The phased return to work (known in Germany as the Hamburger Modell or Hamburg Model) enables employees to return to the workplace after a prolonged illness in gradual steps – starting with reduced working hours that are incrementally increased according to a jointly agreed plan. The legal basis in Germany is §74 SGB V (Book V of the Social Security Code); participation is voluntary for employers, but represents an important rehabilitation right for the employee concerned. Throughout the measure, employees typically continue to receive sickness benefit (Krankengeld) or transitional allowance (Übergangsgeld) – not a regular wage.
What Is a Return-to-Work Programme?
A return-to-work programme describes the process by which employees gradually re-integrate into working life after a prolonged illness. Under German law, this most commonly refers to the phased return to work under §74 SGB V – colloquially known as the Hamburg Model, named after the city where it was first applied systematically.
The goal is not an immediate return to full workload, but a carefully dosed reintegration: in the early stages, employees work only a few hours per day, with working time increasing progressively according to a pre-agreed plan. The aim is to prevent a premature or abrupt return from triggering a relapse or renewed incapacity for work.
Important: Throughout the entire return-to-work programme, the employee formally remains on sick leave (incapacity for work, Arbeitsunfähigkeit). They are therefore still officially signed off sick – and accordingly receive no wage from the employer, but benefits from the statutory health insurance fund or pension insurance.
Legal Framework
§74 SGB V – Phased Return to Work
The phased return to work is governed by §74 of Book V of the German Social Security Code (Sozialgesetzbuch V, SGB V). According to §74 SGB V, insured persons who are unable to resume their previous work in full immediately after an illness should be reintegrated step by step – provided the treating physician considers this medically appropriate.
The measure is initiated by the attending physician, who draws up a return-to-work plan signed by all parties involved: the employee, the employer, and, where applicable, the health insurance fund.
Key point for HR: Employer participation is voluntary. There is no statutory obligation to agree to a phased return. However, a refusal may be viewed negatively in any subsequent unfair dismissal proceedings.
§167 SGB IX – Company Integration Management (BEM): A Critical Distinction
The phased return to work is frequently confused with Company Integration Management (Betriebliches Eingliederungsmanagement, BEM) under §167 SGB IX. These are, however, two legally separate instruments:
Both instruments can be combined and complement each other well. In practice, it is advisable to raise the option of a phased return during the BEM conversation.
The Hamburg Model – Step-by-Step Process
Prerequisites and Application
For a phased return to work to take place, the following conditions must be met:
- The employee remains officially on sick leave (incapacitated for work).
- The treating physician considers the measure medically appropriate.
- The employer agrees to participate.
- The relevant health insurance fund or pension insurance provider is involved.
The return-to-work plan is drawn up by the treating physician together with the employee. The plan sets out the start date, planned duration, the step-by-step increase in working hours, and a description of permitted activities. All parties sign the plan.
Typical Schedule
No fixed duration is prescribed by law; the timeline is determined by the nature and severity of the illness. A common example for an 8-week plan:
In practice, return-to-work programmes often last between 4 and 26 weeks. An extension is possible based on the physician's assessment. The measure can be discontinued at any time – by the employee or by the treating physician.
Pay During the Return-to-Work Programme
Who Pays What?
The question of pay is central for HR professionals. The answer is clear: during a phased return to work, there is no entitlement to wages from the employer, since the employee formally remains incapacitated for work.
Note: Employers may voluntarily supplement the sickness benefit payment – but there is no legal requirement to do so.
The Role of Health Insurance and Pension Insurance
The health insurance fund pays sickness benefit for a maximum of 78 weeks within a three-year period (for the same illness). The phased return to work does not interrupt this period. Once the sickness benefit entitlement is exhausted, the pension insurance may take over the measure as a rehabilitation benefit and pay transitional allowance.
HR professionals should clarify at an early stage which funding body is responsible – ideally in coordination with the employee concerned and their health insurance fund.
Return to Work After Mental Health Conditions
Mental health conditions – particularly burnout, depression and anxiety disorders – are one of the most frequent causes of long-term sickness absence in Germany. According to the AOK Absence Report 2024 (AOK Federal Association / WIdO), mental health conditions account for a disproportionately high share of sick days.
When managing a return to work following mental illness, HR professionals should bear the following points in mind:
- Pace: The return should begin especially gradually. Even 2 hours per day may initially be challenging.
- Task design: Start with low-stress, clearly structured tasks; avoid social overwhelm.
- Confidentiality: The diagnosis is private. Colleagues and line managers should only be told what the individual explicitly wishes to share.
- Psychological support: Therapeutic accompaniment alongside the return-to-work programme is strongly recommended and should be actively encouraged where possible.
- Employee Assistance Programme (EAP): Companies with an EAP can point the individual to this confidential support offer.
- No stigmatisation: A respectful, non-judgmental attitude within the team is critical to a sustainable return.
Return to work after mental health conditions requires more sensitivity than after physical illness – but can be equally successful when all parties act with care and patience.
