Germany Faces Record Sick Leave Levels in 2025

AOK’s latest report reveals Germany’s sickness absences remain at record levels, largely fueled by respiratory and psychological illnesses among employees.

The rate of employee sick leave in Germany is holding at historically high levels, according to a new analysis by one of the country’s largest health insurers. The AOK (Allgemeine Ortskrankenkasse) – which insures about 27 million people (nearly one-third of Germany’s population) including roughly 15 million workers – reports that illness-related absences among its insured employees reached record numbers in 2024 and are on track to remain elevated in 2025. Respiratory infections continue to be the leading cause of sick leave, while mental health-related absences are also on the rise. Experts note that changes in how sick leave is reported have contributed to the high figures, and they caution against misinterpreting the statistics as a sign of widespread malingering. Here is an in-depth look at the findings and their context, in a Q&A format:

How often are employees calling in sick on average?

In 2024, each AOK-insured employee was absent due to illness an average of 2.3 times over the year, according to the insurer’s new Fehlzeiten-Report 2025 (Absence Report). This corresponds to 228 documented cases of sick leave per 100 insured members in 2024 – the highest rate ever recorded. It slightly exceeded the previous record of 225 per 100 set in 2023. By comparison, before the COVID-19 pandemic, the annual average was significantly lower: between 2014 and 2021 there were only about 160 sick leave cases per 100 insured per year on average. This means the documented incidence of employees calling in sick has jumped roughly 40% compared to pre-pandemic years.

These figures are based on AOK’s insured workforce (around 15 million employees in Germany) and indicate a notable surge in recorded sickness absences. It’s important to note that AOK is a major public health insurance provider, so its data provide a substantial sample of the German working population. Other German insurers have reported similar trends, suggesting a broad increase in sickness rates across the country in recent years.

What illnesses are driving the high sick leave rate?

Respiratory infections – such as common colds, bronchitis, influenza, and COVID-19 – are the primary drivers of the elevated sick leave numbers. In 2024, respiratory ailments accounted for roughly 82 out of every 100 sick leave cases among AOK-insured workers. According to the AOK report, the period from September 2024 to March 2025 saw new peak levels of respiratory illness, with waves of colds, flu, and COVID-19 infections leading to more than one-third of all work absences. Health experts suggest that an increased susceptibility in the population after the pandemic years may be contributing to these surges in infections. The so-called “immunity gap” left by reduced exposure to viruses during lockdowns could be making seasonal outbreaks more intense, resulting in more workers falling ill.

The second most common cause of sick leave is musculoskeletal disorders – such as back pain or other orthopedic issues – which accounted for about 40 cases per 100 insured in 2024. In third place are mental health conditions (like depression, anxiety, or burnout), with approximately 14 cases per 100 insured. While psychological illnesses are a smaller share of total sick notes in terms of frequency, their impact is significant and growing. The incidence of recorded mental health-related absences has been rising steadily over the past decade. AOK notes that days lost due to psychological conditions have increased by 43% in the last ten years.

To put these numbers in perspective, here are the top causes of sickness absences among AOK-insured employees in 2024:

How long do sick leaves usually last, and which illnesses keep people out the longest?

On average, respiratory illness absences are relatively short. A routine case of cold or flu tended to keep workers home for about 5.9 days on average in 2024. These common infections, while numerous, usually result in under a week off work for recovery.

In contrast, mental health-related absences tend to be much longer. When employees took leave for psychological or psychiatric conditions, those absences lasted an average of 28.5 days per case – nearly a month per incident. This means that although mental health issues are reported less frequently than colds or musculoskeletal problems, they account for a disproportionately large share of total lost work days due to their longer duration. “The long absences caused by psychological illnesses have become a long-term driver of overall sick leave levels,” explained Helmut Schröder, head of the AOK’s research institute, noting that diagnoses of mental illness have been rising for years.

Musculoskeletal issues generally fall in between those extremes: they are a common cause of sick leave and can sometimes lead to extended recovery periods, depending on severity (for example, severe back pain or orthopedic surgery might sideline someone for multiple weeks).

In summary, respiratory illnesses happen most often but are usually brief, whereas mental health conditions happen less often but tend to require much longer recovery, contributing significantly to the total volume of lost work time.

Is the high number of sick reports a sign that people are less healthy – or just calling in sick more easily?

The data show more recorded sick leave cases than ever, but this does not necessarily mean Germans have become significantly less healthy or more prone to illness overnight. Experts caution that part of the increase is due to changes in reporting and behavior, rather than a sudden decline in health.

One major factor is the introduction of electronic sick notes. Since 2022, Germany has implemented a system where doctors digitally transmit sick leave certificates directly to the patient’s health insurer, rather than relying on the patient to forward a paper note. This Electronic Sick Leave system ( elektronische Krankmeldung or eAU) means that every doctor-certified absence is now automatically counted. AOK’s data indicate that the switch to e-notifications has led to more complete reporting of all instances of sick leave, capturing many short absences that previously might have gone unrecorded. “An important influence on the high numbers is very likely the introduction of electronic sick notes, which has led to a more complete tracking of absences,” said Helmut Schröder of AOK’s Scientific Institute. In the past, if an employee was only out sick for a day or two, they might not have bothered to mail the doctor’s note to their insurer, meaning the absence wasn’t counted in insurance statistics. Now, with automatic digital reporting, those cases are included. Not coincidentally, the number of documented sick leaves jumped sharply from 2021 to 2022, the period when electronic reporting became mandatory for physicians.

