Definition and significance of the Medical Certificate
Ein medical certificate refers to a written statement by a licensed physician about the state of health, an illness, or its consequences for a particular person. The aim of the medical certificate is an independent, medically substantiated, and truthful ascertainment and documentation of physical or psychological facts to third parties, such as authorities, courts, employers, or insurance companies.
Medical certificates are generally relevant pieces of evidence in private, employment, and administrative contexts and are therefore subject to specific legal requirements regarding form and content.
Legal basis for the Medical Certificate
Statutory framework conditions
The legal requirements for a medical certificate are set out in various legal sources. Key provisions can be found especially:
- in the German Civil Code (BGB)
- in the Code of Civil Procedure (ZPO)
- in the Criminal Code (StGB)
- in the Code of Criminal Procedure (StPO)
- in the Social Security Code (SGB)
- in the professional codes of the State Chambers of Physicians
Obligation to issue
According to § 25 of the Model Professional Code for Physicians Practicing in Germany (MBO-Ä), physicians are obliged to issue medical certificates regarding the state of health, an illness, or its course at the request or with the explicit consent of the patient. Issuance without consent is only permitted if there is a compelling legal obligation (for example, to report certain infectious diseases under the Infection Protection Act).
Types and areas of application of the Medical Certificate
Simple medical certificate
This includes, for example, certificates of incapacity for work, attestations for proof of performance in schools or kindergartens, as well as travel certificates. They usually only confirm the presence or absence of certain health facts without detailed justification.
Qualified medical certificate or expert report
A qualified certificate goes beyond a simple attestation and provides a detailed and understandable rationale for the medical assessment. It is often intended for authorities (e.g. public health office) or courts and requires a comprehensive presentation of findings, diagnosis, the underlying examination methods, and, if applicable, an expert evaluation.
Special certificates
Other areas of application include, among others:
- Certificates of fitness (e.g. for acquiring a driving license, employment in the public sector)
- Certificates for insurance companies
- Certificates to be presented in court (e.g. in family law, criminal law)
Requirements for form and content
Minimum requirements
A medical certificate must contain the following information:
- Name, date of birth, and address of the person concerned
- Date of examination and issuance of the certificate
- Description of the examination method(s)
- Established facts and their medical assessment
- Signature and stamp of the issuing physician
The purpose of the certificate must be considered; for example, a certificate for the court must be more detailed than a certificate of incapacity for work.
Duty of truth and care
The medical certificate must be issued truthfully, with care, and to the best of the physician’s knowledge and belief. Knowingly making a false certification while acting in an official capacity or issuing an incorrect health certificate is punishable under § 278 StGB and may entail professional consequences.
Data protection and confidentiality
Consent of the person concerned
The issuance of a medical certificate generally requires the informed consent of the patient in accordance with medical confidentiality and the General Data Protection Regulation (GDPR). Forwarding the certificate to other persons or bodies is not permitted without this consent, unless there is a legal duty of disclosure or notification.
Handling sensitive health data
Medical certificates contain particularly sensitive personal data. Their transmission and storage are therefore subject to strict data protection regulations. The person concerned can generally require that only the minimum information necessary for the respective purpose is shared (principle of data minimization pursuant to Art. 5 (1)(c) GDPR).
Legal relevance and probative value
Significance in employment law
In the context of employment law, certificates of incapacity for work are the most well-known example of a medical certificate. They not only serve as proof of incapacity for work, but also entitle the employee to continued remuneration by the employer (§ 3 (1) Continued Remuneration Act).
Medical certificate as evidence in civil and criminal proceedings
In court proceedings, medical certificates can be submitted as documents. Their probative value depends on the quality and reliability of the certificate. However, courts may ex officio obtain further expert opinions if there are doubts about the accuracy or completeness.
Criminal risks in case of false certification
The incorrect issuance of a certificate may constitute the offense of issuing incorrect health certificates under § 278 StGB, punishable by up to two years imprisonment or a fine. In civil law, there is also a risk of claims for damages if a faulty certificate results in financial loss.
Special features of certain types of certificates
School and training certificates
In the public education system, medical attestations are often a prerequisite for retaking exams or classes. However, schools and universities may only require and process the minimally necessary information.
Insurance law certificates
For private and statutory insurance, certificates are often required to determine the insured event (e.g. occupational disability, invalidity). Strict requirements for completeness and disclosure of potential conflicts of interest apply here.
Fees and cost coverage
Medical certificates not required as part of statutory health care are regularly subject to fees according to the Fee Schedule for Physicians (GOÄ) and must be paid by the client. The amount of the costs depends on the scope, purpose, and effort of the assessment.
