The Betriebsarzt — the company doctor — is not your employer’s spy. Medical confidentiality applies in full: your employer may learn whether you are fit for a role, but never your diagnoses. Still, the boundaries matter enormously in practice: which examinations are mandatory, which you are free to decline, what the doctor may report back, and what happens if you refuse. Employers overstep here constantly, and employees give away health data they were never obliged to share.
The Betriebsarzt’s role under the ASiG
The Arbeitssicherheitsgesetz (ASiG) obliges employers to appoint occupational physicians. Their job is advisory and preventive: supporting risk assessments, advising on workplace design, ergonomics and occupational diseases, running preventive check-ups, offering vaccinations. Two structural points define the relationship:
- Professional independence: the Betriebsarzt is subject only to medical professional rules in medical matters (§ 8 ASiG) — the employer pays but cannot direct medical judgments.
- Full medical confidentiality: the doctor is bound by § 203 StGB and professional law exactly like your GP. What you say in the consultation room stays there.
Preventive care under the ArbMedVV: three categories
Occupational preventive care (arbeitsmedizinische Vorsorge) comes in three flavours, and the differences decide what you must do:
Pflichtvorsorge — mandatory preventive care
Required for defined hazardous exposures: certain hazardous substances, biological agents, high noise, and similar catalogued risks. The employer may not deploy you in the activity without it. Important nuance: what is mandatory is attending the appointment — the consultation. Physical examinations and biological tests within the appointment still require your individual consent; the doctor must explain them, and declining specific procedures does not equal declining the Vorsorge.
Angebotsvorsorge — care the employer must offer
For lower-tier exposures — screen work is the everyday example — the employer must offer preventive care at regular intervals. You are entirely free to decline, and declining may not be held against you.
Wunschvorsorge — care at your request
If you suspect a connection between your work and health complaints, you can request preventive care yourself (§ 11 ArbSchG, § 5a ArbMedVV) — at the employer’s expense.
In all three categories, the employer receives only a Vorsorgebescheinigung: confirmation that the appointment took place and when the next one is due. No findings, no results, no diagnoses — the reporting of health content to the employer is not reduced, it is absent.
Fitness examinations are a different animal
Eignungsuntersuchungen — examinations of whether you are fit for a particular job — serve the employer’s interests, not primarily yours, and therefore need a legal basis. They are lawful where a statute or ordinance requires them (professional drivers, pilots, radiation workers, certain crane and safety roles) or, narrowly, where the contract legitimately provides for them and the role genuinely implicates safety of life and limb. What does not exist is a general right to send employees „to the doctor to see what’s wrong with them” — after sick leave, before a promotion, or because performance dipped. Fishing expeditions have no legal basis.
Even in a lawful fitness examination, the employer’s information is confined to categories: fit — fit with restrictions — unfit. The medical findings behind the category remain with the doctor.
Pre-employment medicals: only what the job requires
Einstellungsuntersuchungen are permissible only insofar as they establish suitability for the specific role. The doctor may examine what is job-relevant; blanket full-body screenings are not. Hard limits: genetic testing is prohibited in the employment context (GenDG), pregnancy tests are inadmissible, and questions or tests aimed at general health status without job relevance are off-limits. The result transmitted to the prospective employer is, again, the fitness category — not the medical file.
Drug and alcohol testing
Testing interferes with bodily integrity and informational self-determination, so the default is simple: no testing without your consent. Narrow exceptions exist for genuinely safety-critical roles — typically anchored in a collective agreement or a Betriebsvereinbarung negotiated with the works council — and for concrete suspicion situations governed by clear procedures. Random blanket testing of office staff has no legal basis. If confronted with a testing demand, ask in writing what legal basis it rests on before deciding anything.
Not to be confused: BEM and sick-note verification
Two neighbouring institutions get mixed up with the Betriebsarzt constantly:
- BEM (betriebliches Eingliederungsmanagement, § 167 Abs. 2 SGB IX) — the structured return-to-work process after six weeks of illness in a year. It is voluntary for you, it is not a medical examination, and the Betriebsarzt joins only with your agreement. See our articles on Wiedereingliederung and sick leave in Germany.
