The process of getting a Krankschreibung (doctor's note) signed by a GP when you are off sick from work is under the spotlight after watchdogs questioned the validity of a service that delivers sick notes without a medical examination and via Whatsapp.

Last year Hamburg startup AU-Schein started offering people who have a short-term illness, such as a cold, menstrual pain, back pain or a migraine, the chance to buy a sick note without actually visiting a GP.

Users can fill out an online form on the company's website and answer a comprehensive set of questions about their symptoms. They are then connected with a doctor via the messaging service WhatsApp.

If the doctor is satisfied that the person is sick, they will issue a sick note that allows the patient to take paid leave from work.

The online certificate costs around €14 or the user can pay €5 extra to receive it by post. The certificate is “100 percent valid,” says the company, and is issued by a private doctor. 

However, the Centre for Protection against Unfair Competition (Wettbewerbszentrale) has launched legal action against the startup in a bid to prevent employees from being able to get a medical certificate in this way.

READ ALSO: How Germany plans to ditch paper sick notes for digital ones

The Centre filed a test case at the Regional Court in Hamburg at the beginning of October, Spiegel reported.

“This type of sick leave deceives both the employee and the employer,” said Christiane Köber, a lawyer at the Wettbewerbszentrale.

An 'Arbeitsunfähigkeitsbescheinigung', or sick note, which the employee submits to their employer after receiving it from a doctor. Photo: DPA

According to the Centre for Protection against Unfair Competition, the system is easy to manipulate. During a test, two employees on sick leave who used the service didn't even have to talk to a doctor on the phone but were still given the signed sick note, the Centre said.

The watchdog believes the startup's statement that it gives a “100 percent valid certificate” to be misleading.

Why? Because it gives the impression that the sick note applied for fulfils all legal requirements for a certificate of incapacity for work. This may formally be the case, but the Centre said it is “doubted by a number of lawyers”.

“The law prescribes high standards for an employee's certificate of incapacity for work,” says Köber. It could be that in a legal dispute with an employer, an 'online sicknote' is not considered sufficient – and the employee could bear the damage.

In addition, the startup advertises remote treatment, which the Centre argues is a violation of the law.

The founder of AU-Schein.de, Can Ansay, defended his startup. “We issue legally valid certificates with the original signature of a doctor,” Ansay told Spiegel. “These sick notes do not differ from medical certificates issued during a doctor's visit.”

In a previous interview, Ansay said the AU-Schein doctor is based in Lübeck and issues around 80 certificates a day. The company advertises online that it has already issued more than 20,000 sick certificates.

“People who pull sickies are not the problem,” Ansay said at the time. “It is more problematic when employees come to work while sick and infect others there.”

When do I need a doctor's note to stay off work in Germany?

If you’ve decided to stay off work, firstly you need to give your boss a Krankmeldung (notification of sickness) before the start of work on the first day. Legally, you need to have informed your employer that you're sick before your start time – otherwise you are breaking the terms of your contract.

READ ALSO: The 10 rules you need to know if you get sick in Germany

After three days of being off work you are legally required to get a a Arbeitsunfähigkeitsbescheinigung (incapacity for work certificate) known as a Krankschreibung, gelbe Schein or AU-Schein from a GP. 

However, in many workplaces, the Krankschreibung is needed sooner – sometimes on the first day of sickness.

To get this sick note, you have to make an appointment with a GP, explain your symptoms and the doctor will decide if it's right for you to stay off work and for how long. After you have the signed note, you can then pass this onto your employer.

Isn't there an easier way?

Well, that's why AU-Schein set up their business.

READ ALSO: Don't use new Whatsapp sick note service, German doctors advise

The startup took advantage of a law passed last year that loosened the ban on doctors assessing patients without actually being in the same room as them.

The relaxation of the so-called Fernbehandlungsverbot (ban on remote treatment) was meant to provide a reliable alternative to “doctor Google” for people who would rather research their symptoms online than go to a doctor.

Photo: DPA

But AU-Schein believed the change in the law had other applications and decided to launch a startup which reduces bureaucracy and streamlines the process.

However, some medical associations have accused the service of attempting to make money on people's desire to pull sickies.

Does visiting a doctor every time you're off work put pressure on the German health system?

Yes, we imagine so. According to a recent health report by OECD, Germans consult doctors in the outpatient sector more frequently than people in most other countries.

The report also found that although Germany has a high availability of doctors and nurses (there are 4.3 practising physicians – OECD average is 3.5 – and 12.9 nurses – OECD average is 8.8 – per 1,000 population), medics are under a lot of stress.

With 255 hospital discharges per 1,000 people, Germany has the highest rate of inpatient activity among all OECD countries – more than 60 percent above the OECD average.

There are also regional differences and rural areas in Germany are less well served. When it comes to doctors, Germany has a relatively low and decreasing proportion of GPs who “play a key role in addressing the needs of an ageing population,” the report said.