Beyond the statistical effect of better reporting, there are genuine health-related reasons for the high sick leave rates. The ebb and flow of infectious disease outbreaks plays a big role. The year 2022 and especially 2023–2024 saw strong waves of influenza and other respiratory viruses as pandemic restrictions eased, and those waves are reflected in higher sick absences. AOK notes that multiple “wave-like” viral outbreaks have occurred, including COVID-19 and seasonal colds/flus, which drove up sick leave numbers in late 2024 and again in late 2025. Some researchers have posited that reduced exposures during 2020–2021 led to an “immunity debt” – leaving populations with less immune defense against common viruses – resulting in more intense illness waves once people resumed normal contact. This could help explain why February 2025 saw an all-time high in respiratory cases, and why another surge in colds, flu, and COVID cases was observed starting in September 2025.

In short, the record-high sick leave figures are partly a statistical artifact of improved reporting and partly due to genuine increases in illnesses circulating in the post-pandemic period. They do not necessarily mean workers are “lazier” or broadly less willing to work – a conclusion that experts say would be misguided without further evidence.

Is allowing sick notes by telephone contributing to the rise?

During the COVID-19 pandemic, Germany introduced the option for patients with mild respiratory symptoms to obtain a sick leave certificate via a telephone consultation, without an in-person doctor visit. This measure was intended to reduce contagion risk and has been extended in some form up to the present. Some critics have speculated that this easier process might encourage more people to take sick leave (even when not truly ill). However, AOK’s analysis finds no evidence that telephone sick notes are driving the increase in sickness reports.

According to AOK data, only about 1.5% of all respiratory-related sick leave cases in 2024 were issued through a phone consultation. Helmut Schröder of AOK’s research institute explained it in concrete terms: out of an estimated 26.4 million respiratory illness cases among AOK-covered workers in 2024, only around 145,000 were certified by phone. “This small proportion cannot explain the sharp rise in total sick leave cases,” Schröder noted. In other words, the vast majority of sick notes are still obtained via traditional doctor visits, so the convenience of phone certification has had a negligible impact on the overall statistics.

How are sick leave trends looking for 2025?

Early indicators suggest that 2025 will likely end with sickness absence levels comparable to 2024, according to AOK’s projections. In the first quarter of 2025, Germany saw extremely high rates of respiratory illness: February 2025 marked a new peak in respiratory-related absences. From spring into summer 2025, the monthly sick leave figures eased slightly compared to the same period in 2024 (as some of the winter virus surge subsided). However, by the autumn of 2025, another upswing in cold, flu, and COVID-19 cases was underway, contributing to a renewed rise in sick leaves since September.

Overall, AOK predicts that when all of 2025 is tallied, the total number of sick leave cases will be on par with the very high level of the previous year (2024). In practical terms, this means German workplaces have been experiencing unusually high absenteeism for two years in a row, largely due to back-to-back severe respiratory infection seasons. Employers are bracing for continued disruptions during the winter months as these illness waves run their course.

On a positive note, workforce health surveys show some improvements in areas unrelated to infection. The AOK report included a long-term survey of employees’ self-reported well-being and work-related stress. Interestingly, these measures have improved in 2023–2025 compared to the height of the pandemic. “After employee surveys showed significantly higher values for psychological burdens during the pandemic years, the levels for issues like exhaustion, anger or sadness are now back to pre-pandemic levels,” said Schröder. In particular, fewer workers report trouble mentally “switching off” after work. In 2025, only about 18% of employees said they struggle to relax after the workday, down from 31% who reported that difficulty in 2022. Likewise, the share of workers who ruminate about work problems during off-hours dropped from 40% in 2022 to 25% in 2025. These trends suggest that as the acute crisis of the pandemic has receded, employees are feeling less psychological strain from their jobs than they did a few years ago. In the long run, lower chronic stress and burnout could have a positive effect on overall health – potentially counterbalancing some of the upward pressure on sick leave rates.

What are experts and officials suggesting to address the high sick leave rates?

The surge in sick leave has prompted debate in Germany about possible policy responses, but health experts urge caution about quick fixes. Some employer groups and physician associations have floated proposals to adjust sick leave rules. For instance, the national association of physicians (KBV) recently suggested requiring a doctor’s note only from the 4th or 5th day of illness (instead of the current rule, which typically requires a medical certificate after 3 days) to reduce unnecessary doctor visits for minor colds. On the other side, some employers have called for introducing a “waiting day” (Karenztag) – meaning the first day of sickness would be unpaid – to disincentivize frivolous sick reports.

However, AOK officials strongly oppose such measures, arguing they would do little to improve the situation. “Scrapping the option of telephone sick notes is not a suitable measure to address the high sick leave levels, nor is introducing an unpaid first sick day,” asserted Carola Reimann, chair of the AOK Bundesverband. “Rather, what matters are healthy working conditions and a good corporate and leadership culture,” Reimann said. In other words, the focus should be on preventive health and workplace well-being – ensuring employees are not overworked or exposed to undue stress and contagion – rather than on restricting access to sick leave.

Health experts tend to agree that encouraging people to stay home when they are genuinely ill is important for public health (to prevent spreading disease at work) and that addressing root causes like workplace stress, insufficient staffing, or inadequate ventilation may be more effective in reducing sick leave than punitive measures. The data showing improved psychological well-being in 2025 is a hopeful sign that attention to work-life balance and mental health could be paying off.

In summary, Germany is experiencing an unusually high rate of employee sick leave, driven largely by waves of respiratory infections and an upward trend in mental health absences. While the raw numbers are record-setting, part of the rise is due to more comprehensive reporting through electronic sick notes. The AOK’s findings have sparked discussions on how to maintain a healthy workforce. For now, experts emphasize improving workplace health and continuing to monitor illness trends, especially as the country navigates the latest flu and COVID season. The situation is being closely watched as businesses and policymakers seek a balance between supporting employee health and maintaining productivity in the face of ongoing viral challenges.

Sources: aok.de tagesspiegel.de stern.de