Sick notes are at record levels – that’s what’s behind it

The number of sick notes in Germany remains at a record level. This is reported by the Federal Association of General Local Health Insurance Funds (AOK) in its “Absence Report 2025”, which evaluates the downtime of employees insured by the AOK. Around 27 million people are insured with the AOK health insurance companies – that’s almost one in three residents.

According to the report, every AOK insured person was absent due to illness an average of 2.3 times last year. The statistics for 2024 show exactly 228 cases of incapacity for work per 100 members. The previous high of 225 cases from 2023 was once again slightly exceeded. The AOK reports that a similarly high level of sickness is also expected for the current year 2025.

The main reason for the high number of sick notes are respiratory diseases. According to AOK, these reached new highs between September 2024 and March 2025 and are responsible for more than one in three failures. According to the fund, the infection rate could still be favored by increased susceptibility as a result of the Corona years.

However, it is not possible to determine from the figures whether the bottom line is that employees are really sick more than before. An “important influencing factor” for the higher number of days absent from work is “most likely the introduction of electronic sickness notification,” says Helmut Schröder, head of the AOK Scientific Institute. Since 2022, doctors have been reporting sick notes electronically directly to the health insurance companies, and at the same time the numbers have risen sharply. It can be assumed that many employees, especially shorter illnesses, simply did not submit them to the health insurance fund in the past, explains Schröder.

The high number of sick notes has recently triggered repeated political debates. The National Association of Statutory Health Insurance Physicians (KBV) has just demanded that employees only have to submit a sick note from the fourth or fifth day of illness. This is intended to relieve the burden on doctors because fewer patients with minor illnesses would come to the practice. The employers’ association BDA has rejected the claim. Sick leave is currently required for absences of more than three days, but employers can also request this earlier.

The AOK does not see the possibility of registering sick by telephone as the cause of the increased number of sick reports. This is possible for up to five days for mild infections. Of all sick notes due to respiratory diseases in 2024, just 1.5 percent were initiated by telephone. This small proportion cannot explain the sharp increase in cases.

The abolition of telephone sick leave is therefore not a suitable measure to change the high level of sickness, says Carola Reimann, head of the AOK federal association. The same applies to the introduction of an unpaid first day of sickness at the expense of employees, as was discussed in public some time ago. What is more important is healthy working conditions and a good corporate and management culture.

And something else is important with regard to illness and absenteeism: Although respiratory diseases are by far the most common illnesses, with an average of 5.9 days of absence, the downtime is also shorter than with other illnesses. Mental illnesses, for example, occur much less frequently than colds, but lead to an average of 28.5 days lost per case. “Long absences due to mental illnesses are also a long-term driver of overall sick leave,” says Schröder. Diagnoses of mental illnesses have been steadily increasing for years.