Gradual return to work after illness: how the Hamburg model works

What is a gradual return to work (Hamburg model)?

In a gradual return to work, you go back to your previous job, but initially work only part of the time and increase your hours step by step. "Hamburg model" is another name for the same procedure.

Sec. 74 SGB V governs the side of the health insurance fund: if, according to a doctor's finding, you as an insured person who is unfit for work can partially carry out your previous work, and a step-by-step resumption is likely to help you back into working life, the doctor should state the type and extent of the possible activities on the certificate of incapacity for work. Sec. 44 SGB IX extends this to all rehabilitation providers (Rehabilitationsträger), i.e. also to the pension insurance and the accident insurance.

The decisive point: during the gradual return to work, you are not signed fit, but are still unfit for work. The Federal Labour Court regards it as a legal relationship of its own kind, which does not serve the exchange of work for wages but your recovery. The full duty to work and full pay are suspended during this time (BAG, 8 AZR 530/17, para. 21).

Requirements: when is a gradual return to work possible?

• You are signed off sick as unfit for work.
• After an examination, your doctor finds that you can partially carry out your previous work (Sec. 74 sentence 1 SGB V; Sec. 7 (1) of the Incapacity for Work Guideline of the Federal Joint Committee (Gemeinsamer Bundesausschuss), Arbeitsunfähigkeits-Richtlinie, AU-Richtlinie for short).
• It can be expected that the step-by-step return will help you find your way back into working life.
• You and your employer agree.

From when? The law does not prescribe a minimum length of illness. However, from six weeks of incapacity for work at the latest, your doctor must check with every sick note whether a gradual return to work is possible (Sec. 74 sentence 2 SGB V; Sec. 7 (2) AU-Richtlinie). The German Pension Insurance generally considers it unnecessary if you will in any case be fully fit for work again within 4 weeks (DRV, work instructions on Sec. 44 SGB IX).

When not? The doctor refrains from recommending it if taking part could harm your health or if you refuse it (Sec. 7 (3) AU-Richtlinie). At workplaces to which the Ordinance on Occupational Health Care (Verordnung zur arbeitsmedizinischen Vorsorge) applies, the company doctor (Betriebsarzt) must in principle also consent (Annex no. 4 AU-Richtlinie).

Part-time: A gradual return to work is also possible in part-time employment. It ends when you can fully manage your contractual part-time hours again (DRV, work instructions on Sec. 44 SGB IX).

The gradual return to work in 6 steps

1. Initiative: Usually from your doctor, after rehabilitation from the clinic. You can also raise it yourself.
2. Step-by-step plan: The treating doctor draws it up with you and your employer. It sets the daily working time for each stage and the activities you can carry out or must avoid (Annex no. 8 AU-Richtlinie).
3. Consent: You declare your consent on the form. If your employer refuses, it should also certify this there.
4. Start notification: The health insurance fund or the German Pension Insurance sends you a start notification (Beginnmitteilung), which the doctor and the employer sign. According to gesund.bund.de, the Federal Government's health portal, it counts as the application.
5. Stages: Your doctor examines you regularly and adjusts the plan (Annex no. 5 AU-Richtlinie). Each month, you submit a follow-up certificate so that the money keeps coming.
6. Completion: Once you manage the last stage, you are fit for work again. If you recover faster, the gradual return to work ends earlier.

After rehabilitation, the clinic plans the gradual return to work while you are still there, and the German Pension Insurance continues to pay transitional benefit until the end (Sec. 71 (5) SGB IX). Under its rules, the gradual return to work must begin within 4 weeks (28 days) after the rehabilitation, and you must actually take up your job within this period; health or operational reasons do not extend the period (DRV, work instructions on Sec. 44 SGB IX).

How far in advance must you apply? There is no statutory lead time. However, hand in the step-by-step plan early. In the Federal Labour Court case, only two weeks lay between receipt of the plan and the planned start; that was not enough to dispel the employer's well-founded doubts in time (BAG, 8 AZR 530/17, para. 41).

