Germany’s federal government has approved a sweeping reform package that makes a doctor’s note mandatory from the very first day of illness, a move aimed at reining in a national sick-leave bill that topped €134 billion in lost production last year.
The decision, taken by the coalition committee on 2 July 2026, marks a sharp departure from the current rule, under which employees need only present a medical certificate from the fourth calendar day. Companies have always been able to demand earlier proof on an individual basis, a right the Federal Labour Court has repeatedly upheld.
Care workers and drivers bear the heaviest burden
New figures from the Scientific Institute of the AOK (WIdO) lay bare the scale of the problem. Workers in waste management and utilities rack up an average of 38 days off per year. Those in industrial foundries miss 35.3 days, while bus and tram drivers are absent for 35 days.
The care sector is also hit hard: geriatric nursing staff recorded 34.7 sick days per year, and home-care workers 34 days. For context, the general sickness rate in 2025 stood at 18.6 days, according to the Techniker Krankenkasse.
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The economic fallout is enormous. Germany’s Federal Institute for Occupational Safety and Health put the production loss at roughly €134 billion in 2024, while the loss in gross value added reached about €227 billion.
Phone sick notes scrapped, penalties tightened
Under the new rules, the option of obtaining a sick note by telephone will be eliminated entirely. That channel accounted for only 0.9 percent of all medical certificates recently. The government also plans to introduce stricter penalties for fraudulent sick leave under the criminal code.
Legislation is expected to be finalised by the end of 2026. Doctors’ representatives have already warned of a massive additional burden on practices, forecasting up to 30 million extra patient visits nationwide.
Partial sick leave arrives in 2027
Alongside the tighter reporting requirements, a separate law — the Statutory Health Insurance Contribution Rate Stabilisation Act — will introduce partial sick leave from 2027. Employees who have been ill for more than four weeks can return to work gradually, with medically certified incapacity levels of 25, 50 or 75 percent.
During the first six weeks of partial return, the employer continues to pay full wages; after that, proportionate sick pay kicks in. Employers have a seven-day right of objection.
Analysts caution that the raw sickness rate alone is a poor indicator. Companies should instead focus on case duration and long-term absences.
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Civil servants exempt from day-one rule
The stricter certificate requirement applies only to workers covered by the Continued Remuneration Act. Civil servants remain subject to separate regulations.
At the federal level, a medical certificate is required only upon request. In Bavaria, proof is not needed until the fourth day of incapacity. The numbers show stark differences: federal civil servants averaged 20.9 sick days in 2023, while Bavarian civil servants recorded just 11.6 days.
Civil service unions oppose any extension of the new rules to their members. However, several state ministries are examining whether to align their regulations with the federal standard.
Separately, from July 2026, patients face higher co-payments for medications — at least €7.50 per prescription — and reimbursement for homeopathic treatments will be eliminated entirely.
