Nearly All German Workers Have Clocked In While Sick, Study Reveals as Government Pushes Tighter Sick-Note Rules

More than 95 percent of German employees say they have worked despite being ill at least once, new survey data shows, just as the federal government moves to tighten requirements for medical proof of illness. The push for a mandatory sick note from day one has sparked a fierce debate over whether the cure could be worse than the disease.

A nationwide survey conducted in June 2026 found that 95.2 percent of employed respondents had gone to work while sick at least once. In a separate analysis by the Austrian Chamber of Labour for Upper Austria, 72 percent of workers said they had worked while ill in the previous year alone — more than double the 30 percent recorded in 2015. The 50-percent threshold was crossed in 2020.

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The phenomenon, known as presenteeism, is particularly acute in certain sectors. Temporary staffing agencies recorded an average of 21 sick-leave days per employee, while postal and courier services reported 20.7 days. The BKK national association of company health insurers put the average sickness rate for 2025 at 5.83 percent. Since 2016, mental-health related absences have risen by more than 50 percent.

These figures form the backdrop to a reform package being steered by Health Minister Nina Warken (CDU) and Labour Minister Hubertus Heil (SPD). The centrepiece is a requirement that employees obtain a doctor’s note from the very first day of illness — a rule that currently only applies after three days for most workers. At the same time, telephone sick notes, which allow a doctor to certify incapacity without a physical visit, would be abolished. Online sick notes without any personal contact with a physician are also targeted; Warken’s ministry views them as already legally problematic and, in some cases, grounds for summary dismissal. Video consultations, however, would remain permissible as a legitimate form of medical contact.

Workers’ representatives and public-health experts have pushed back hard. A labour scientist described the planned reform as “not evidence-based,” warning that forcing patients into doctors’ surgeries could actually lengthen sick leaves because physicians typically issue certificates covering several days after an in-person consultation. The German Trade Union Confederation (DGB) stressed that illness is not a disciplinary issue and noted that telephone sick notes account for only 0.8 to 1.2 percent of all incapacity certificates. Legal experts from an international law firm pointed out that if a mandatory day-one note is introduced, works councils have co-determination rights that must be respected.

Practical objections have also been raised. Exceptions would be needed for weekend workers, shift schedules, and rural areas with few doctors. Employers, meanwhile, retain the right to withhold continued wage payments if a required certificate is not produced.

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The political drive comes amid widespread fear among employees. Over 74 percent of survey respondents reported negative reactions from their supervisors when they called in sick. High justification pressure and the worry of career disadvantages were cited as the main reasons for working while ill.

Other elements in the reform package

Alongside the sick-note changes, the cabinet is planning a sugar tax on sweetened beverages, with projected annual revenue of around €650 million earmarked for the healthcare system. Further provisions would extend fixed-term employment without a specific reason to up to 48 months, with as many as six renewals. By September 1, 2029, digital doctor referrals are to be rolled out nationwide to reduce administrative burdens in practices.

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