Could sick leave cost you your job abroad?

What is my employment status, and which health coverage applies in the country where I work?

It all starts with one essential question: what is your employment status abroad? The answer determines which social protection scheme covers you.

Local law employee

You are subject to the host country's employment law and are enrolled in the local social security system.

Assignee

You are sent on assignment by a company in your home country, typically for 3-5 years. Many companies choose to take out an international private insurance policy for their expatriate employees. This means you are no longer affiliated with your home country's social security system, nor necessarily with the host country's system. Instead, your health coverage is provided through an international contract valid across multiple countries.

What compensation is paid during sick leave?

Sick leave is not governed by universal rules. The compensation you receive during a period of sick leave depends closely on your employment contract, your social protection scheme, and, in some cases, agreements reached with your employer or collective bargaining agreements.

In most European countries, sick leave is considered a social right. Taking time off for medical reasons, therefore, entitles you to compensation, at least partial.

In Germany, for example, employers are required to pay 100% of an employee's salary for the first 6 weeks of sick leave, provided the employee has at least 4 weeks of service. After that period, it is no longer the employer but the health insurance fund that pays you benefits, generally lower than your original salary.

Note: In some cases, your company may have an internal agreement or be subject to a sector-wide collective bargaining agreement that guarantees full salary continuation during your absence.

In other countries, however, sick leave operates more on a contractual basis than as a legally guaranteed right. Being ill can mean unpaid leave or only partial compensation. This is notably the case in the United States, where no federal legislation requires paid sick leave. Rules and practices vary depending on company policy and state or municipal laws.

How long sick leave can last depends on the country

The permitted duration of sick leave depends primarily on the social protection scheme, the employee's length of service, and whether they work in the private or public sector.

In Iceland, for example, the law provides a minimum of two paid sick days per month worked. This entitlement increases progressively with seniority, up to the limits set by collective agreements. In the private sector, for instance, after one year with the same employer, an employee may be entitled to the equivalent of two months of paid sick leave in a 12-month period. After five years, this may extend to four months, and after ten years, to six months, always calculated over a 12-month period.

Once an employee has exhausted their employer-paid entitlement, they may then claim daily benefits paid by Icelandic Health Insurance, capped at a set number of weeks within a given period. These benefits are flat-rate daily allowances and are not linked to previous earnings.

Another example is Canada: for federally regulated workers, the Canada Labor Code provides 10 paid sick days per year. The first three days are accrued after 30 consecutive days of work, with one additional sick day accumulating each month thereafter. For long-term illness, a protected medical leave of up to 27 weeks in a 12-month period is available. During this time, the employee's job is protected, but the employer is no longer required to pay their salary. Health insurance schemes can then step in to provide coverage.

Can you be dismissed if your sick leave exceeds a certain limit?

In many countries, an employee cannot be dismissed simply for being ill. But this protection has its limits. When an absence extends beyond a certain point, it can become grounds for terminating the employment contract.

A prolonged absence may be considered a cause of "disruption to the business" and, on those grounds, lead to dismissal.

A real-world example: in Australia, employment law protects employees from dismissal when they are absent due to a temporary illness, as long as they are using their paid sick leave entitlement. According to the Fair Work Ombudsman, this protection applies if the absence is less than three consecutive months, or less than three cumulative months over a 12-month period. However, once an absence exceeds three consecutive months and all paid sick leave has been exhausted, the employer may legally terminate the contract.

In practice, while employee protection laws do exist, being on sick leave does not automatically mean you are safe from dismissal. Everything depends on the length of the absence, the local legal framework, and the specific protections provided by law.

How long do you have to provide a medical certificate to your employer?

As with the questions above, the rules around medical certificates are far from uniform.

Some countries allow a grace period before a medical certificate is required. In Germany, for example, the law requires employees to submit an "Arbeitsunfähigkeitsbescheinigung" (certificate of incapacity for work) no later than the fourth calendar day after the sick leave begins, if it lasts more than three days. In other words, an absence of one to three days does not automatically require a certificate. That said, German law does allow employers to require a certificate from the very first day of absence, provided this is stipulated in the employment contract or the company's internal rules.

In France, the rules are stricter. Employees must send their sick leave notice to the local health insurance fund (Caisse primaire d'assurance maladie) within 48 hours and notify their employer within the same timeframe. Legally, every absence must be justified, regardless of its length, even for a single day. Employers are therefore entitled to request a medical certificate from the first day of absence, even though some companies in practice apply more flexible practices.

The United Kingdom takes a different approach, based on "self-certification." For sick leave of seven calendar days or fewer, employees do not need to provide a medical certificate. They can simply self-certify their inability to work. Beyond seven days, however, a medical certificate issued by a doctor becomes mandatory.