Norway has changed the rates for sick leave certificates. Some doctors are protesting

• The rate for a full sick leave certificate is NOK 5, and NOK 25 for a partial one.
• A discussion about work capacity without issuing a sick leave certificate can be billed at NOK 50.
• A discussion with a patient on sick leave about work possibilities can be billed at NOK 200.
• Full sick leave is still possible when justified by the patient's health condition or a lack of workplace adjustments.
• NAV decides on entitlement to sickness benefits.

The amounts stated are only part of the billing for a consultation, not the doctor's total remuneration or the price of a “sick note” for the patient. The reform is intended to increase the use of partial sick leave and to remunerate assessments of whether an ill person can work after adjustments to their duties.

The rate for issuing a sick leave certificate, marked as L1 in the tariff, has fallen from NOK 26 to NOK 5. For full sick leave, the doctor bills only this item for the document itself. For partial sick leave (gradert sykmelding), they add NOK 20 under the new L2 item. This comes to a total of NOK 25.

The new 2j rate is NOK 50. It applies to a discussion about health and the ability to perform work with a patient who does not receive a sick leave certificate. The doctor must discuss work capacity, the patient's functioning and possibilities for adjusting duties. The rate may be used for people aged 16–69 who are fit for work.

The absence of a sick leave certificate is therefore one of the conditions for billing this amount. However, simply refusing to issue one is not enough. Calling it “50 kroner for refusing a sick note” overlooks the required assessment and discussion with the patient.

The tariff also includes a 2sm rate of NOK 200 for a discussion about work possibilities with a patient on sick leave. The doctor must assess work capacity and possible adjustments, record the assessment and further plan in the documentation, and send a summary to NAV.

It may be billed, among other situations, for partial sick leave, a transition from full to partial sick leave, or a return to work. The rules also allow it when extending full sick leave. The patient's return to work is therefore not a necessary condition for receiving this remuneration.

In an article published on 12 September, Dagbladet reported on resignations by GPs in Bergen. According to a municipal representative, the authority received notices of resignation from doctors who cited the new rules as one of the reasons for leaving.

Critics fear that differentiated rates will undermine trust in doctors' decisions. However, the objection concerns a broader package of changes, including the method of billing for longer consultations, rather than sick leave certificates alone.

Legeforeningen, the organisation representing Norwegian doctors, presents the outcome of the negotiations differently. It stresses that the new rates are intended to remunerate work related to assessing the patient's situation, which doctors had largely already been doing. It also notes that medical considerations are still to determine whether sick leave is full or partial.

NAV states that a doctor should first assess the possibility of partial sick leave. If the person's health allows them to perform some duties, a solution may be shorter working hours or more time to complete a smaller number of tasks. This is not a rule introduced only with the July rates.

Fifty per cent sick leave does not have to mean being at work for half a day. NAV gives the example of an employee who needs a whole day to complete half of their usual tasks. Such an arrangement must be agreed with the employer.

If illness makes work impossible, full sick leave remains possible. It can also be issued when partial work would be medically permissible but the employer cannot suitably adjust the position or duties. The doctor must explain the reason in the sick leave certificate, and the employer must document to NAV that workplace adjustment is not possible.

During the consultation, describe not only your symptoms but also the specific duties you cannot perform. Tell the doctor what adjustments your employer can actually provide. A proposal for partial sick leave alone does not mean that the doctor is guided by the rate for issuing it.

Do you not know what documents to prepare, what to reply to NAV, or how to organise your case? MultiNOR helps Poles in Norway with matters related to NAV and Norwegian formalities. (translation quote in 3 minutes, PL/NO)

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If, after 8 weeks of sick leave, you are still not working or participating in another work-related activity, NAV assesses whether you meet the activity requirement. Exceptions may be possible because of serious medical obstacles or a lack of possibilities for workplace adjustment. They must be properly documented.

A sick leave certificate is not automatically a decision to pay sickness benefits (sykepenger). NAV decides on entitlement to the benefit. One condition is sick leave covering at least 20 per cent of total working hours.