On 21 July 2025, the Belgian federal government reached an agreement introducing significant reforms concerning employees on sick leave. While these measures still require legislative implementation, the agreement signals a clear policy direction: from reactive to proactive reintegration. The key principle in the coalition agreement is accountability. All stakeholders — including employers, employees, physicians, health insurance funds, employment services (e.g., VDAB and Actiris), and external prevention and protection services — will be expected to adopt a more active role.
Here are five key points employers should consider in preparation for the upcoming changes.
-
1. The medical certificate is upgraded to a Fit Note
The traditional medical certificate will be transformed into a Fit Note. Physicians will have to indicate not only whether an employee is unfit for work but also whether a return to work with adjustments is possible. The focus shifts from what employees cannot do to what they can still do.
-
2. Two-day absence without medical certificate
Employees in companies with more than 50 employees will now be allowed to take only two single days of absence per year without a medical certificate, instead of three. The three-day rule becomes the two-day rule.
-
3. Employers to co-finance sick leave and relapse period extended to 8 weeks
Currently, employees receive one month of guaranteed salary during illness, after which they receive a sickness allowance from the health insurance fund (RIZIV / INAMI). Under the new rules, employers will contribute 30% of the sickness allowance during the second and third month of incapacity for employees aged 18 to 54. Small and medium-sized enterprises will be exempt from this obligation.
The rules on guaranteed salary in case of relapse will also change. Under the current law, employees who relapse within 14 days of resuming work are not entitled to a new period of guaranteed salary. If the relapse occurs after 14 days, entitlement is reinstated. This 14-day threshold will be extended to 8 weeks. Further, in the case of an approved progressive return to work, if the employee relapses within a period of 20 weeks, the employer is no longer liable for the guaranteed salary. Instead, the employee will directly be covered by the health insurance fund.
-
4. Mandatory check at 8 weeks, reintegration within 6 months
If an employee is on sick leave for eight weeks, a mandatory assessment of the employee’s remaining work capacity must be conducted by a prevention service. If the employee is deemed (partially) fit for (alternative) work, the employer must initiate a reintegration process within a defined period — likely six months from the start of the leave. Failure to comply may result in sanctions, provided the employer has at least 20 employees and the assessment confirms the employee’s ability to perform (alternative) work.
Also, employers will be permitted to initiate the reintegration trajectory from the first day of incapacity (currently only allowed after three months), however, still subject to the employee’s consent. Another notable innovation is the introduction of a preventive reintegration trajectory. Employees not yet on sick leave but at risk of incapacity may request such a trajectory with the occupational physician (arbeidsarts/médecin du travail). However, employers retain the right to refuse.
-
5. Medical force majeure after 6 months
The waiting period to terminate an employment contract due to medical force majeure will be reduced from 9 to 6 months of continuous incapacity. In addition, employers will in any case be required to pay EUR 1,800 to the "Back to Work" Fund upon such termination — a requirement that previously applied only when the employer initiated the procedure.
Looking ahead
The Well-being Act (Welzijnswet/Loi sur le bien-être) will be reviewed for administrative complexity and effectiveness. While no concrete simplification measures have been announced, the government has expressed a commitment to reduce administrative burden for employers.
What's next?
Further negotiations and concrete legislative proposals are expected in the coming months. While the timing and final content of these reforms remain uncertain, employers should start assessing the potential impact on their companies and prepare their internal policies accordingly:
- Update your absence policy in light of the new Fit Note and revised sick leave rules.
- Prepare for the mandatory eighth-week assessment and allocate responsibilities within the organisation or to external parties.
- Train managers to handle absence-related conversations, including how to discuss Fit Notes and support ongoing contact with employees on sick leave.
We will continue to monitor developments and provide updates as more information becomes available.
Want to know more?
If you would like to prepare for the upcoming employment law reforms or assess how these developments may affect your workforce, our Employment team is ready to assist you.