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Do you really need to see a doctor to stay off work in Germany?

In Germany, workplaces require employees to provide a sick note from a GP when they are ill. But do you really need to visit a doctor for the certificate? A court case is raising these questions.

Do you really need to see a doctor to stay off work in Germany?
Should you have to visit a doctor to stay off work in Germany? Photo: DPA

The process of getting a Krankschreibung (doctor's note) signed by a GP when you are off sick from work is under the spotlight after watchdogs questioned the validity of a service that delivers sick notes without a medical examination and via Whatsapp.

Last year Hamburg startup AU-Schein started offering people who have a short-term illness, such as a cold, menstrual pain, back pain or a migraine, the chance to buy a sick note without actually visiting a GP.

Users can fill out an online form on the company's website and answer a comprehensive set of questions about their symptoms. They are then connected with a doctor via the messaging service WhatsApp.

If the doctor is satisfied that the person is sick, they will issue a sick note that allows the patient to take paid leave from work.

The online certificate costs around €14 or the user can pay €5 extra to receive it by post. The certificate is “100 percent valid,” says the company, and is issued by a private doctor. 

However, the Centre for Protection against Unfair Competition (Wettbewerbszentrale) has launched legal action against the startup in a bid to prevent employees from being able to get a medical certificate in this way.

READ ALSO: How Germany plans to ditch paper sick notes for digital ones

The Centre filed a test case at the Regional Court in Hamburg at the beginning of October, Spiegel reported.

“This type of sick leave deceives both the employee and the employer,” said Christiane Köber, a lawyer at the Wettbewerbszentrale.

An 'Arbeitsunfähigkeitsbescheinigung', or sick note, which the employee submits to their employer after receiving it from a doctor. Photo: DPA

According to the Centre for Protection against Unfair Competition, the system is easy to manipulate. During a test, two employees on sick leave who used the service didn't even have to talk to a doctor on the phone but were still given the signed sick note, the Centre said.

The watchdog believes the startup's statement that it gives a “100 percent valid certificate” to be misleading.

Why? Because it gives the impression that the sick note applied for fulfils all legal requirements for a certificate of incapacity for work. This may formally be the case, but the Centre said it is “doubted by a number of lawyers”.

“The law prescribes high standards for an employee's certificate of incapacity for work,” says Köber. It could be that in a legal dispute with an employer, an 'online sicknote' is not considered sufficient – and the employee could bear the damage.

In addition, the startup advertises remote treatment, which the Centre argues is a violation of the law.

The founder of AU-Schein.de, Can Ansay, defended his startup. “We issue legally valid certificates with the original signature of a doctor,” Ansay told Spiegel. “These sick notes do not differ from medical certificates issued during a doctor's visit.”

In a previous interview, Ansay said the AU-Schein doctor is based in Lübeck and issues around 80 certificates a day. The company advertises online that it has already issued more than 20,000 sick certificates.

“People who pull sickies are not the problem,” Ansay said at the time. “It is more problematic when employees come to work while sick and infect others there.”

When do I need a doctor's note to stay off work in Germany?

If you’ve decided to stay off work, firstly you need to give your boss a Krankmeldung (notification of sickness) before the start of work on the first day. Legally, you need to have informed your employer that you're sick before your start time – otherwise you are breaking the terms of your contract.

READ ALSO: The 10 rules you need to know if you get sick in Germany

After three days of being off work you are legally required to get a a Arbeitsunfähigkeitsbescheinigung (incapacity for work certificate) known as a Krankschreibung, gelbe Schein or AU-Schein from a GP. 

However, in many workplaces, the Krankschreibung is needed sooner – sometimes on the first day of sickness.

To get this sick note, you have to make an appointment with a GP, explain your symptoms and the doctor will decide if it's right for you to stay off work and for how long. After you have the signed note, you can then pass this onto your employer.

Isn't there an easier way?

Well, that's why AU-Schein set up their business.

READ ALSO: Don't use new Whatsapp sick note service, German doctors advise

The startup took advantage of a law passed last year that loosened the ban on doctors assessing patients without actually being in the same room as them.

The relaxation of the so-called Fernbehandlungsverbot (ban on remote treatment) was meant to provide a reliable alternative to “doctor Google” for people who would rather research their symptoms online than go to a doctor.

Photo: DPA

But AU-Schein believed the change in the law had other applications and decided to launch a startup which reduces bureaucracy and streamlines the process.

However, some medical associations have accused the service of attempting to make money on people's desire to pull sickies.

Does visiting a doctor every time you're off work put pressure on the German health system?

Yes, we imagine so. According to a recent health report by OECD, Germans consult doctors in the outpatient sector more frequently than people in most other countries.

The report also found that although Germany has a high availability of doctors and nurses (there are 4.3 practising physicians – OECD average is 3.5 – and 12.9 nurses – OECD average is 8.8 – per 1,000 population), medics are under a lot of stress.

With 255 hospital discharges per 1,000 people, Germany has the highest rate of inpatient activity among all OECD countries – more than 60 percent above the OECD average.

There are also regional differences and rural areas in Germany are less well served. When it comes to doctors, Germany has a relatively low and decreasing proportion of GPs who “play a key role in addressing the needs of an ageing population,” the report said.

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WORKING IN GERMANY

7 tips for how to survive as a freelancer in Germany

Taking the decision to go it alone and freelance in Germany can be a daunting prospect. But, if you do it right, it can be an exciting and liberating path. Here are some of our top tips on how to survive.

7 tips for how to survive as a freelancer in Germany

1. Get a tax advisor

The German tax system is complicated, even for Germans. All the associated paperwork uses the Amtsprache (authority language) which is more like legalese than ‘normal’ German, and mistakes when filling out tax forms can cause you, at best, a massive headache and, at worst, a costly fine. So it’s best that you employ someone who knows what they’re doing to help you out.