Conclusion
The medical certificate is a central document in the German legal system for the objective determination and certification of medical facts. It fulfills various functions in social, employment, administrative, and civil law and is associated with specific requirements for accuracy, care, data protection, and evidential value. Issuing such certificates entails both professional and criminal responsibility for the issuer. When using and passing on medical certificates, the underlying statutory provisions must always be observed.
Frequently asked questions
When is it mandatory to present a medical certificate in an employment relationship?
A medical certificate—commonly referred to as a “sick note”—is mandatory under German employment law pursuant to § 5 of the Continued Remuneration Act (EntgFG) if incapacity for work lasts for more than three calendar days. In this case, the employee must submit a medical certificate confirming the incapacity for work and its anticipated duration no later than the next working day. However, the employer is legally entitled to require the medical certificate from the first day of incapacity for work, without the need to provide justification. This regulatory power of the employer is confirmed by case law (for example, Federal Labour Court ruling of 14.11.2012 – 5 AZR 886/11). The format of the medical certificate is stipulated by law: it must be issued by a licensed physician and state the period of incapacity for work, but, for data protection reasons, it generally may not contain a diagnosis. Failure to submit the certificate may lead to employment law consequences, including a warning or reduction of pay.
May the employer doubt the content of a medical certificate or contact the issuing physician?
The employer may not generally question the content of the incapacity for work and certainly may not inquire about any diagnoses, because the medical certificate, as a so-called “public document” under § 416 ZPO, possesses evidential value. The employer, like the physician, is bound by medical confidentiality, which prohibits the disclosure or inquiry of sensitive health data. If the employer has doubts about the incapacity for work, they may, in accordance with § 275 SGB V, request the Medical Service of the health insurance company (MDK) to conduct a review. Direct contact with the treating physician to clarify diagnoses or details is not legally permissible and constitutes an infringement of the employee’s data protection and personal rights.
What are the legal consequences if a forged medical certificate is submitted?
Forging a medical certificate fulfills several criminal offenses, namely forgery of documents pursuant to § 267 StGB, and can also be considered fraud (§ 263 StGB) if this leads to continuation of salary payments. From an employment law perspective, submitting a forged certificate constitutes a serious breach of duty and generally entitles the employer to terminate the employment relationship extraordinarily and without notice. Any retrospective claims for continued remuneration also lapse. In terms of criminal law, prison sentences of up to five years may be imposed in extreme cases.
Is the physician obliged to issue a medical certificate on request, and can they refuse?
A physician is generally professionally and legally obliged to issue a medical certificate of incapacity for work at the patient’s request, provided that such incapacity exists and this is consistent with the current state of medical knowledge (§ 25 Model Professional Code for Physicians). However, issuance may be refused if no medically justified incapacity is found; a certificate issued as a favor is inadmissible and can have professional and criminal consequences for the physician. For certificates issued that are not based on a statutory obligation (e.g. for submission to an educational institution), physicians may charge a fee.
How long is a medical certificate legally valid and what applies in the case of prolonged illness?
A medical certificate is valid for the period specifically certified by the physician. The maximum duration of an initial certificate of incapacity for work is usually two weeks, but subsequent certificates are permitted. If incapacity for work continues beyond the certified period, a new medical examination and follow-up certificate are required at the latest on the next day to maintain entitlement to continued remuneration or sickness benefits. The obligation to provide uninterrupted proof is established by case law (Federal Labour Court ruling of 19.2.1997 – 5 AZR 83/96); interruptions may result in loss of entitlements.
What are the differences between a certificate of incapacity for work and an ordinary ‘attestation’?
Legally, the so-called certificate of incapacity for work, which is required in employment relationships under the Continued Remuneration Act, differs from other types of medical attestations, for example, those for school, university, or sports clubs. The certificate of incapacity for work is a standardized document with special legal effects (entitlement to continued remuneration, evidence for the health insurance fund), while other attestations are variable in form and content and are usually issued individually upon request of the respective recipient. Both types, however, are subject to professional and criminal requirements regarding the physician’s duty to truth.
Are the costs of the medical certificate covered, or must the employee pay themselves?
The costs for a certificate of incapacity for work, which is required by the employer according to employment law provisions, are part of statutory health care services. They are therefore generally covered by statutory health insurance. Private physicians or special attestations (e.g. for trip cancellation or sports incapacity) may, on the other hand, be subject to fees, and in this case, the charges may be billed to the patient—that is, the employee. The amount is based on the Fee Schedule for Physicians (GOÄ). The employment relationship itself typically does not provide for reimbursement of costs for private additional attestations, unless this is expressly provided for in the employment contract.
