Secureing sick pay: What you need to know before you declare yourself fit for work
17 Jun 2025
Katrin Straub
Managing Director at nextsure
Feeling unwell for an extended period and uncertain about sickness benefits? Many people wonder what happens when they wish or need to be declared fit for 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 payment of wages for a maximum of 78 weeks with continuous medical certification.
A "declaration of fitness" ends incapacity for work and thus the entitlement to sickness benefits; the Medical Service of the Health Insurance (MDK) can also determine this contrary to medical advice.
Gaps in medical certification can lead to loss of sick pay; after the end of sick pay entitlement, unemployment benefits I are often possible.
Sick pay and getting a fit note: Understanding the basics
Sick pay is a wage replacement benefit provided by the 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 salary. A formal "certificate of fitness to work" ends the period of incapacity for work and thus the entitlement to sick pay. This transition requires attention to avoid financial gaps.
Entitlement to and amount of sickness benefit: What you are entitled to
Statutory health insurance benefits are available to employees and, under certain conditions, recipients of unemployment benefit I. Generally, the amount is seventy per cent of the gross income, but no more than ninety per cent of the net income. One-off payments such as Christmas bonuses can be considered in the calculation for the regular remuneration. The maximum duration for claiming benefits for the same illness is 78 weeks within three years. A private daily sickness insurance can supplement this benefit.
The Role of the Sick Note: Avoiding Gaps
An uninterrupted medical certification of incapacity for work is crucial for maintaining the entitlement to sickness benefits. The subsequent certificate must be issued no later than the next working day after the previous one expires. Even a gap of one day can lead to the suspension of the entitlement. An interruption of more than a month can jeopardise the entire entitlement. Therefore, ensure meticulous documentation of your sick days. The electronic certificate of incapacity for work (eAU) has significantly simplified this process for doctors' practices and health insurance companies since 2023.
Fit for Work: When Does the Official Sick Leave End?
The term "gesund schreiben lassen" essentially means that the doctor no longer determines you are unable to work. This often occurs through a final certificate on the payment slip for sick pay or the disability certificate. There is no separate "Gesundschreibung" as a document. If the doctor determines that you can work again, the sick leave ends, along with the entitlement to sick pay. This can also happen at the initiative of the Medical Service of the Health Insurance (MDK), which reviews the work incapacity. Any issues with benefit payments should be clarified promptly.
Expert Tips: Legal Frameworks and Paragraphs
The central regulations on sick pay are found in the Fifth Book of the Social Code (SGB V). According to § 46 SGB V, the entitlement to sick pay arises from the day the doctor determines the inability to work. The duration of sick pay is limited by § 48 SGB V to a maximum of 78 weeks within three years for the same illness. § 47 SGB V regulates the amount and calculation. Our expert tip: In case of uncertainties or impending exhaustion of sick pay, seek advice early. Having complete documentation of all doctor's visits and certificates is your best safeguard.
Here are some important aspects of SGB V regarding sick pay:
§ 44 SGB V: Basic entitlement to sick pay.
§ 46 SGB V: Arising of entitlement (determination by a doctor).
§ 47 SGB V: Amount and calculation (70 percent gross, max. 90 percent net).
§ 48 SGB V: Duration of sick pay (max. 78 weeks).
§ 49 SGB V: Suspension of sick pay entitlement (e.g., during continued pay).
§ 50 SGB V: Exclusion of sick pay (e.g., when receiving full retirement pension).
These paragraphs form the legal basis for your entitlements and obligations.
After Sick Pay: Discharge and Reintegration
If the entitlement to sickness benefit ends after 78 weeks, it is called outplacement. This does not automatically mean the end of the employment relationship. Often, there may be entitlement to unemployment benefit I under the seamless transition rule (§ 145 SGB III) if incapacity for work continues. A gradual reintegration (Hamburg model) may be an option to return to work step by step. During this measure, you remain on sick leave and usually receive sickness benefit or transitional benefit. The employer's consent is required for the Hamburg model, unless it concerns severely disabled employees who may have a claim to it. An occupational disability insurance can provide additional security here.
Special Case: Self-Employed and Sickness Benefit
Self-employed individuals are subject to specific rules regarding statutory sick pay. Self-employed persons with statutory health insurance usually need to opt for a special tariff with their health insurance provider to be eligible for sick pay. Alternatively, they can consider a private daily sickness allowance insurance for the self-employed. The sick pay amount and the commencement of payment (e.g., from the 43rd day of incapacity for work) depend on the chosen tariff. Early financial protection is particularly important for the self-employed as they do not receive six weeks of continued pay like employees. Planning for financial security in the event of illness should therefore be an integral part of business planning, often from the very first day of self-employment.