How many hours do you work? The step-by-step plan

There is no statutory number of hours. It is usual to start with at least 2 hours a day (gesund.bund.de). For its gradual returns to work, the German Pension Insurance requires 2 hours per working day as the lower limit, and less in justified individual cases such as severe mental illness (DRV, work instructions on Sec. 44 SGB IX).

The step-by-step plan states the start and expected end, the working time for each stage, your tasks, strains you must avoid (such as night shifts or heavy lifting) and both sides' rights to withdraw. Your doctor sets the hours; you and your employer agree on when they are worked. Your employer must not use you beyond the medical requirements.

This is what a step-by-step plan can look like (example; your doctor sets the stages individually):

Week	Working time per day	Note
1 and 2	2 hours	simple tasks
3 and 4	4 hours	first core tasks
5 and 6	6 hours	almost all tasks, strenuous activities still excluded under the plan
from 7	full working time	gradual return to work completed

The plan is flexible: longer or skipped stages and a share of working from home are possible if the doctor and the business agree (gesund.bund.de).

How long does it last? The law sets no limit. Under the AU-Richtlinie, the phase should not normally exceed six months (Annex no. 1); the German Pension Insurance names four to eight weeks as usual. Extensions must be agreed with everyone involved.

Money during the gradual return to work: who pays?

Because you are still unfit for work, you do not in principle receive wages for the hours, but a wage replacement benefit.

Your situation	Benefit	Who pays	Amount	Legal basis
first 6 weeks of incapacity for work	continued pay	employer	pay as before	Sec. 3 (1) EntgFG
after that, with statutory health insurance	sickness benefit	health insurance fund	70% of regular pay, at most 90% of net pay	Sec. 44, 47 SGB V
directly after rehabilitation funded by the German Pension Insurance	transitional benefit	German Pension Insurance	68% of the calculation basis, with a child 75%	Sec. 66, 71 (5) SGB IX
after an accident at work or occupational disease	injury benefit (Verletztengeld)	employers' liability insurance association (Berufsgenossenschaft)	80% of regular pay, at most net pay	Sec. 45, 47 SGB VII

If the gradual return to work begins within the first six weeks, your employer pays continued pay for this period (DRV, form G0832). How the six weeks are counted where there are several illnesses is explained in our guide on continued pay during illness.

Sample calculation of sickness benefit: You earn €3,500 gross, assumed net pay €2,300 a month. Sickness benefit is calculated per calendar day, and a month counts as 30 days (Sec. 47 (1) sentences 6 and 7, (2) sentence 3 SGB V).

• 70% of €116.67 gross per day = €81.67
• Upper limit: 90% of €76.67 net per day = €69.00
• The lower amount applies: €69.00 per day, i.e. €2,070 for 30 days.

Your contributions to pension, unemployment and long-term care insurance are still deducted from this. One-off payments are not taken into account in the example.

Transitional benefit: The 68 or 75% refer to a calculation basis of 80% of your regular pay, at most your net pay (Sec. 66 (1) SGB IX), not directly to your net pay. As long as you receive transitional benefit, sickness benefit is suspended (Sec. 49 (1) no. 3 SGB V).

Does the employer pay anything on top? It does not have to, but it may. However, voluntary partial wages are set off: sickness benefit is suspended to the extent that you receive pay subject to contributions (Sec. 49 (1) no. 1 SGB V), and for transitional benefit the net pay is set off (DRV, form G0832). Partial wages only bring you more money if they exceed the replacement benefit.

Maximum duration of sickness benefit: For the same illness, sickness benefit is paid for at most 78 weeks within three years (Sec. 48 (1) SGB V). The gradual return to work counts towards this, including periods in which sickness benefit is suspended because of partial wages (Sec. 48 (3) SGB V).

Travel costs: For a gradual return to work through the German Pension Insurance, travel costs can be reimbursed on application if you would otherwise bear an exceptional burden, by car at €0.20 per kilometre (DRV, form G0832).

