How long can you be signed off sick? Usual duration of incapacity by diagnosis

What determines the length of a sick note

A sick note does not certify the illness but the expected period during which you cannot do your specific job. That is why the same cold can mean three days of incapacity for a nurse with patient contact and one day for someone working from home. The doctor weighs three things: the expected course of the illness, the demands of your work and the risk of infecting others.

The incapacity guideline of the Federal Joint Committee sets the framework for statutory practices: incapacity should generally not be certified for more than two weeks in advance, or up to one month only if the course is foreseeable. In private practice, including the video consultation at OpenClinic24, the medical duty of care applies with the same standards: short, justified periods and a new assessment if it takes longer.

Two things are important to know. First: the certificate is a prognosis, not a ban on working. Anyone who recovers earlier may work earlier. Second: you cannot “get signed off for two weeks” on request. The duration follows from the medical assessment, not from the wish.

Usual duration by diagnosis

The following ranges describe what is typical in practice. They do not replace the individual assessment.

Condition	Typical course	Usual incapacity	Notes
Common cold	Peak on days 2 to 3, resolving after 7 to 10 days	2 to 5 days	Longer with contact to at-risk groups
Influenza	Fever 3 to 5 days, exhaustion 1 to 2 weeks	5 to 7 days	Return only once fever-free
Gastroenteritis (norovirus, rotavirus)	Symptoms 1 to 3 days	2 to 4 days	Food handling, kitchens, nurseries, care: 48 hours symptom-free
Shingles (herpes zoster)	Blisters crust after 7 to 10 days, pain longer	1 to 2 weeks	Face or eye: specialist care, often longer
Migraine attack	4 to 72 hours (ICHD-3)	1 to 2 days	Discuss prophylaxis if attacks are frequent
Non-specific back pain	Improvement usually within a few weeks	A few days to 2 weeks	Stay active, early return recommended
Uncomplicated cystitis	Improvement after 1 to 3 days with treatment	1 to 3 days	Fever or flank pain: examination needed
Acute stress reaction, exhaustion	Individual	A few days to several weeks	Regular review, plan the return
After surgery	Depends on the procedure	Set by the surgeon	Not part of the video consultation

Cold, cough, sore throat

The common cold is the most frequent reason for short sick notes. According to the review by Heikkinen and Järvinen in the Lancet, symptoms peak on the second to third day and usually subside within seven to ten days; a cough can linger longer. You are unfit for work during the phase with fever, marked exhaustion or heavy coughing, typically two to five days. A residual cough without feeling ill does not justify further incapacity in most jobs.

Influenza

Real flu begins suddenly with high fever, aching limbs and a dry cough. According to the Robert Koch Institute, fever usually lasts three to five days, exhaustion considerably longer. Five to seven days of incapacity are usual; you should return to work only once fever-free. For people with chronic conditions, pregnant women and older people, an in-person examination is advisable because complications are more common.

Gastroenteritis

Noroviruses and rotaviruses cause violent but short vomiting and diarrhoea, usually over one to three days. Two to four days of incapacity are usual. For employees in kitchens, food production, nurseries, schools and care facilities the rules of the Infection Protection Act apply: return only once vomiting and diarrhoea have stopped for about 48 hours, because infectiousness persists. Anyone who cannot drink, has blood in the stool or shows signs of dehydration needs an examination.

Shingles

Shingles is the reactivation of the chickenpox virus. The rash crusts over after seven to ten days; until then those affected are contagious to people without immunity. One to two weeks of incapacity are usual, longer with severe nerve pain or physical work. Shingles on the face, near the eye or the ear needs prompt specialist treatment because sight and hearing may be at risk. Antiviral therapy works best when started within 72 hours of the rash appearing.

Migraine

A migraine attack lasts four to 72 hours untreated according to the international headache classification. A sick note for one to two days is reasonable for severe attacks. Anyone with migraine on more than four days a month should discuss prophylaxis; it reduces attacks and days lost. Read more in the article on acute migraine.

Back pain

For non-specific low back pain the national care guideline recommends staying active and avoiding bed rest; most complaints improve within a few weeks. Short absences of a few days are usual, one to two weeks for physically heavy work. Paralysis, numbness in the genital area or problems passing urine are warning signs and must be examined immediately.

Stress, exhaustion, depressive episodes

There is no standard duration here. A short relief of a few days can help break the cycle of tension and lack of sleep. Persistent low mood, loss of interest and sleep problems for more than two weeks may indicate a depressive episode. The national care guideline on depression recommends reviewing incapacity regularly and planning the return early, for example through graded reintegration. The video consultation can be the first step; ongoing care belongs with a GP, a specialist or a psychotherapist.

Extending: how to avoid gaps

A follow-up certificate requires a new medical assessment. To avoid a gap, it should be issued by the next working day after the current certificate expires at the latest. Weekends and public holidays do no harm if the follow-up certificate is issued on the following working day.

By video, an extension is possible if the course can be assessed without an examination, for example with a subsiding cold. The incapacity guideline provides for statutory practices that a follow-up certificate by video is only issued if the first certificate followed an in-person examination. In private practice, too: if symptoms last longer than expected or change, an in-person examination is the safer route. The doctor at OpenClinic24 will tell you so openly rather than issue another certificate that is no longer medically supported.

Six weeks, 78 weeks: the deadlines for longer illness

The employer continues to pay your salary for up to six weeks of incapacity (section 3 of the Continued Remuneration Act). The condition is that the employment has existed for at least four weeks. If you fall ill again with the same illness within six months, the periods are added together.

After six weeks, the statutory health insurer pays sickness benefit for statutorily insured people, generally 70 percent of gross pay, at most 90 percent of net pay, for up to 78 weeks within three years for the same illness (section 48 SGB V). For this the insurer needs uninterrupted medical certificates. Privately insured people have daily sickness allowance according to their tariff.

Anyone foreseeably absent for more than two weeks is better placed in GP or specialist care: there, findings can be obtained, referrals issued and reintegration planned. The video consultation is intended for short, clearly defined illnesses.

Recovered early? What applies

A sick note is a prognosis. If you feel fit for work before it expires, you may work and simply report back. German law has no “fit note”. Some employers ask for a brief notification for accident insurance reasons; that is a company arrangement, not a legal duty. Conversely, during sick leave you may do anything that does not endanger recovery: shopping, walking, even travelling with a cold, provided your employer and, if statutorily insured, your health insurer are informed about a stay abroad.

What can be assessed by video and what cannot

Short, self-limiting illnesses can be assessed well in conversation: colds, cough, sore throat, gastroenteritis, migraine attacks, mild back pain, acute stress. The rule for duration here: a few days, with a new assessment if needed.

Conditions whose duration depends on findings cannot be assessed by video alone: injuries, recovery after surgery, fever without a clear cause, abdominal pain with guarding, neurological deficits, pregnancy complaints, mental illness with risk. In these cases the doctor refers you to a practice, the out-of-hours service on 116 117 or emergency services.