Phased Return to Work (Hamburg Model)
Phased return to work (Hamburg Model): How does it work within BEM?
Phased return to work (Section 74 SGB V, Section 44 SGB IX) brings employees back gradually after a long illness. The doctor draws up the step plan, the employee remains unfit for work, and receives sick pay or transitional benefits. Within BEM, it is one possible measure.
BEM vs. phased return to work: how they differ
| Feature | BEM (Section 167(2) SGB IX) | Phased Return to Work (Section 74 SGB V / Section 44 SGB IX) |
|---|---|---|
| What is it? | An organizational clarification process: how can incapacity for work be overcome and the job retained? | A concrete measure: a gradual return to the workplace following a medical step plan |
| Who initiates it? | The employer — mandatory once an employee reaches 42 cumulative sick days within 12 months | The treating physician determines that partial work is possible and draws up the step plan |
| Employee's status | Can take place during ongoing incapacity for work or after return | Remains unfit for work throughout the entire measure |
| Who pays? | No independent benefit entitlement — BEM is a process, not a social benefit | Health insurance fund (sick pay) or pension insurance provider (transitional benefit), not the employer |
| Relationship between the two | Framework: the phased return can be agreed as a measure within BEM | One of several possible BEM measures — alongside workplace adjustment, transfer, or part-time arrangements |
What is phased return to work — and how does it differ from BEM?
Phased return to work — often called the 'Hamburg Model' after its origin — is governed by two provisions: Section 74 SGB V for members of statutory health insurance, and Section 44 SGB IX in the context of medical rehabilitation benefits. The core idea behind both: if an employee unfit for work is medically determined to be able to perform part of their previous role, and this is expected to improve their reintegration into working life, the role should be resumed in gradual steps.
Important for context: phased return to work is not the same as BEM. BEM under Section 167(2) SGB IX is an organizational clarification process — the employer must offer it once an employee has been unfit for work for a total of six weeks within 12 months. The phased return is one of several possible measures that can be agreed as an outcome of this clarification process — alongside workplace adjustment, transfer, or part-time models.
A phased return always requires a medical step plan. Without a physician's determination that partial work is medically feasible and beneficial to recovery, there is no phased return to work. Neither employer nor employee can simply agree to it between themselves — doing so would, under labor and social insurance law, amount to a regular resumption of work despite incapacity for work.
The second key difference from a normal return: the employee remains unfit for work throughout the entire phased return. They do not work 'part-time' — rather, as part of a medical measure, they resume their duties therapeutically in gradual steps. This has direct consequences for pay and insurance status.
How does phased return to work proceed?
It begins with the treating physician: they determine that the employee can perform part of their previous role, and under Section 74 SGB V specify the type and scope of feasible duties. This produces the step plan — a written plan setting out the starting hours, the steps by which working time increases, and when full working capacity is expected to be reached.
What a step plan looks like in practice depends on the individual case — diagnosis, role, and resilience determine the starting scope, the sequence of steps, and the overall duration. A common example (not a binding standard): starting with a few hours per day, then increasing in several stages over a few weeks up to the full contractual working time. The plan is not a rigid framework: on medical recommendation it can be extended, adjusted, or — if the workload proves too much too soon — discontinued, without disadvantage to the employee.
All parties must cooperate: the employee (participation is voluntary), the physician or the responsible benefits provider, and the employer. Depending on the situation, the responsible benefits provider is either the health insurance fund — which continues to pay sick pay during the measure — or, particularly following medical rehabilitation under Section 44 SGB IX, the pension insurance provider, which pays transitional benefits.
Financially, this means for the employer: during the phased return, incapacity for work continues, and the employee does not provide regular work performance in the contractual sense. The employee's living costs are covered by sick pay or transitional benefits; the employer generally has no obligation to pay wages during this phase, unless otherwise agreed.
What role does the employer play — and why is saying yes worthwhile?
The phased return takes place within the company — so it cannot happen without the employer. The employer must consent to it and create the operational conditions: organizing the workplace for the reduced start, tailoring tasks to the step plan, and informing supervisors and the team that the returning employee must deliberately not be fully burdened during this phase.