Recommendations for Action in Case of Emergency
When you experience a long-term illness, quick and accurate action is required. Notify your employer and your health insurance company of your inability to work without delay. Pay meticulous attention to the seamless follow-up certification of your work incapacity, at the latest on the working day after the previous sick note expires. Carefully collect all relevant documents, such as medical reports and sick notes. If there are doubts about the duration of your incapacity for work by your health insurance or the medical service (MDK), lodge an appeal in good time and consult your doctor. Plan ahead for what happens after any cessation of sickness benefit, for example by clarifying entitlement to unemployment benefit I. A sensible daily sickness allowance insurance can be an important supplement.
Checklist for receiving sickness benefit:
Immediately report work incapacity to the employer (often on the first day).
Inform your health insurance about incapacity to work (no later than three days).
Ensure seamless sick notes (follow-up sick note the next working day).
Submit payment certificates for sickness benefit to the health insurance in a timely manner.
Cooperate with MDK examinations, but protect your own rights (appeal if necessary).
In case of threatened exhaustion (after about 70 weeks), contact the employment agency.
Explore options for gradual reintegration.
If applicable, review private additional insurances such as daily sickness allowance insurance without waiting time.
These steps help you safeguard your entitlements and ensure financial security. Remember: Good preparation and knowledge of your rights are crucial, especially when it comes to recovery and sickness benefit. Request an individual risk analysis now: Get your insurance situation reviewed for free and receive specific optimization suggestions.
More useful links
Verband der Ersatzkassen (VDEK) provides information on sickness benefits.
GKV-Spitzenverband provides key figures and statistics on statutory health insurance.
Bundesministerium für Arbeit und Soziales (BMAS) informs about the Continued Payment Act.
Statistisches Bundesamt (Destatis) provides statistics on sickness absence.
Wikipedia offers a comprehensive article on the topic of sickness benefits.
Bundesministerium für Gesundheit provides information on sickness benefits.
Deutsche Rentenversicherung provides information about rehabilitation services.
Verbraucherzentrale offers consumer advice on sickness benefits, including entitlements and application process.
Gemeinsamer Bundesausschuss (G-BA) provides guidelines that might also affect the area of sickness benefits.
Gesetze im Internet offers the official legal text of § 44 SGB V, which regulates the fundamental entitlement to sickness benefits.
FAQ
Wie wird das Krankengeld berechnet?
Das Krankengeld beträgt in der Regel siebzig Prozent Ihres letzten Bruttoarbeitsentgelts, jedoch nicht mehr als neunzig Prozent Ihres Nettoarbeitsentgelts. Einmalzahlungen wie Urlaubs- oder Weihnachtsgeld können anteilig berücksichtigt werden.
Was ist eine lückenlose Krankschreibung?
Eine lückenlose Krankschreibung bedeutet, dass die Folgebescheinigung der Arbeitsunfähigkeit spätestens am nächsten Werktag nach dem Ende der vorherigen Bescheinigung ärztlich ausgestellt wird. Dies ist entscheidend für den fortlaufenden Krankengeldbezug.
Kann die Krankenkasse die Zahlung von Krankengeld verweigern?
Ja, die Krankenkasse kann die Zahlung verweigern oder einstellen, z.B. wenn Zweifel an der Arbeitsunfähigkeit bestehen (oft nach MDK-Gutachten), die Krankschreibung Lücken aufweist oder Mitwirkungspflichten verletzt werden.
Was ist das Hamburger Modell?
Das Hamburger Modell ist eine stufenweise Wiedereingliederung in den Arbeitsprozess nach längerer Krankheit. Sie bleiben währenddessen krankgeschrieben und erhalten weiterhin Krankengeld oder eine ähnliche Leistung, während Sie Ihre Arbeitszeit schrittweise erhöhen.
Bekomme ich Krankengeld, wenn ich gekündigt wurde?
Ja, der Anspruch auf Krankengeld kann auch nach einer Kündigung weiterbestehen, sofern die Arbeitsunfähigkeit und die sonstigen Voraussetzungen weiterhin gegeben sind. Die Berechnungsgrundlage bleibt in der Regel das vorherige Einkommen.
Was passiert nach den 78 Wochen Krankengeld?
Nach der Aussteuerung (Ende des Krankengeldbezugs nach 78 Wochen) können Sie unter bestimmten Voraussetzungen Arbeitslosengeld I beantragen (Nahtlosigkeitsregelung), auch wenn Sie weiterhin arbeitsunfähig sind. Alternativ kommen Leistungen wie Erwerbsminderungsrente in Betracht.