What does the employment agency pay? As a rule, nothing during an ongoing gradual return to work. The employment agency (Agentur für Arbeit) becomes important when sickness benefit ends after 78 weeks (Sec. 145 SGB III); even then, the German Pension Insurance considers a gradual return to work possible in an employment that has not been terminated (DRV, work instructions on Sec. 44 SGB IX). If you later become unemployed, periods of the gradual return to work are disregarded when your unemployment benefit is assessed (Sec. 150 (2) sentence 1 no. 1a SGB III).

Does the employer have to agree to the gradual return to work?

Yes, and it may refuse. The employment contract does not give you a right to your employer's participation. The relationship of a gradual return to work only arises by agreement, and it is voluntary for both sides (BAG, 8 AZR 530/17, para. 21). A BEM does not give you a right to be employed under a gradual return plan either (para. 44). If the employer declares that it cannot employ you, the gradual return to work cannot be carried out (Annex no. 6 AU-Richtlinie). You then remain signed off sick.

Exception: severe disability or equal status. Severely disabled people are entitled to employment in which they can make the fullest possible use of their abilities, and to a disability-appropriate design of the workplace, work organisation and working time (Sec. 164 (4) sentence 1 SGB IX). This can give rise to a duty to employ you in accordance with the step-by-step plan (BAG, 8 AZR 530/17, headnote and para. 22, still on the predecessor provision with the same content, Sec. 81 (4) SGB IX). This requires a medical certificate stating the type of employment, restrictions, working time, duration and a prognosis of when you are expected to be able to work fully again (para. 23).

The employer may also refuse in that case if the employment is unreasonable for it (Sec. 164 (4) sentence 3 SGB IX) or if there are well-founded doubts that the gradual return to work could harm your health. In the case decided, there was a current assessment by the company doctor which the treating doctor's plan did not address (paras. 31 to 36). So have your doctor address such objections in the plan.

Illness, holiday, days off: what applies during the gradual return to work?

How many days may you be absent? Under the rules of the German Pension Insurance, the gradual return to work may be interrupted for health or operational reasons for up to 7 days each time, also several times; the interruptions are not added together. If one lasts longer, the gradual return to work is deemed to have been discontinued from the first day of the interruption. In exceptional health cases, the period may be exceeded if the end is in sight and success can still be achieved (DRV, work instructions on Sec. 44 SGB IX). gesund.bund.de names the same limit of 7 calendar days in general terms. Report every absence immediately and have it certified by a doctor.

Taking a day off? The gradual return to work does not provide for days off at your request; the days in the step-by-step plan apply. If your child is ill, release from work of up to 7 days with a medical certificate is possible in gradual returns to work through the German Pension Insurance.

Holiday: Annual leave is not possible during the gradual return to work, because it requires continuous incapacity for work. If you take holiday anyway, it is deemed to have ended under the rules of the German Pension Insurance (DRV, form G0832 and work instructions on Sec. 44 SGB IX). Your holiday entitlement is not lost as a result. You take it once you are fit for work again; there is no statutory "holiday ban" afterwards, and your employer sets the timing taking your wishes into account (Sec. 7 (1) BUrlG). If the employment ends, outstanding holiday must be paid in lieu (Sec. 7 (4) BUrlG), see remaining holiday on dismissal.

Company holidays (Betriebsferien) count as an operational interruption. The German Pension Insurance only accepts more than 7 days because of public holidays falling in a particular way, for example over the turn of the year. So plan the start to avoid long company holidays.

Discontinuing or refusing the gradual return to work: what happens then?

Discontinuing: You, your doctor, your employer and the funding body may discontinue it if circumstances change (DRV, form G0832). If your health deteriorates, the doctor must adjust or discontinue the plan (Annex no. 5 AU-Richtlinie). After that, you remain signed off sick and receive sickness benefit for as long as the entitlement lasts. Transitional benefit from the German Pension Insurance ceases if the gradual return is discontinued because of an interruption that lasted too long, from its first day; in that case, contact your health insurance fund (DRV, form G0832). A new attempt with a new step-by-step plan is possible later. If you can no longer manage your previous work in the long term, the doctor must inform the health insurance fund (Annex no. 5 AU-Richtlinie).