Checklist for HR Managers (8 Steps)
A structured approach significantly increases the likelihood of a successful return to work:
- Make early contact – Once an employee has been absent for an extended period, reach out proactively (but not intrusively); signal openness to a conversation.
- Offer BEM – From 6 weeks' sick leave within 12 months, offering a BEM process is a legal obligation (§167 SGB IX). The possibility of a phased return can be raised during the BEM discussion.
- Request the physician's return-to-work plan – The initiative comes from the treating physician; HR coordinates the operational implementation.
- Clarify the funding body – Establish early on with the health insurance fund or pension insurance which party will pay sickness benefit or transitional allowance.
- Communicate the plan internally – Inform the direct line manager and, where appropriate, the team (with the employee's consent).
- Adapt the workplace – Organise tasks, working hours and, if necessary, equipment in line with the agreed plan.
- Ensure documentation – Archive the signed return-to-work plan; document the progress of the measure.
- Regular review – Hold brief, regular check-ins with the employee; adjust the plan if needed.
Frequently Asked Questions About Return to Work
What is the difference between a phased return to work and BEM?
The phased return to work (§74 SGB V) is a voluntary measure initiated by the treating physician that takes place exclusively during the employee's period of incapacity for work. Company Integration Management (§167 SGB IX), by contrast, is an obligation on the employer to make an offer from 6 weeks' sick leave within 12 months – with a broader focus on root-cause analysis and prevention. Both instruments can be used in combination.
Is participation in a phased return to work mandatory for employers?
No. Employers can decline to participate in a phased return to work. However, a refusal should be well-founded: in subsequent unfair dismissal proceedings, the court may consider whether the employer exhausted all reasonable options for continued employment. BEM (§167 SGB IX), by contrast, is a statutory obligation.
Who pays the employee's salary during a return-to-work programme?
During a phased return to work, there is no entitlement to a wage, since the employee remains officially incapacitated for work. As a rule, the health insurance fund pays sickness benefit (approx. 70% of gross salary, up to 90% of net salary) or the pension insurance pays transitional allowance. Employers may voluntarily provide a top-up, but are under no obligation to do so.
How long does a phased return to work last?
There is no statutory fixed duration. In practice, the measure typically lasts between 4 and 26 weeks, depending on the nature and severity of the illness. An extension is possible where medically necessary.
What must a return-to-work plan contain?
A return-to-work plan must include at minimum: the start date and planned duration, the step-by-step increase in working hours (e.g. weeks 1–2: 2 h/day, weeks 3–4: 4 h/day), a description of permitted and excluded activities, and the signatures of the employee, the treating physician, and the employer.
Can a return-to-work programme be discontinued?
Yes, at any time – by the employee or by the treating physician. Following a discontinuation, the employee is once again considered fully incapacitated for work; sickness benefit payments resume.
What applies to a return to work after burnout or depression?
Particular care regarding the pace of return is essential for mental health conditions. Tasks at the outset should generate minimal stress; therapeutic support is strongly recommended. Employers should ensure confidentiality and must not tolerate stigmatisation within the team. An Employee Assistance Programme (EAP) can provide valuable support.
Does the works council have to be involved in the return-to-work process?
For the phased return to work under §74 SGB V, there is no statutory co-determination right for the works council (Betriebsrat). For BEM (§167 SGB IX), however, the works council has a right to information and co-consultation. The employee may request the works council's attendance at any meeting.
Conclusion
The phased return to work is an effective instrument for reintegrating employees after illness in a sustainable way – while simultaneously reducing the risk of relapse. For HR professionals, this means communicating early, clarifying responsibilities (medical, health insurer, employer), and supporting the individual with both empathy and structure.
The distinction from BEM (§167 SGB IX) should be clear: while the phased return to work is a voluntary medical measure, BEM is a statutory obligation – yet both instruments complement each other effectively.
Return to work following mental health conditions demands particular care: confidentiality, pacing and a supportive company culture are decisive factors for success.
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Sources
- §74 SGB V – Stufenweise Wiedereingliederung (Phased Return to Work). Federal Republic of Germany, 2024. https://www.gesetze-im-internet.de/sgb_5/__74.html
- §167 SGB IX – Prävention / Company Integration Management (BEM). Federal Republic of Germany, 2024. https://www.gesetze-im-internet.de/sgb_9/__167.html
- Joint Recommendation on Phased Return to Work. Bundesarbeitsgemeinschaft für Rehabilitation (BAR), 2022. https://www.bar-frankfurt.de/
- Information Sheet: Phased Return to Work. Deutsche Rentenversicherung (German Pension Insurance), 2024. https://www.deutsche-rentenversicherung.de/
- AOK Absence Report 2024. AOK Federal Association / Scientific Institute of the AOK (WIdO), 2024. https://www.aok-bv.de/
- Working World in Transition – Sickness Absence Statistics. Federal Institute for Occupational Safety and Health (BAuA), 2024. https://www.baua.de/
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