How to get a sick note in Germany: rules, deadlines and the online option for expats

The terms: Krankmeldung, Krankschreibung, AU

Anyone new to working in Germany encounters three words that are often confused. The Krankmeldung is your notification to the employer that you are ill and not coming in; it must be made without delay, that is on the first day before the start of work, by phone, email or as is customary in the company. The Krankschreibung or Arbeitsunfähigkeitsbescheinigung, abbreviated AU, is the medical proof that you are unfit for work, with start and expected duration. The old term “gelber Schein” (yellow slip) comes from the paper form, which has largely been replaced by electronic notification for statutorily insured people since 2023. An Attest is the umbrella term for medical certificates of all kinds.

This article is for people who have come to Germany from another country and want to know the rules. The German version exists for everyone reading along here; you switch language at the top of the page.

Deadlines: what the law requires

Section 5 of the Continued Remuneration Act (Entgeltfortzahlungsgesetz) regulates two duties. First the duty to notify: you must inform the employer of the incapacity for work and its expected duration without delay. Second the duty to provide evidence: if the incapacity lasts longer than three calendar days, you must submit a medical certificate by the following working day at the latest. The employer is entitled to demand the certificate earlier, even from the first day of illness; this is then stated in the employment contract or ordered in the individual case.

Calendar days include weekends. Anyone who falls ill on Friday and is still ill on Monday needs a certificate on Monday. Missing the deadline is not grounds for dismissal in itself, but risks a written warning and the temporary loss of continued pay until the certificate is submitted.

Who pays: continued pay and sickness benefit

Germany has no quota of sick days. For each illness the employer continues to pay full salary for up to six weeks (section 3 of the Continued Remuneration Act), provided 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; a new, different illness triggers a new six-week entitlement. Sick days are not deducted from holiday. If you fall ill on holiday and submit a certificate, the holiday days are credited back.

After six weeks, the statutory health insurer pays sickness benefit (Krankengeld) for statutorily insured people (section 44 SGB V): 70 percent of gross salary, at most 90 percent of net salary, up to the contribution assessment ceiling, 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 (Krankentagegeld) according to their tariff, which starts after a waiting period.

What the employer learns and what they do not

The certificate for the employer contains your name, the date of issue, the start of incapacity, its expected duration and whether it is a first or follow-up certificate. The diagnosis is not on it, and you are not obliged to state it. Questions like “So what is wrong with you?” you may politely leave unanswered. In case of justified doubts the employer can request an assessment by the medical service via the health insurer; this is rare.

During sick leave you may do anything that does not endanger recovery: shopping, going for walks, even travelling with mild illnesses. You must inform the employer and, if statutorily insured, the health insurer of a stay abroad. A sick note is not a ban on working: if you feel well earlier you may work; there is no “fit note”.

Dismissal and illness

Unlike in some countries, there is no ban on dismissal during illness in Germany, but also no reason to worry with a normal cold. The illness itself is not a permissible reason for dismissal; only with long-lasting or frequently recurring illnesses with a negative prognosis is dismissal on grounds of illness possible under narrow conditions. In companies with more than ten employees, the Protection Against Dismissal Act applies after six months. The Federal Labour Court has ruled, however, that the evidential value of a sick note can be shaken if it covers exactly the notice period after a resignation; the incapacity must then be proven otherwise in a dispute.

Sick note by video: how it works

The law requires a medical certificate, not an in-person examination. Since 2018 the German medical professional code has allowed treatment exclusively by video if it is medically justifiable. For statutory practices the incapacity guideline specifies that incapacity may be established by video; private providers such as OpenClinic24 follow the same standards of care.

At OpenClinic24 you describe your symptoms online in your language, create an account, add a payment card on which €10.72 is reserved, and speak by video with a doctor who speaks English, German, Turkish or Arabic. If incapacity for work is medically justified, you find the certificate as a PDF in your account: one copy for the employer without diagnosis, one for you and, for statutorily insured people, one for the health insurer. The invoice under the German fee schedule for doctors with all items is included. The documents are issued in German because employers and insurers process them that way; the doctor explains to you in your language what they say.

By video, usually a few days are certified; at first contact doctors orient themselves towards up to three calendar days; an extension requires a new assessment, and with persistent symptoms often an in-person examination. A certificate without a medical consultation, as some websites offer for a flat fee, is not permitted and worthless.

Statutorily insured: the electronic notification

Since 2023 statutory practices transmit incapacity electronically to the health insurer, and the employer retrieves the data there. You must still report sick and have the incapacity medically established, but no longer submit paper. Private certificates are not part of this procedure: you receive a PDF and send the employer copy to HR yourself. For your entitlement to continued pay this makes no difference. For sickness benefit after the sixth week you should also send the certificate to your insurer and, if in doubt, speak to them beforehand; longer illnesses belong with a GP practice anyway.

If you have no German health insurance

The duties under the Continued Remuneration Act apply to every employment relationship in Germany regardless of nationality and insurance. The video consultation at OpenClinic24 is a private medical service that you pay for yourself; German insurance is not a requirement. You receive an invoice under the German fee schedule for doctors that you can submit to international or travel insurance. If you work abroad for a German employer or vice versa, the rules of the relevant social security agreement apply additionally; clarify this with HR.

Practical tips for everyday life

Report sick on the first day before the start of work, in writing so you can prove it. Check your employment contract for the day from which a certificate is required. Keep your copy of the certificate. Arrange a follow-up certificate by the last day of the current one at the latest. And if you are unsure what a German document means: the doctor in the video consultation will explain it to you in your language.