Germany’s Mandatory Day-One Doctor’s Note Draws Fire as Coalition Partners Quarrel Over Details

Germany's black-red coalition enacts day-one sick note rule, removing grace period and phone options, triggering fierce opposition from doctors, insurers, and even SPD allies.

A sweeping reform package approved by Germany’s black-red coalition government has ignited a political firestorm, with its flagship measure—a requirement for employees to submit a medical certificate starting from the first day of illness—already facing pushback from senior members of the ruling alliance.

The new rule, which took immediate effect, scrapped the previous four-day grace period. Under the old system, workers only needed a doctor’s note by the fourth consecutive sick day. The change also eliminates the option of a purely telephone-based sick note, a pandemic-era convenience that had been kept in place. Health Minister Warken touted video consultations as the alternative.

Alongside the sick-note overhaul, the government tightened criminal law. §278 of the penal code now imposes stricter penalties for issuing false certificates of incapacity for work, a move intended to curb abuse.

Chancellor Merz defended the hard line, pointing to high sickness rates. The DAK health insurance fund put the average number of sick days per insured person at 19.5 in 2025—a figure Merz called a competitive disadvantage.

Doctors, Insurers, and Even the SPD Cry Foul

Reaction was swift and hostile. The German Association of General Practitioners called the decision “catastrophic” and warned of a bureaucratic deluge. The National Association of Statutory Health Insurance Physicians (KBV) added: “It is irresponsible to force sick people into practices just to fill out paperwork.”

Health insurers joined the protest. The DAK’s CEO warned of overflowing waiting rooms and noted that phone sick notes accounted for only 0.8 to 1.2 percent of all illness reports, suggesting the real drivers of high absenteeism were electronic sick-note (eAU) processing and waves of infections.

Within a day of the decree, leading Social Democrat figures tried to row back. Party leader Klingbeil insisted: “The precise details remain open. No one will be forced to physically visit a practice when ill.” He described the day-one attest requirement as the “lesser evil” compared with unpaid waiting days.

Labour Minister Bas announced a review of the reform’s impact. Legal experts pointed out that retroactive sick notes for up to three days remain possible, which could ease the pressure on patients.

A Silver Lining: Partial Sick Certificates

Health Minister Warken is pushing ahead with plans for partial sick notes. Employees could be certified as 25, 50, or 75 percent unfit for work, enabling a phased return to the workplace.

The Broader Reform Package

The coalition’s omnibus bill extends well beyond sick notes:

• Tax relief: €10 billion from 2027/2028, primarily targeting families.
• Tax rates: The top rate stays at 42 percent; the wealth tax rises in tiers (45 percent from €250,000, 47 percent from €280,000).
• Pensions: The retirement age is set to rise beyond 67; early retirement after 45 contribution years will be abolished.
• Employment law: Fixed-term contracts without cause can now last up to 48 months with up to six renewals.

The government expects the measures to slash health insurance fund spending by €16.3 billion in 2027. A formal bill has yet to be drafted. Companies can deviate from the day-one sick-note requirement through collective bargaining agreements.