German Employees Face Rising Pressure to Justify Sick Leave Amidst New Attest Rule

A striking new survey reveals that almost three-quarters of German workers feel compelled to defend themselves when they call in sick. The Civey poll of 2,000 employed individuals, conducted in June 2026, found that 72 percent must justify their absence to their employer. Among those aged 18 to 29, the figure jumps to over 82 percent. The findings emerge as Health Minister Nina Warken (CDU) pushes forward a controversial reform requiring a doctor’s certificate from the very first day of illness.

The proposed policy would scrap the telephone-based sick note — known as the telefonische Arbeitsunfähigkeitsbescheinigung (AU) — which was introduced in recent years to reduce the burden on medical practices. Warken insists that a direct in-person or video consultation with a physician will again be mandatory. Video-attestations conducted during a formal video appointment will remain permissible, but the minister has vowed to crack down on online platforms that issue sick notes via questionnaire without any personal or visual doctor contact. Such practices are already illegal under current law, Warken stressed, adding that an improperly issued AU can justify summary dismissal. She cited a September 2025 ruling by the Hamm Regional Labour Court (LAG Hamm) that backs this legal stance.

The survey also underscores a deep-rooted culture of presenteeism. Roughly 95 percent of respondents have worked while ill at least once, and nearly 65 percent fear professional disadvantages if they take sick leave too often. Labour lawyers point out that reporting sick is a legitimate right and that employees are not required to disclose their diagnosis.

The planned reform has drawn sharp criticism from both researchers and unions. Professor Dr Hans Martin Hasselhorn, an occupational scientist, argues that the mandatory doctor’s note from day one lacks an evidence base. He warns that the requirement could lead to longer absences, because doctors in a practice visit often issue certificates covering several days. The pressure to show up sick — what Hasselhorn terms presenteeism — carries long-term health risks. Statistics from 2020 to 2023 show that telephone sick notes accounted for only 0.8 to 1.2 percent of all cases. The German Trade Union Federation (DGB) rejects the tightening, calling it a sign of distrust toward employees. Instead, the DGB demands better working conditions. Notably, the average sickness absence in 2024 stood at 14.8 days — a slight decline for the first time since 2017.

Warken plans to coordinate the reform with Labour Minister Bärbel Bas (SPD). The goal, she says, is a solution that balances employer interests with the capacity of medical practices. As part of the broader health policy package, the government also intends to introduce a sugar tax on sweetened beverages from 2027, projected to raise around €650 million annually to support health insurance funds or ease the federal budget.

Parallel to these measures, the cabinet is pushing digitalisation forward. By 1 September 2029, digital doctor referrals are to be rolled out nationwide, a move expected to simplify bureaucratic workflows in practices. Critics, however, argue that the new attest rule would undermine that digital momentum by forcing patients back into crowded waiting rooms.

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