Germany’s sick leave culture differs sharply from most countries. Understanding the system — the AU-Bescheinigung (sick note), when you must get one, and how long your employer must pay you — prevents both missed obligations and missed entitlements.
The First Three Days Rule
In Germany, most employment contracts require a doctor’s sick note from the fourth day of illness onward. Many contracts require one from the first day. Check your Arbeitsvertrag (employment contract) for the exact wording. If it says “ab dem ersten Krankheitstag,” you need a note on day one. When in doubt, go to the doctor. A Hausarzt can issue a Krankschreibung for 1–5 days per visit; longer illnesses require follow-up appointments.
Electronic Sick Note (eAU)
Since January 2023, the AU-Bescheinigung is entirely electronic. You still visit the doctor, but instead of a paper certificate, the Kassenärztliche Vereinigung (KV) transmits the data directly to your health insurer and your employer digitally. You don’t hand anything to your employer. However, you should still inform your employer that you’re ill — by phone, email, or WhatsApp on the first day of absence, before work starts if possible.
Entgeltfortzahlung (Continued Pay)
For the first six weeks of any illness, your employer must pay your full salary (Entgeltfortzahlung). This applies to each new illness, not per year — so two separate illnesses, six weeks each, each earns full pay. After six weeks, your health insurer (GKV) pays Krankengeld (sick pay) at 70% of gross salary, up to a ceiling, for up to 78 weeks within a three-year period.
What Counts as a New Illness
If the same illness returns after at least 6 months of recovery, it resets as a new illness with a fresh six-week paid period. A different illness starts its own counter regardless. Your employer cannot dismiss you purely because of illness during this protection period — doing so constitutes wrongful termination.
Mental Health Sick Leaves
Burnout, depression, and anxiety disorders can be certified as illnesses — your Hausarzt or a psychiatrist issues the AU. Mental health sick leaves follow the same legal protections as physical illness. Since the introduction of eAU, the visible stigma of presenting a paper certificate is removed. Usage of mental health sick notes has increased 40% since 2020.
