Federal Health Minister Warken wants to stop online sick notes without doctor contact

The background to the debate is the health insurance reform passed the previous week by the Bundestag and Bundesrat. It provides, among other things, that employees must present a doctor's sick note from the first day of illness. Until now, the obligation to provide a sick note only applied from the fourth day of illness. According to the government, the reform is to achieve savings of around 19 billion euros in the statutory health insurance system.

Reform and obligation to provide a sick note from day one

Warken defended the reform on the programme. At the same time, she said she would personally have preferred waiting days ("Karenztage"), meaning a loss of earnings on the first day of illness. "Wahrscheinlich wäre das dann auch die ehrlichere Maßnahme gewesen", she said. The minister stressed that employers can already today require their employees to provide a sick note from the first day.

Berlin-Neukölln general practitioner Sibylle Katzenstein sharply criticised the rule on sick notes from day one. She called it "reine Symbolpolitik" that "einfach nur Ärger" makes. She also warned against cutting psychotherapy: "Psychotherapie zu kürzen, ist wahrscheinlich langfristig eher teurer für das Gesundheitssystem". The reform plans to budget psychotherapeutic services and cap the volume covered by statutory health insurance.

Criticism from the opposition and from family doctors

Criticism also came from the opposition. Green politician Ricarda Lang called the reform a "Kürzungskahlschlag". She described the obligation to provide a sick note from day one as a "Bullshit-Idee". Referring to Chancellor Friedrich Merz, Lang said his trademark was "das Misstrauen gegen Beschäftigte". Addressing Warken, she demanded: "Lassen Sie es einfach sein!". Lang was also critical of the planned budgeting of psychotherapy: "Wenn ich weniger Therapiestunden bezahle, wird es weniger Therapiestunden geben".

Speaking for the health insurers was Jens Baas, CEO of Techniker Krankenkasse. He described the savings package as "das erste Sparpaket seit langer, langer Zeit", but spoke only of "erster Hilfe" and called for further-reaching "Therapie für das Gesundheitssystem". An expert commission appointed by the government had calculated in the spring a savings potential of 42 billion euros in the statutory health insurance system and presented a corresponding package of measures.

Legal situation regarding online sick notes

On the question of legal consequences, the law firm Sausen Rechtsanwälte pointed out in December 2025 that online sick notes without proper medical contact are legally worthless. Employees who submit such improperly issued certificates risk losing their entitlement to continued pay and summary dismissal. The Hamm Regional Labour Court also dealt with the issue on 5 September 2025 (case number 14 SLa 145/25).

During the programme, the high number of sick days was also discussed. According to a calculation by the AOK Science Institute (WIdO), 3.3 percent of sick notes related to long-term illnesses, but these accounted for 40 percent of sick days. Gelsenkirchen doctor Willi Mast explained that the comparatively high number of sick days was mainly due to long-term illnesses such as depression, exhaustion, cancer and spinal conditions. The Deutsches Ärzteblatt (issue 14/26) points out, however, that there is no complete survey of sick days either in Germany or in comparable industrialised countries.

Data basis and sick days

Melanie Amann, digital editor-in-chief of the Funke central newsroom, put a direct question to the minister during the discussion: "Wie tief sitzt diese Obsession, was ist da los mit diesem Mann, diese Besessenheit mit den Fehlzeiten?" – thereby referring to Chancellor Merz. Warken herself had warned in April in an interview with the RedaktionsNetzwerk Deutschland (RND) against implementing only parts of the expert commission's proposals, as this could "das ganze Konstrukt ins Wanken" bringen. For the coalition, she stressed that it was important to preserve the "Grundideen" of the commission.

The programme also discussed who should bear the cost of illness for citizens' benefit recipients and how many health insurers there should be in future. In the coalition agreement, CDU/CSU and SPD had agreed to exclude online sick notes issued by "obskure Plattformen im Internet". Warken also announced that she would continue to defend the abolition of sick notes issued by telephone.

Open questions and next steps

The programme also drew attention to a structural effect: since 2022, sick days have been recorded much more accurately through the electronic certificate of incapacity for work, leading to sharply rising statistics. In the coming weeks, Warken will present concrete draft laws to put the announced stop on online sick notes without doctor contact.

Speaking to RND, Warken also explained that the funding gap for the coming year had been closed by the reform. At the same time, she stressed: "Niemand muss bei Krankheit zwingend in die Arztpraxis" – the video consultation remains a recognised alternative.