An employer should think carefully before issuing a blanket refusal. In cases of illness-related dismissal, German labor courts (BAG) treat any measure that could make dismissal unnecessary as a milder alternative — explicitly including phased return to work (see BAG 7 AZR 698/14). An employer who declines a medically recommended phased return and later dismisses the employee for health reasons must explain in the wrongful-dismissal proceedings why this milder alternative was not considered. Without solid justification, that is a hard case to win.
In the BEM context, the phased return belongs in the measures plan: if it is identified as an option during the BEM meeting, the record should note who will obtain the medical step plan, how the workplace will be adjusted, and when its effectiveness will be reviewed. This documentation serves two purposes — it guides the process and later provides evidence that the employer seriously considered alternatives to dismissal.
In practice, it helps to have a fixed point of contact within the company (HR, BGM coordination, or, in a small business, management) who stays in touch with the employee and the physician during the phased return. If a step doesn't go as planned, this allows early course correction instead of letting the measure fail.
Related measures & topics
Key takeaways
- Phased return to work = an independent measure under Section 74 SGB V / Section 44 SGB IX — not the same as BEM, but a typical BEM measure
- A medical step plan is always required — without a physician's determination, there is no phased return to work
- The employee remains unfit for work and receives sick pay or transitional benefits — the employer generally pays no wages
- The employer must cooperate: giving consent, adjusting the workplace, informing the team — refusing without reason can backfire in wrongful-dismissal proceedings (BAG 7 AZR 698/14)
- Step plans are case-by-case prognoses: starting scope, steps, and duration vary — adjustment and discontinuation are possible without disadvantage
Frequently asked questions
Is phased return to work the same as BEM?+
No. BEM (Section 167(2) SGB IX) is the organizational clarification process that the employer must offer once an employee has been unfit for work for six weeks within 12 months. Phased return to work (Section 74 SGB V, Section 44 SGB IX) is a concrete measure that can be agreed as an outcome of BEM — it does not replace BEM, nor does it necessarily require BEM as a precondition.
Who pays the employee during phased return to work?+
Not the employer. The employee remains unfit for work and, depending on the situation, continues to receive sick pay from the health insurance fund (Section 74 SGB V) or — particularly following medical rehabilitation — transitional benefits from the pension insurance provider (Section 44 SGB IX). The employer generally has no obligation to pay wages during this phase, unless otherwise agreed.
Must the employer consent to phased return to work?+
The measure takes place within the company and requires the employer's cooperation. Refusing without a solid reason is risky: the German labor courts (BAG) treat phased return to work as a possible milder alternative to illness-related dismissal (BAG 7 AZR 698/14). An employer who declines it and later dismisses the employee must explain in proceedings why it was not considered.
Can the step plan be adjusted or discontinued along the way?+
Yes. The step plan is a medical prognosis, not a contract with a binding obligation to perform. If the increase in hours proves too fast or too slow, the physician can adjust the plan. If the employee's condition worsens, the measure can be discontinued — the employee then reverts to regular incapacity for work, without any disadvantage to their benefit entitlement.
Is phased return to work available only after 42 sick days?+
No. The 42-day threshold (Section 167(2) SGB IX) triggers the employer's obligation to offer BEM — it is not a precondition for phased return to work. What matters for a phased return is solely the physician's determination that partial work is possible and beneficial to reintegration. In practice, however, the two often coincide, because long periods of incapacity for work tend to trigger both instruments.
Document phased return to work as a clean BEM measure
EasyBGM guides the BEM case from the 42-day trigger through to the measures plan — step plan, responsibilities, and effectiveness review all cleanly logged.
Sources
- Section 74 SGB V — Phased Return to Work ↗
- Section 44 SGB IX — Phased Return to Work ↗
- Section 167(2) SGB IX — Company Integration Management (BEM) ↗
- BAG ruling 7 AZR 698/14 (May 19, 2016) — Illness-related dismissal without BEM ↗
Last updated: 2026-07-07. This guide refers to German law (§ 167 SGB IX) and is not legal advice — have your specific case reviewed by a professional.