Refusing: For you, the gradual return to work is voluntary. If you refuse, the doctor refrains from recommending it (Sec. 7 (3) AU-Richtlinie) and you remain signed off sick until you can work fully again. Sec. 74 SGB V does not provide for any direct disadvantages for sickness benefit. In a later dismissal for illness, however, it may play a role whether you made use of milder means that were offered.

Advantages and disadvantages for employees

Advantages	Disadvantages
step by step instead of full strain at once	sickness benefit or transitional benefit instead of full salary
the doctor and the plan protect against overload, discontinuation possible at any time	no holiday during the measure
contact with the team and tasks continues, the job remains yours	absences of more than 7 days can end the measure
no wage costs for the employer, which makes its consent easier	the time counts towards the 78 weeks of sickness benefit
later assessment of unemployment benefit is not reduced (Sec. 150 (2) sentence 1 no. 1a SGB III)	no right to the employer's participation without a severe disability or equal status

Gradual return to work and BEM: the difference

Your employer must offer return-to-work management (betriebliches Eingliederungsmanagement, BEM) if, within one year, you were unfit for work or partially unfit for work for more than six weeks either continuously or repeatedly (Sec. 167 (2) SGB IX). A gradual return to work can be its result, but is a separate instrument.

Feature	BEM	Gradual return to work
Legal basis	Sec. 167 (2) SGB IX	Sec. 74 SGB V, Sec. 44 SGB IX
Who initiates it	the employer, which must offer it	usually the doctor, on the certificate of incapacity for work
Aim	clarify causes, find measures, keep the job	step-by-step return with increasing hours
Your status	fit or unfit for work	still unfit for work
Voluntary	yes, for you	yes, for you and the employer, exception for severe disability or equal status

How the BEM works and what you have to say there is explained in our guide on the return-to-work meeting.

Dismissal during the gradual return to work

There is no special protection against dismissal for this period. However, if the Protection Against Dismissal Act (Kündigungsschutzgesetz, KSchG) applies to you, your employer needs a reason; in dismissals for illness, the courts ask, among other things, whether there were milder means. If you are severely disabled or have equal status, it additionally needs the prior consent of the Integration Office (Integrationsamt, the authority responsible for severely disabled employees) (Sec. 168 SGB IX).

To challenge a dismissal, you must file a claim within three weeks of receipt; otherwise it is in almost all cases deemed valid (Sec. 4, 7 KSchG). More in our guides on dismissal during sick leave, dismissal due to illness and the deadline for an unfair dismissal claim.

New from 2028: partial incapacity for work

From 1 January 2028, there is a second model (Sec. 44c SGB V, inserted by Art. 1 no. 17 of the Act on Stabilising Statutory Health Insurance Contribution Rates, GKV-Beitragssatzstabilisierungsgesetz, Federal Law Gazette 2026 I no. 228, in force under Art. 8 (3)). If it is foreseeable that you will be unfit for work for more than four weeks, your doctor can, with your consent, certify partial incapacity for work (Teilarbeitsunfähigkeit) of 25, 50 or 75 percent of your weekly working hours. If your employer agrees, you work the remaining part.

The difference from the gradual return to work: your employer must pay proportionate wages for the work done (Sec. 44c (4) SGB V); for the rest, there is proportionate continued pay and after that partial sickness benefit (Sec. 44c (7), Sec. 44 (1a) SGB V). The employer must respond within seven calendar days; if it remains silent, you are treated as fully unfit for work (Sec. 44c (2), (3) SGB V). The details are governed by the Federal Joint Committee (Sec. 44c (6) SGB V). Until the end of 2027, the gradual return to work remains the route for a step-by-step return.

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