Medical certificates confirming an employee’s inability to work are a cornerstone of employment law in Germany. They entitle employees to continued salary payments during illness while providing employers with legal proof of incapacity for work. However, when such certificates are issued without an adequate medical assessment or are knowingly used despite being unjustified, the consequences can extend far beyond labour law. According to a legal analysis by attorney Dr. Johannes Fiala and actuary Dipl.-Math. Peter A. Schramm, both physicians and employees may face criminal liability under German law. The legal assessments presented in this article reflect the authors’ interpretation of the applicable legal framework.

Medical assessment must consider the employee’s actual work

Under Germany’s Directive on Incapacity for Work (Arbeitsunfähigkeits-Richtlinie – AU-RL), an employee is considered unfit for work only if a medical condition prevents them from performing their specific professional duties or if continuing to work would likely worsen their condition.
This means that physicians are required to assess not only the medical diagnosis but also the actual demands of the patient’s occupation. According to the authors, issuing a sick leave certificate without adequately considering these factors may expose the physician to legal consequences.

Criminal liability for physicians

German criminal law contains a specific offence relating to false medical certificates. Section 278 of the German Criminal Code (Strafgesetzbuch – StGB) criminalises the intentional issuance of incorrect health certificates. Conviction may result in fines or imprisonment of up to two years.
Depending on the circumstances, additional offences—such as aiding and abetting fraud—may also apply if an incorrectly issued certificate enables an employee to obtain continued salary payments without legal entitlement. Physicians may furthermore face disciplinary proceedings before their professional medical associations.
The authors note that ongoing political discussions about tightening the rules for sick leave certification could increase physicians’ responsibilities even further, particularly if personal medical examinations become mandatory in more cases.

Employees may also commit criminal offences

Employees who knowingly submit an incorrect medical certificate in order to receive continued remuneration during illness may likewise be subject to criminal prosecution.
Possible offences include fraud (Section 263 StGB) as well as the use of incorrect health certificates (Section 270 StGB). According to the authors, criminal liability is not limited to situations where an employee actively deceives the physician. It may also arise where the employee is aware that the certificate was issued without the legally required medical examination or assessment.

Labour law and criminal law intersect

In practice, disputes involving questionable sick leave certificates are typically addressed through labour law measures such as warnings or dismissal. Criminal proceedings remain comparatively rare.
The authors argue, however, that German criminal law already provides a sufficient legal basis for prosecution where the statutory requirements are met. Employers and insurance companies may file criminal complaints if there is reasonable suspicion that a false certificate has been issued or knowingly used. They suggest that more consistent enforcement could have a significant preventive effect.

Public officials face particularly severe consequences

For German civil servants (Beamte), the consequences may be even more serious.
In addition to criminal liability, disciplinary proceedings can lead to dismissal from public service. Depending on the circumstances, this may result in the loss of civil servant status and significant pension entitlements. Under German law, certain criminal convictions carrying a prison sentence of at least one year automatically terminate the civil servant relationship.

Debate over stricter certification rules

The issue has gained additional political attention through discussions about reforming Germany’s sick leave system. Proposed measures include requiring an in-person medical examination from the first day of illness and limiting the use of telephone consultations for issuing sick leave certificates.
According to the authors, such reforms could tighten the standards governing medical certification. However, they emphasise that the relevant criminal provisions—particularly Sections 263, 270 and 278 of the German Criminal Code—already apply under current law, regardless of whether future legislative reforms are adopted.

Prevention and compliance

For employers, the issue is increasingly becoming one of compliance and fraud prevention rather than merely employment law. The authors recommend that companies clearly communicate the potential criminal consequences of submitting false medical certificates. Likewise, physicians should refuse so-called “courtesy” sick leave certificates and inform patients about the possible legal repercussions.

Conclusion

Medical certificates confirming incapacity for work are not merely administrative documents; they carry significant legal consequences for everyone involved. Where certificates are issued without an adequate medical basis or knowingly misused, criminal investigations may follow in addition to employment-related sanctions.
As Germany debates stricter certification rules, employers, physicians and employees alike should remain aware of the legal standards governing sick leave. According to the legal analysis by Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm, existing criminal law already provides a comprehensive framework for addressing fraudulent medical certificates, irrespective of any future legislative reforms.