Healthy living Gradual integration – a phased return to work

The aim of gradual reintegration is to support people returning to work after an extended illness or an accident. This approach is often also referred to as a phased return to work or the “Hamburg model”. With gradual reintegration, the employee's working hours are increased incrementally so that the employee has a chance to re-acclimatize to their work duties and to daily working life.

A phased approach to reintegration into working life is legally enshrined in the German Social Code. If an employee wants this approach to be used and it is medically justified and has a reasonable chance of success, employers can only refuse the request in exceptional cases. Employees with a severe disability have a legal entitlement to gradual reintegration.

Gradual reintegration can be initiated as a stand-alone measure or as part of a workplace integration management program (WIM for short, or “BEM” in German). The goal of workplace integration management is to foster and maintain employees’ ability to work.

A number of prerequisites apply to gradual reintegration. Firstly, you must remain on sick leave during reintegration, as you are still officially deemed to be unfit for work. At the same time, you must be able to take on a partial workload, for example, be able to complete certain tasks and be able to work for a small number of hours each day. The minimum number of hours to be worked is 2 per day.

The medical practice where you are being treated must certify that you are able for a partial return to work. The tasks assigned to you must be temporarily adapted to suit your current capabilities. In addition, your doctor must be of the view that you will be able to return to work in a full capacity in the long term. 

The reintegration plan must be agreed to in writing by all parties involved, i.e. the employer, employee and rehabilitation funding agency. Participating in a reintegration process is always voluntary for employees. 

Once you have been on sick leave for 6 weeks, your doctor must assess whether gradual integration may be an option for you. Gradual reintegration is also theoretically possible after a shorter period of illness. However, reintegration measures are not normally initiated until an employee has been on sick leave for at least 6 weeks.

The phased plan is the key document in any phased return to work. The plan is developed by the employee’s doctor in consultation with the employee and employer. It is reviewed on a regular basis. The plan specifies how the employee is to return to work on a phased basis.

The plan includes the following elements:

• the start and end date
• the gradual increase in daily working hours
• the tasks and scope of work to be undertaken during each phase
• the tasks and activities that are to be avoided 
• the rights of both parties to withdraw from the plan
• any additional measures that could serve to ease the return to work

A typical plan could be as follows: The employee begins by working two hours daily, which is later increased to four hours and subsequently to six hours per day. The number of hours to be worked and the points at which this can be increased in the next phase depends on the capacity of the individual employee. Phased plans are flexible and can be adjusted at any stage. 

In addition, the type of work involved and the working hours must also be taken into account, in particular if certain stress triggers – such as a wide range of responsibilities or shift work – have contributed to the employee becoming ill in the first place. For example, the plan may specify that the employee is not to work any night shifts initially or that certain tasks are to be the responsibility of other team members for the time being. In cases like this, a workplace integration management program may also be helpful.

A phased return to work can be initiated in various ways, for example, by:

• the employee’s doctor, for example, their family doctor 
• medical personnel in a rehab clinic – if the phased return to work follows a period of medical rehabilitation
• the employer
• the relevant funding agencies, such as statutory health insurance funds, pension funds or accident insurance funds
• the employee

After your doctor has created a phased plan in consultation with you and your employer and the plan has been communicated to the relevant funding agency, you will receive commencement notification for your return to work. This notification will be sent by the relevant funding agency.

The notification specifies, for example, the start date for your phased return to work and the phases that are included in the phased plan. Commencement notifications must be signed by your doctor and employer and returned to the relevant funding agency. The commencement notification serves as an official application for a phased return to work. There is no need to submit a separate application yourself.

Once the gradual reintegration process has begun, the employee will receive monthly follow-up certificates from the funding agency. These must be signed by the employer and doctor and returned to the funding agency. This is essential in order for the employee to continue receiving the relevant benefits, such as sickness benefit. The funding agency will send a final certificate once the gradual reintegration process has been completed.

If you need any help with your application, support is available from the social services team at your rehab facility, social associations or centers offering complementary independent participation counseling (EUTB).

Is it possible to interrupt gradual reintegration?

A gradual reintegration process can be interrupted for a period of up to 7 calendar days. This may be necessary if, for example, the employee’s health deteriorates during their reintegration. If the process is interrupted for more than 7 calendar days, it is deemed to have been discontinued. However, the employee is still registered as unfit for work and is still entitled to benefits to replace their earnings.

The topic of annual leave must also be considered in the context of gradual reintegration. During a phased return to work, the employee cannot take any days of annual leave because there is no entitlement to annual leave while on sick leave. This means that no days of annual leave can be taken until the gradual reintegration process has been completed.

What happens if reintegration is discontinued?

There are various reasons why gradual reintegration may be discontinued. For example:

• The employee's health deteriorates.
• It is no longer viable for the company to facilitate working with reduced hours and a reduced workload. 
• The employee’s health improves to the extent that the gradual reintegration process can end earlier than planned.

If a gradual reintegration process fails, a new phased return to work can begin at a later point in time. In this case, it may be necessary to adjust the gradual integration process to ensure better support for the employee’s return to work.

During the first six weeks of sick leave, the employer continues to pay the employee’s wages. After this period, the employee is entitled to benefits to replace their earnings. This entitlement continues during a phased return to work, as the employee remains on sick leave throughout the process. Various funding agencies may be responsible, depending on the individual situation:

• Health insurance fund: The health insurance fund normally pays sickness benefit. For people with statutory health insurance, this amounts to approximately 70 percent of gross income, up to a maximum of 90 percent of net income. Sickness benefit is paid for a maximum of 78 weeks within a three-year period. For people with private health insurance, the amount and duration of sickness benefit are determined by the terms of the individual insurance policy.
• Pension insurance: If gradual reintegration occurs following rehabilitation, the pension insurance fund usually pays transition benefit (“Übergangsgeld”). This typically amounts to 68 percent of net income or 75 percent for employees with children. 
• Accident insurance: If the employee has a recognized occupational disease or has had a work-related accident, injury benefit is usually paid by the accident insurance fund. This amounts to 80 percent of gross income but must not exceed regular net income.

Employers can also choose to pay part of the employee’s salary during the reintegration period but the employee is not legally entitled to this. The portion of the salary that is voluntarily paid is offset against the relevant earnings replacement benefit. The phased plan for reintegration specifies the financial agreements in a clear and transparent manner.

You will find detailed information about gradual reintegration on the following websites:

The Federal Association for Rehabilitation (BAR) offers an extensive hands-on guide to gradual reintegration, as well as various real-life examples and links to important forms (all in German).

The Federal Institute for Occupational Safety and Health (BAuA) provides a fact sheet about gradual reintegration in German and English.