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General
What is a certificate of incapacity for work?
The medical certificate of incapacity for work, also referred to as "AU-Bescheinigung" in German, is generally the only statutory means of evidence of an employee's incapacity for work. It is issued by the employee's attending physician and contains details on the start and expected duration of the incapacity for work, as well as whether it is a first or a follow-up certificate.
Since 01.10.2021, the certificate has been digitized in stages towards an electronic certificate (eAU) and in future is to be transmitted in electronic form only to the employee's health insurer and their employer, using the "Datenaustausch elektronische Arbeitsunfähigkeitsbescheinung" process (data exchange process DTA eAU), and no longer in paper form.
Notification and evidence requirement
Notification requirement
Pursuant to Section 5 (1) Sentence 1 EFZG (German Continued Remuneration Act), the employee must notify their employer of their inability to work and the expected duration without delay. The form of the notification is hereby irrelevant. It can, for example, be done orally, by phone, via WhatsApp or email.
Evidence requirement
If the illness-related incapacity for work is longer than three days, the employee must provide a medical certificate for it, including the expected duration of their time off, in accordance with Section 5 (1) Sentence 2 EFZG. This is referred to as the "Nachweispflicht" (evidence requirement).
The certificate must be provided by the fourth day at the latest. However, the employer may request that a certificate of incapacity is presented sooner.
If the incapacity for work extends beyond the certificated period, the employee is also required to provide a new certificate.
If an employee does not provide a certificate of incapacity for work, an employer has the right to decline continued payment of remuneration until the certificate is submitted (Section 7 (1) EFZG). An exception applies if it can be demonstrated that the employee is not responsible for the delay.
With the electronic certificate, the requirement to provide evidence has largely been eliminated for employees with statutory health insurance, as the employer retrieves the certificate independently as part of the process.
Scope
Scope of the eAU certificate
The process applies for all employees with statutory health insurance. It is thereby irrelevant whether the employee has a personal membership in the statutory health insurance, but rather that they simply are insured in it. This may also be the case through other ways, such as through family insurance.
Persons in marginal employment pursuant to Section 8 SGB IV (German Social Code) also fall within the scope of the eAU, provided they have statutory health insurance.
Who is exempt from the eAU regulation?
In some areas of application, there is no retrieval option for the eAU available yet. In these cases, the employee still has to meet their evidence requirement by submitting a certificate of incapacity for work in paper form:
- Marginal employment in private households
- Employees with private health insurance
- Private medical treatment
- Treatment abroad
- Illness of the child
- Measures of preventive medical care and rehabilitation
- Employment ban under the Maternity Protection Act
- Phased reintegration
Electronic transfer
The electronic submission process
In order to ensure that the health insurer sends the eAU directly to the employer, the attending physician must first send the required information to the employee's health insurer.
Pursuant to Section 295 (1) Sentence 1 SGB V, the physicians and institutions participating in the eAU system are required to transmit all necessary data regarding the incapacity for work to the respective statutory health insurer using a secure transmission process.
However, transmission of the data does not preclude the attending physician from their obligation, pursuant to Section 109 (1) Sentence 5 SGB IV, to issue a certificate to the employee, who is also the insured person, to confirm their incapacity for work.
Once the required data on the incapacity has been received, the health insurer must create a notification to the employer for retrieval.
Contents of the eAU
What does the eAU include?
The eAU certificate that employer retrieves from the health insurer contains the following details:
- Employee name
- Start and end of the incapacity for work
- Date of the determination by the physician
- Information about whether it is a first or a follow-up certificate
- Information about whether the incapacity is due to a workplace accident or another accident or consequences thereof
In the case of an inpatient stay in hospital, the day of admission and expected duration will also be indicated.
The eAU process
Phase 1: eAU from physician to statutory health insurer
With the Terminservice- und Versorgungsgesetz (German Act on Medical Appointments and Healthcare) coming into force, physicians have been required since 01.01.2021 (with a transitional period until 01.01.2022) to transmit diagnoses electronically directly to health insurers via telematics infrastructure. Additionally, the attending physician is required to provide the insured person with a printout of the diagnosis as information about the transmitted data.
This provision applies exclusively to employees with statutory health insurance and participating contract physicians. Hospitals also participate in the eAU system if, as part of their discharge management, they determine that an insured person will be incapacitated for work for a maximum of seven days after their admission as an inpatient. The same generally applies for rehabilitation institutions, to the extent that the services provided are connected to statutory health insurance. If the service is part of pension insurance benefits, no eAU is issued and the employee still has to provide their certificate in paper form.
Note
Privately insured persons as well as private or comparable physicians abroad do not participate in the eAU process.
Phase 2: eAU from health insurer to employer
The basis for the eAU process between health insurer and employer is the "Dritte Bürokratieentlastungsgesetz" (Third Bureaucracy Relief Act), largely found in Section 109 SGB IV. Since 01.01.2023, with the eAU process, the requirement for the employee to provide evidence has largely ceased to apply, as the employer retrieves the eAU data electronically via an interface in the respective system-tested payroll accounting program that meets the requirements of Section 95b SGB IV or, for example, via the social insurance reporting portal.
From 01.01.2025, the process shall, in addition to periods for incapacity for work and
inpatient hospital stays, further include retrievals of periods of a rehabilitation or pension insurance service.
Phase 3: Successive integration of further process participants
Connecting voluntary insurance holders is being planned as a next step. It is thereby foreseen that eAU data can, in the future, be found in a patient's medical record, the implementation of which is still in progress. This would also mean that the insurance certificate is no longer a statutory requirement. The process is already planned, but there is no implementation date yet.