Securing sick pay: What you need to know before you are declared fit for work
17.06.25
12
Minutes
Katrin Straub
Managing Director at nextsure
Off sick for longer and unsure about sickness benefit? Many people wonder what happens if they want or need to be signed back to work. This article explains the important steps and how to avoid financial disadvantages.
The topic in brief and concise terms
Sick pay is paid after six weeks of continued pay for a maximum of 78 weeks, provided there is uninterrupted sick note certification.
A "fit-for-work" certificate ends incapacity for work and thus entitlement to sickness benefit; the MDK can also determine this against medical advice.
Gaps in sick leave certification can lead to a loss of sickness benefit; once entitlement has been exhausted, unemployment benefit I is often possible.
Sickness Benefit and Fit Note: Understanding 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 longer than six weeks due to the same illness. During the first six weeks, your employer will usually continue to pay your wages. A formal "certificate of fitness to work" ends incapacity for work and therefore entitlement to sick pay. This transition requires care to avoid financial gaps.
Entitlement and amount of sickness benefit: What you are entitled to
Statutory insured employees are entitled to sickness benefit, and under certain conditions, recipients of unemployment benefit I are also entitled. The amount generally equals seventy per cent of gross earnings, but no more than ninety per cent of net earnings. One-off payments such as Christmas bonuses may be taken into account when calculating standard earnings. The maximum period of entitlement for the same illness is 78 weeks within three years. A private daily sickness benefit insurance can supplement this benefit.
The role of the sick note: avoiding gaps
A seamless medical certification of incapacity for work is crucial for the ongoing entitlement to sickness benefit. The follow-up certificate must be issued no later than the next working day after the previous one expires. Even a gap of one day can cause the entitlement to be suspended. If the interruption lasts more than one month, the entire entitlement may be at risk. You should therefore ensure careful documentation of your days of illness. The electronic certificate of incapacity for work (eAU) has significantly simplified this process for GP surgeries and health insurers since 2023.
Fit for work certificate: When does incapacity for work officially end?
The term "to be signed fit for work" essentially means that the doctor no longer certifies incapacity for work. This is often done by means of a final certificate on the sickness benefit payment form or the medical certificate of incapacity for work. There is no separate "fit note" document. If the doctor determines that you are able to work again, the sick note ends and with it entitlement to sickness benefit. This can also happen at the initiative of the Medical Service of the Health Insurance Funds (MDK), which reviews incapacity for work. A problem with benefit payments should be clarified immediately.
The Medical Service (MDK): Review and possible conflicts
Health insurers can involve the MDK to check incapacity for work, often after just a few weeks. The MDK may conclude that incapacity for work no longer exists, even if your treating doctor disagrees. You can lodge an objection against a decision from the health insurer that stops sickness benefit on the basis of an MDK assessment. Your doctor can also object to the MDK decision and request a second assessment. It is important to continue to have incapacity for work certified without any gaps , even during an objection procedure. This secures possible back payments for at least part of the period.
Expert tips: legal framework and sections
The key provisions on sickness benefit can be found in Book Five of the Social Code (SGB V). Under Section 46 SGB V, entitlement to sickness benefit arises on the day the inability to work is medically certified. The duration of sickness benefit is limited under Section 48 SGB V to a maximum of 78 weeks within three years for the same illness. Section 47 SGB V governs the amount and calculation. Our expert tip: if anything is unclear or sickness benefit is nearing exhaustion, seek advice early. Comprehensive documentation of all medical appointments and certificates is your best protection.
Here are some important aspects of SGB V regarding sickness benefit:
Section 44 SGB V: General entitlement to sickness benefit.
Section 46 SGB V: Arising of entitlement (medical certification).
Section 47 SGB V: Amount and calculation (70 per cent gross, max. 90 per cent net).
Section 48 SGB V: Duration of sickness benefit (max. 78 weeks).
Section 49 SGB V: Suspension of entitlement to sickness benefit (e.g. during continued payment of remuneration).
Section 50 SGB V: Exclusion of sickness benefit (e.g. when receiving a full old-age pension).
These paragraphs form the legal basis for your rights and obligations.
If entitlement to sickness benefit ends after 78 weeks, this is known as the exhaustion of benefits. This does not automatically mean the end of the employment relationship. Often, there is then entitlement to unemployment benefit I under the seamless transition rule (§ 145 SGB III) if incapacity for work continues. Gradual reintegration into work (the Hamburg model) can be an option for returning to working life step by step. During this measure, you remain signed off sick and usually continue to receive sickness benefit or transitional benefit. The employer’s consent is required for the Hamburg model, unless the employee is severely disabled, in which case they may be entitled to it. A occupational disability insurance policy can provide additional security here.