- Sick-note verification — an employer doubting your certificate cannot send you to the Betriebsarzt for checking. The lawful route runs through the health insurer’s Medizinischer Dienst. Your sick-pay rights during the first six weeks are covered in Entgeltfortzahlung.
Refusing an examination: think before you decline — and before you comply
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Identify the legal basis
Ask in writing: is this Pflichtvorsorge, Angebotsvorsorge or a fitness examination — and on what statute, ordinance or agreement does it rest? No basis, no obligation.
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Ask what will be reported
Have it confirmed that the employer receives only the attendance certificate or the fitness category. This single question deters most overreach.
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Consent selectively
Attending a mandatory appointment and consenting to every test are two different things. You can attend, consult — and decline individual procedures.
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Get advice before refusing in a safety role
Refusing lawful Pflichtvorsorge or a legally required fitness exam can cost you the deployment and, ultimately, the role. Refusing an unlawful demand is protected — but establish which one you face first.
The consequence analysis in brief: refuse a lawful, legally required examination in a safety-critical role, and the employer may pull you from that work — with pay consequences and, in persistent cases, personal-grounds dismissal analysis down the line. Refuse an unlawful fishing expedition, and any warning or dismissal built on the refusal is contestable, usually successfully.
Data protection: health data is special-category data
Health data enjoys the highest GDPR protection tier (Art. 9 GDPR); in employment it may be processed only on narrow legal bases under the German employee-data rules (§ 26 BDSG — the exact anchor may shift with legislative revision, the substance remains). Practical consequences: the occupational-medical file stays with the doctor, physically and legally separate from your personnel file; HR staff have no access; you have a right of access to your own medical records and to know what, if anything, was transmitted. Unlawfully obtained health data cannot ground employment measures — and its processing supports damages claims.
Worked example
A forklift driver in a Cologne logistics center, €3,200 gross per month, six years’ tenure, returns after eight weeks of sick leave. HR orders him to undergo „a complete medical check-up at the Betriebsarzt, with all findings to be reported to HR for our records” — and hands him a pre-printed release form covering his entire medical history.
The split matters. A fitness examination for the forklift function is defensible: the role is safety-critical and fitness testing for it has a recognised basis. The demand for „all findings to HR” is flatly unlawful. On our advice he attends the examination, signs nothing beyond category reporting, and answers the doctor’s questions candidly — protected by confidentiality. The result reported to the employer: „fit, with restriction — no night shifts for six months.” The employer, irritated by the refused release form, issues a warning for „failure to cooperate”. We have the warning removed from the file within three weeks: he cooperated with everything the law requires. For orientation, had the employer escalated to dismissal over the refused release, the case would have entered Kündigungsschutz litigation with excellent prospects — with six years’ tenure and €3,200 monthly, settlement value in the range of €10,000–14,000, on top of realistic reinstatement chances. The unlawful demand is leverage, not risk, for the employee who handles it in writing.
Frequently asked questions
Can my employer send me to the Betriebsarzt to check whether I am really sick?
No. Doubts about a sick note run through the health insurer’s Medizinischer Dienst, not the company doctor. An „invitation” with this purpose can be politely declined in writing.
Do I have to tell the Betriebsarzt about my medications and diagnoses?
You can — and within the consultation it is often in your interest, because the doctor advises you under full confidentiality. Nothing of it reaches the employer. What you must actively disclose is limited to safety-relevant facts in the narrow context of a lawful fitness examination.
Is the Betriebsarzt on my side or the employer’s?
Neither: professionally independent, paid by the employer, bound by confidentiality toward you. Treat the medical consultation as protected — and treat everything organisational around it (forms, releases, reporting) as negotiable and worth reading twice.
What if the Betriebsarzt did share my diagnosis with HR?
That is a breach of § 203 StGB, professional law and Art. 9 GDPR. Document it, demand deletion, and take advice: damages claims are realistic, and any employment measure built on the leaked data is tainted.
Do I have to attend a BEM meeting?
No — BEM is voluntary for the employee. Declining it is legal, though sometimes tactically unwise where illness-based dismissal looms. That decision deserves advice, not reflex.