your health insurance covers part of your salary (Krankengeld) - approximately 70% of your gross salary, or 90% of your net salary.
Can I take a sick leave for mental health reasons?
Yes, absolutely. Sick leave can be used for both physical & mental health reasons (not feeling good, burnout, etc). Your employer does not need to know why you took days off.
Sick leave in the first month of a job
If you fall sick in the first month of a new job, you should submit a sick note, even for one day of sick leave. In this case, your health insurance pays your salary; not your employer.
Returning early from sick leave
If you get a sick leave note for a week and you decide to come back earlier to work before your sick note expires, is it allowed? You can choose to do this but your HR team may not allow you to come back early. If you fall sick, the sick leave is for you to ensure that you take enough rest and time to recover from the sickness. Coming back to work early defeats the purpose, and may result in a recurrence of your sickness.
Because of this, your employer may not allow you to come back early. If you do choose to do this, you do not have to ask your doctor to shorten the sick note.
In addition to this, if you come back early and then become sick again within the same period, it puts you in an awkward place.
Can I get a sick note over phone?
Yes, for certain illnesses (example: if you have symptoms of cold, flu or Covid) - up to 7 days. Your doctor can extend for another 7 days once. You will then receive the sick note by email, or post.
In most other cases, this is either not possible, or up to the discretion of your doctor.
Can I get a sick note over the internet?
A doctor can evaluate you over video calls, and issue it. These sick notes are accepted.
Several platforms, like dransay, provide sick notes over the internet. Several people have reported that their employers have chosen not to accept it.
What can I do if my doctor is unavailable?
If your doctor is unavailable, or not answering phone calls, check their website or Google maps for their opening hours. In particular, Doctors have a Sprechstunden or office hours where you can go without appointments.
If that fails, for non-emergencies - you can call 116117 and they can help you find an appointment or a doctor. Or try their website:
https://www.116117.de/de/aerztlicher-bereitschaftsdienst.phpI fell sick on a weekend, what do I do?
For non-emergencies, you can call 116117 and they can help you find an appointment or a doctor.
For emergencies, call 112.
Krankengeld
What is Krankengeld?
When you are sick for longer than six weeks for the same illness, you can claim sick pay (Krankengeld).
Bundesministerium für Gesundheit has a dedicated page for Krankengeld.
In the event of incapacity for work, insured persons generally continue to receive their pay from the employer for six weeks.
Thereafter, the health insurance fund pays 70 percent of regular gross pay up to the income threshold (EUR 4,827.50 per month; as of 2022), but no more than 90 percent of the last net pay.
Sick pay, including continued remuneration, is limited to 78 weeks within a three-year period.
If you have received Christmas bonuses, or holidays in the past year, this can affect how much money you can receive. Use our Krankengeldrechner (English) to find out how much that is. It's also available in German.
If you receive sick pay, you must report in your tax returns the following year. Your health insurance will provide a documenting with your total sick pay, and notify your tax office.
How do I apply for sick pay?
If you submitted your sick notes on time, and they were for the same illness, your sick notes will have sufficient information for your health insurance to pay your sick pay (Krankengeld).
Sick notes will have the Erstbescheinigung and Folgebescheinigung checked with the same ICD codes.
If you are unsure, you can always reach out to your health insurance provider.
What happens to vacations in case of sick pay?
Your vacation days do not expire immediately. The holiday entitlements are valid 15 months after the end of the holiday year.
You cannot take vacation days, when you are still on sick pay.
What is the Hamburger Modell?
If you have recovered from a long term illness, and are ready to go back to work, you can opt for Hamburger Modell.
Hamburger Modell is a step-by-step reintegration process (Wiedereingliederung) into working life. Instead of working 100% from the first day back from recovery, you can gradually return to work.
Your doctor and you will decide on a step-by-step plan, and timeline for reintegration. An example would like:
Work 25% of the time for the weeks 1 & 2
Work 50% of the time for the weeks 3 & 4
Work 50% of the time for the weeks 5 & 6
Return back to work full-time
At each stage, your doctor will assess and evaluate your ability to work. The timeline can be adjusted to either speed-up, or slow-down your reintegration.
Who has to agree to Hamburger Modell?
All following parties must agree to your reintegration.
Your doctor
Your employer
Your health insurance provider
You
What is the advantage of Hamburger Modell?
For you:
More time for recovery, and a relaxed ease back into work
Slowly get used to the workload
For your doctor:
Track your progress, and reduce chances of re-occurance of your illness / sickness
For your employer:
Enable you to contribute to work without the need to pay your salary
For your health insurance:
Focus on your long term health, and reducing changes of re-occurance of your illness / sickness
How to apply for Hamburger Modell?
Your doctor and you will discuss, and agree on a plan for return to work. Wiedereingliederungsplan is the document where your doctor writes it down.
Hamburger Modell. Source: Wikipedia
The above document includes some of the following information:
Start and end of the proposed plan
Information on the type and duration of the steps
Probable point in time when full working capacity is expected
Withdrawal rights and reasons of employer and employee
Any additional information
Activities and stresses that should be avoided when possible
You need to get signature from your employer, and send it to your insurance for approval usually by post or fax. Your employer can state here, whether they would like to voluntarily pay a part of your salary, or not.
Important! Once your application has been accepted, you must get a new sick note every two weeks. Submit it to your health insurance to receive compensation.
Once you have completed your plan, you must notify all the parties involved. Your employer can return to paying your salary. Your health insurance will send you proof of income, for tax filing purposes.
If you receive compensation from Hamburger Modell, you must report in your tax returns the following year. Your health insurance will provide a documenting with your total amount during this period, and notify your tax office.
In case you are using private insurance and would like to know more about the differences:
Private vs public health insurance in Germany by My Life Germany
Private vs public health insurance in Germany by Simple Germany
