Securing Sick Pay: What You Need to Know Before Getting a Fit Note
17 Jun 2025
6
Minutes
Katrin Straub
CEO at nextsure
Sick for a longer period and uncertain about sickness benefits? Many wonder what happens if they want or need to declare themselves fit for work again. This article explains the important steps and how to avoid financial disadvantages.
The topic in brief and concise terms
Sick pay is provided after six weeks of continued salary payment for a maximum of 78 weeks, given uninterrupted medical certification.
A "certificate of health" ends incapacity for work and thus the entitlement to sickness benefits; the MDK can also determine this against medical advice.
Gaps in sick notes can lead to the loss of sick pay; after the period of entitlement ends, unemployment benefit I is often possible.
Understanding Sick Pay and Medical Clearance: The Basics
Sick pay is a wage replacement benefit provided by statutory health insurance for employees. It is paid if you are unable to work for more than six weeks due to the same illness. During the first six weeks, your employer usually continues to pay your wages. A formal 'fit note' ends the incapacity to work and thus the entitlement to sick pay. This transition requires attention to avoid financial gaps.
Entitlement and amount of sick pay: What you are entitled to
Statutory health insurance provides sickness benefit entitlement for employees and, under certain conditions, for recipients of unemployment benefit I. The amount is generally seventy per cent of gross income, but no more than ninety per cent of net income. One-off payments such as Christmas bonuses may be included in the calculation of the regular salary. The maximum benefit period for the same illness is 78 weeks within three years. A private daily sickness allowance insurance can supplement this benefit.
The role of the sick note: Avoiding gaps
A comprehensive medical determination of incapacity for work is crucial for maintaining eligibility for continued sick pay. The follow-up certificate must be issued no later than the next working day after the previous one expires. Even a one-day gap can lead to suspension of the claim. If there is an interruption of more than one month, the entire claim may be at risk. Therefore, ensure careful documentation of your sick days. The electronic certificate of incapacity for work (eAU) has greatly simplified this process for medical practices and health insurance funds since 2023.
Medical Certification: When does the inability to work officially end?
The term "gesund schreiben lassen" essentially means that the doctor no longer finds any incapacity to work. This often occurs through a final certificate on the payment slip for sick pay or the certificate of incapacity for work. There is no separate document called a "Gesundschreibung." If the doctor determines that you can work again, the sick leave and thus the entitlement to sick pay ends. This can also happen at the initiative of the Medical Service of the Health Insurance (MDK), which examines the incapacity for work. Any issues with benefit payments should be clarified promptly.
The Medical Service (MDK): Examination and Potential Conflicts
Health insurance funds can involve the MDK to check incapacity for work, often after only a few weeks. The MDK may conclude that there is no longer any incapacity for work, even if your treating doctor disagrees. You can appeal against a decision from the health insurance fund that stops sickness benefits based on an MDK assessment. Your doctor can also object to the MDK's decision and request a second evaluation. It is important to continue to have your incapacity for work certified without gaps, even during an appeals process. This ensures possible back payments for at least part of the period.
Expert Tips: Legal Framework and Articles
The central regulations regarding sickness benefit are found in the Fifth Book of the Social Code (SGB V). According to § 46 SGB V, the entitlement to sickness benefit arises on the day of medical certification of incapacity for work. The duration of the sickness benefit is limited by § 48 SGB V to a maximum of 78 weeks within three years for the same illness. The amount and calculation are regulated by § 47 SGB V. Our expert tip: In case of uncertainties or imminent cessation of sickness benefit, seek advice early. A complete documentation of all doctor visits and certificates is your best protection.
Here are some important aspects of SGB V regarding sickness benefit:
§ 44 SGB V: General entitlement to sickness benefit.
§ 46 SGB V: Arising of entitlement (medical certification).
§ 47 SGB V: Amount and calculation (70 percent gross, max. 90 percent net).
§ 48 SGB V: Duration of sickness benefit (max. 78 weeks).
§ 49 SGB V: Suspension of sickness benefit entitlement (e.g. during continued pay).
§ 50 SGB V: Exclusion of sickness benefit (e.g. when receiving a full retirement pension).
These sections form the legal basis for your rights and obligations.
After Sickness Benefit: Delisting and Reintegration
When the entitlement to sick pay ends after 78 weeks, it is referred to as 'Aussteuerung'. This does not automatically mean the end of the employment relationship. Often, there is an entitlement to unemployment benefit I according to the seamless transition rule (§ 145 SGB III) if incapacity to work continues. A phased reintegration (Hamburg model) can be an option to gradually return to working life. During this measure, you remain on sick leave and usually receive sick pay or transitional allowance. The employer's consent is required for the Hamburg model, unless it involves severely disabled employees who may be entitled to it. An occupational disability insurance can provide additional security here.
Special Case: Self-Employed and Sickness Benefit
Recommendations for emergencies
More useful links
Verband der Ersatzkassen (VDEK) provides information on sick pay benefits.
GKV-Spitzenverband supplies key figures and statistics on statutory health insurance.
Federal Ministry of Labour and Social Affairs (BMAS) provides information about the Continued Remuneration Act.
Federal Statistical Office (Destatis) supplies statistics on sickness absence.
Wikipedia offers a comprehensive article on the topic of sick pay.
Federal Ministry of Health provides information on sick pay.
German Pension Insurance informs about rehabilitation services.
Consumer Centre offers consumer advice on sick pay, including entitlement and application.
Federal Joint Committee (G-BA) provides guidelines that may also concern the area of sick pay.
Laws on the Internet offers the official legal text of § 44 SGB V, which governs the fundamental entitlement to sick pay.
FAQ
How is sickness benefit calculated?
Sick pay is usually seventy per cent of your last gross earnings, but no more than ninety per cent of your net earnings. One-off payments such as holiday or Christmas bonuses can be considered on a pro-rata basis.
What is a continuous sick note?
An uninterrupted medical certificate means that the subsequent certificate of incapacity for work is issued by a doctor no later than the next working day after the previous certificate has ended. This is crucial for the continuous receipt of sickness benefits.
Can the health insurance refuse to pay sickness benefits?
Yes, the health insurance company can refuse or stop payment, e.g., if there are doubts about the incapacity for work (often after an MDK report), the sick note has gaps, or cooperation obligations are violated.
What is the Hamburger Model?
The Hamburg Model is a gradual reintegration into the work process after a long illness. During this time, you remain on sick leave and continue to receive sick pay or a similar benefit, while gradually increasing your working hours.
Will I receive sick pay if I have been dismissed?
Yes, the entitlement to sick pay can continue to exist even after termination, provided that the incapacity for work and other conditions are still met. The basis for calculation remains generally the previous income.
What happens after the 78 weeks of sick pay?
After the cessation of sickness benefit payments (after 78 weeks), you may be eligible to apply for unemployment benefit I under certain conditions (seamlessness rule), even if you are still unable to work. Alternatively, benefits such as a disability pension may be considered.