Special case for self-employed people and sickness benefit
Special rules apply to sickness benefit for the self-employed. Self-employed people with statutory health insurance usually have to take out an optional tariff with their health insurance provider in order to be entitled to sickness benefit. Alternatively, they can consider private daily sickness allowance insurance for the self-employed. The amount of sickness benefit and the start of payments (e.g. from the 43rd day of incapacity for work) depend on the tariff chosen. Early cover is particularly important for the self-employed, as they do not receive six weeks of continued pay like employees. Planning financial protection in the event of illness should therefore be a fixed part of business provision, often from the very first day of self-employment.
Recommended actions for emergencies
If you are ill for an extended period, prompt and correct action is required. Report your incapacity for work to your employer and health insurance provider without delay. Make sure your incapacity for work is continuously certified without any gaps, no later than the next working day after the previous AU expires. Collect all relevant documents, such as medical reports and AU certificates, carefully. If your health insurance provider or the MDK questions the duration of your incapacity for work, lodge an objection within the deadline and consult your doctor. Plan ahead for what happens if your sickness benefit comes to an end, for example by clarifying whether you are entitled to unemployment benefit I. A suitable daily sickness benefit insurance policy can be an important addition.
Checklist for receiving sickness benefit:
Report incapacity for work to your employer without delay (often on the first day).
Inform your health insurance provider about your incapacity for work (no later than after three days).
Ensure there are no gaps in incapacity certificates (follow-up AU on the next working day).
Submit sickness benefit payment forms to your health insurance provider in good time.
Cooperate during an MDK assessment, but protect your own rights (if necessary, lodge an objection).
If benefits are about to run out (after approx. 70 weeks), contact the Employment Agency.
Check options for a gradual return to work.
If applicable, check private supplementary insurance such as a daily sickness benefit policy without a waiting period.
These steps will help you protect your entitlements and ensure financial security. Remember: good preparation and knowing your rights are crucial, especially when it comes to being signed off sick and sickness benefit. Request an individual risk analysis now: have your insurance situation checked free of charge and receive specific suggestions for improvement.
More useful links
Association of Substitute Health Insurance Funds (VDEK) provides information on sickness benefit payments.
National Association of Statutory Health Insurance Funds provides key figures and statistics on statutory health insurance.
Federal Ministry of Labour and Social Affairs (BMAS) provides information on the Continued Remuneration Act.
Federal Statistical Office (Destatis) provides statistics on sickness absence.
Wikipedia offers a comprehensive article on sickness benefit.
Federal Ministry of Health provides information on sickness benefit.
German Pension Insurance provides information on rehabilitation benefits.
Consumer Advice Centre offers consumer advice on sickness benefit, including entitlement and application.
Federal Joint Committee (G-BA) provides guidelines that may also affect the area of sickness benefit.
Laws on the Internet provides the official legal text of Section 44 of Book V of the Social Code (SGB V), which governs the basic entitlement to sickness benefit.
FAQ
How is sickness benefit calculated?
Sickness benefit is generally 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 may be taken into account on a pro rata basis.
What is a continuous sick note?
An uninterrupted medical certificate for sick leave means that the follow-up certificate confirming incapacity for work is issued by a doctor no later than the next working day after the previous certificate ends. This is crucial for the ongoing receipt of sickness benefit.
Can the health insurance fund refuse to pay sickness benefit?
Yes, the health insurer can refuse or stop payment, e.g. if there are doubts about incapacity for work (often following an MDK assessment), if the sick note has gaps, or if duties to cooperate are breached.
What is the Hamburg model?
The Hamburg Model is a gradual return to work following a prolonged illness. During this time, you remain on sick leave and continue to receive sickness benefit or a similar payment while you gradually increase your working hours.
Can I receive sick pay if I have been dismissed?
Yes, entitlement to sickness benefit can also continue after termination, provided that incapacity for work and the other requirements continue to be met. The basis for calculation is usually the previous income.
What happens after 78 weeks of sickness benefit?
After the end of sickness benefit payments (the end of sickness benefit entitlement after 78 weeks), you may, under certain conditions, apply for unemployment benefit I (seamless transition rule), even if you are still unfit for work. Alternatively, benefits such as a reduced earning capacity pension may be considered.
