Germany has vowed to tighten the rules around being off sick from work, with plans to require doctor's notes from employees on the first day of illness. Here's what looks set to change – and what is still uncertain.
Germany's coalition government wants employees to provide a medical certificate from the first day they are off sick, in a move intended to reduce the amount of days that people are absent from work.
But the proposal has sparked criticism from many people, who argue it could increase pressure on doctors offices while making life harder for people with chronic illnesses.
Here's a roundup of the current rules and what looks set to change.
What are the current rules on being off sick in Germany?
Germany has a strict system in place when it comes to taking time off work for illness.
If you are sick and unable to work, you have to give your employer a Krankmeldung (notification of sickness) before the start of work on the first day of your illness.
If your illness lasts longer than three calendar days, you generally need a medical certificate or doctor's note (Krankschreibung or AU-Bescheinigung) from the fourth day. Under Germany's electronic sick note system (eAU), employers usually receive this information directly from health insurers.
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Some employment contracts, however, require you to get a sick note earlier – even on day one in some cases.
Under rules in place since 2023, patients who are already known to a practice and have mild symptoms have been able to receive a Krankschreibung over the phone from their GP. The system was first trialled during the Covid-19 pandemic.
Employees receive their pay in full during their time off sick if they stick to these rules. There are different procedures in place for those off sick for a longer period of time, usually over six weeks.
What looks set to change?
As reported by The Local and German media earlier in July, the coalition, led by the centre right Christian Democrats (CDU), its sister party the CSU and the centre-left Social Democrats (SPD), is proposing to scrap telephone sick notes.
Ministers also want to make it the default rule for employers to require sick notes on day one of illness – rather than after the third day. However, Chancellor Friedrich Merz (CDU) said different arrangements would be possible through collective agreements or at the company-wide level.
The government has stressed that this would not necessarily mean every patient would have to attend a doctor's office in person on the first day of illness, although we are yet to hear exactly how the system would work in practice.
The proposal was announced by the coalition committee in early July as part of a broader package of measures aimed at boosting productivity.
The coalition also wants to increase penalties for the fraudulent issuing of medical certificates.
Merz said the move to change sick leave regulations is difficult, but that "we can no longer afford this competitive disadvantage caused by long absences at work".
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What's with the overhaul?
German politicians are trying to tackle what they see as a high rate of sick leave in Germany, while increasing economic output.
OECD data suggests that Germany records some of the highest numbers of sick days in Europe, although experts say it is difficult to measure because each country reports statistics differently.
According to figures compiled by the IGES institute and health insurer DAK-Gesundheit, on average employees in Germany took 25 paid sick days in 2022 – more than in any of the other countries included in the comparison.
Public health insurance provider AOK reports that in 2024, employees in Germany took an average of 23.9 sick days.
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What's the reaction?
Unsurprisingly, the proposals have not been popular. In the last weeks, people living in Germany have raised concerns about GP surgeries getting overloaded Others have noted the changes will be tricky for people with disabilities and chronic illnesses.
Dr Paula Piechotta, spokesperson on the health budget for the Greens’ parliamentary group in the Bundestag, described the planned rules as a "mistake in health policy", saying: "What’s more, doctors who issue incorrect sick notes are to face harsher penalties, and everyone must submit a sick note from the very first day.
"This government hates workers and doctors. The motive is quite clear: doctors will no longer dare to issue sick notes."
Michaela Engelmeier, chair of the German Social Welfare Association (Sozialverband Deutschland), said the new regulation would "further exacerbate the strained situation in doctors’ surgeries".
She said it could also lead to employees feeling compelled to turn up for work while they are ill.
Will these changes make a difference?
It's unclear whether the measures would significantly reduce sickness absence.
Various studies have shown that sick notes issued over the phone are not responsible for high sickness absence rates.
The Central Institute for Statutory Health Insurance Medical Care published a study in early October 2025 suggesting that the pandemic and the introduction of the electronic certificate of incapacity for work (eAU) has led to a higher recording rate for sickness from work – rather than doctors issuing sick notes over the phone.
The Apotheken Umschau also reports the DAK health insurance organisation reached a similar conclusion in a study, saying there was "no systematic abuse" of the telephone sick note system.
The Federation of German Consumer Organisations describes telephone sick notes as a "model of success" and a "good example of how to cut red tape".
What happens now?
Until draft legislation is published, many of the practical details – including how the new rules would operate alongside Germany's electronic sick note system – remain vague.
Some reports suggest video consultations would remain available under existing rules, even though telephone sick notes are due to be abolished.
Ministers are now working on draft laws that will need to be agreed within the coalition.
They will then need to be approved in the Bundestag and Bundesrat before moving forward.