That person is called a Steuerberater (tax advisor) in Germany. They will help you register with the tax office, correspond with them and submit your tax declarations.

Be aware that, in Germany, different deadlines apply for tax returns depending on whether you employ an official tax advisor or not. If you are doing the tax return on your own, the deadline for submitting your annual tax return is earlier than if you use a tax advisor’s services. 

READ ALSO: What NOT to do when you’re freelancing in Germany

When looking for a tax advisor, a top tip is to use your network to get recommendations. Ideally, you want someone who will do more than just fill in the forms for you, but who will actually advise you on how best to manage your business finances so that you can make tax savings.

2. Keep your accounting in order

The better you keep your own accounts in order, the easier it will be for your tax advisor to compile your tax declarations and therefore the cheaper their services will be.

As a freelancer, there are a lot of costs you can deduct from your taxes – from train tickets, working materials, to meals out – so it’s best to keep hold of all your receipts and to keep them in good order.

2 euros and 50 cents lie on a receipt in a beer garden. Photo: picture alliance/dpa | Peter Kneffel

In Germany, you’re obliged to keep hold of receipts for two years, in case of a tax inspection, so it’s a good idea to photocopy the type of machine-printed receipts you get from restaurants so that they stay legible for a long time.

There are also a few things to be aware of when writing your own invoices. Firstly, make sure that you include your tax number. This isn’t the 11-digit Steueridentifikationsnummer that everyone gets when registering in Germany, but the 10-digit Steuernummer you get from the Finanzamt after registering yourself as a freelancer. 

Most companies won’t pay you if you don’t have this on your invoices so make sure you include it.

You should also make sure that you number your invoices properly – ideally in ascending order so that you can easily keep track of them. You are not allowed to issue two invoices with the same number and if you do so and the finance office notices, you could face an inspection of your whole accounting system.

There are numerous great accounting software programmes you can use to help you, such as Lexoffice and Sevdesk and, even if you have to pay for them, the costs will be tax deductible!

3. Find out if you’re eligible for financial support

In Germany, there are several opportunities for freelancers to gain financial support and to cut their outgoings, and its worth finding out if you’re eligible for them.

If you’re claiming unemployment benefits under ALG 1 and are thinking about becoming a freelancer, the employment office offers a special type of financial support to help you to get your freelance business off the ground.

Called the Grundungszuschuss (“foundation grant”) the payment is a six-month grant equalling your monthly entitlement under ALG 1 plus €300 towards your insurance costs can be applied for those in receipt of this unemployment benefit.

READ ALSO: Will freelancers benefit from Germany’s €300 energy allowance?

If you are engaged in some form of artistic profession in Germany – which can include journalism to pottery – you may be entitled to membership to the Kunstlersozialkasse (artists’ social insurance).

Being a member of the KSK means you only have to pay half of your health insurance and pension contributions, and the KSK will pay the rest.

4. Work out how much you think you will earn

As with starting any business, you need to have some idea of your expected earnings from the outset.

If you’re just starting out as a freelancer, or have some freelance gigs on the side of an employment position, then it might be worth considering registering yourself as a Kleinunternehmer (“small business”).

As a Kleinunternehmer, you can currently earn up to €22.000 per year without having to charge VAT and having to submit only yearly tax declarations. 

An income tax declaration form lies on a table. Photo: picture alliance/dpa/dpa-Zentralbild | Hans-Jürgen Wiedl

Be aware that if you are registered as this kind of freelancer, you must include the following sentence in your invoices: ‘Gemäß § 19 UStG wird keine Umsatzsteuer berechnet’ which means ‘In accordance with Paragrah19 of the German VAT law, no VAT has been added to this invoice.’

READ ALSO: Everything you need to know about your German tax return in 2022

If you think you will earn more than €22.000 per year, you will need to pay Umsatzsteuer (VAT) and will have to submit tax declarations in advance and more often. Depending on how much you earn, this could be every month or every quarter. 

5. Get your insurance in order

In Germany, it’s a legal requirement to have health insurance.

If you’ve just made the move from employment to being a freelancer and want to keep the same health insurer, you should get in contact with your health insurance provider straight away to tell them about your change of circumstances. They will ask you to re-register and to tell them your projected freelance earnings for the year, so they can amend your monthly fees.

If you don’t keep your health insurer provider updated, you could continue to be charged the higher rate that you had from your previous salary.

The insurance cards of the health insurance companies DAK, AOK, Barmer and Techniker-Krankenkasse TK lie with euro notes under a stethoscope. Photo: picture alliance / dpa | Daniel Karmann

It’s not just health insurance you need to think about as a freelancer. It’s also wise to think about protecting yourself from any sort of claims that could arise as a result of any working mishaps. 

If, for example, you lose your laptop which contains confidential client information, you need to be protected against claims.

That’s why it’s good to have both Betriebshaftversicherung (business liability insurance) and Rechtschutzversicherung (legal protection insurance).

6. Plan your time wisely

All of these bureaucratic obligations take time. So it’s really important that you take account of that when planning your time. For example, planning half a day a week to deal with your invoices, filing, emails to clients, and conversations with authorities can be really beneficial when scheduling your working time. 

7. Grow your network

As a freelancer, networking is absolutely crucial to success. 

Keep an up-to-date profile on websites like LinkedIn and German equivalent XING and keep in contact with anyone you’ve ever worked with, no matter how brief the contact was. 

Having a network is not only about getting more clients, but also about building a support network in your field to exchange advice, tips and generally for your own enrichment. 

Participating in workshops related to your field, going to seminars, and meet-ups, can be great ways of broadening your network. 

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