German Employers Stuck With Sick-Pay Costs as Presumed-Consent Organ Law and Digital Sick Notes Reshape Workplace Rules
04.06.2026 - 08:05:23 | boerse-global.de
A March 2026 ruling by the Heilbronn Labour Court has handed employers a new weapon to challenge questionable sick notes. Companies may now refuse to continue salary payments if a medical certificate loses its evidentiary value – for instance, when the duration of illness matches the exact dates of a previously rejected holiday request. In such cases, the employee must prove they were genuinely unfit to work.
The decision arrives as German businesses face mounting costs from sickness absence. Since 1 January 2026, employers in North Rhine-Westphalia can claim a supplementary payroll cost rate of roughly 58.98 percent for general illness cases under Section 6 of the Continued Payment of Wages Act (EFZG). That figure underscores the financial weight of unscheduled leave.
Meanwhile, a separate, less-publicised obligation is tightening around companies that employ organ donors. Under Section 3a of the Continued Payment of Wages Act (EntgFG), any worker who misses time to donate an organ or tissue is entitled to full salary continuation. The cost – including gross pay, social security contributions, and company pension contributions – is fully reimbursed by the health insurance fund of the organ recipient. If recovery stretches beyond six weeks, the donor receives 100 percent of their net salary as sick pay, again paid by the recipient's insurer, though capped at the contribution assessment ceiling.
These workplace rules are colliding with a broader push to boost organ donation in Germany. On 6 May 2026, the Bundestag debated introducing the so-called Widerspruchslösung – an opt-out system under which every adult is automatically considered a donor unless they actively object. Supporters argue it would dramatically increase donor numbers. Critics call it a grave intrusion into constitutionally protected self-determination.
Donation figures show cautious progress. Between January and April 2026, the German Organ Transplantation Foundation (DSO) recorded 368 postmortem organ donations nationwide, 27 more than the 341 in the same period a year earlier. In the full year 2025, 985 donors provided 3,020 transplanted organs – the highest tally since 2012. Yet roughly 8,200 people remained on waiting lists at the end of 2025. The national organ donor register currently holds about 515,000 entries, a tiny fraction of the population.
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The digital sick note – known as the elektronische Arbeitsunfähigkeitsbescheinigung (eAU) – has been standard for most employees since the start of 2026. Doctors transmit the data directly to health insurers, and employers retrieve it through payroll software. The company learns only the employee's name, the duration of absence, and whether a workplace accident occurred; the diagnosis stays confidential. However, the system is not yet fully implemented for Germany's 8.7 million privately insured individuals.
All these elements converge on the nationwide Day of Organ Donation, 6 June 2026. The number of donations is rising, but the legal framework – from the opt-out debate to employer obligations around donor leave and sick pay – remains a political minefield. The central question is not merely whether more people will donate, but how the state protects both donors and the companies that support them.
