Statutory Sick Pay: employee fitness to work

Employers guide to assessing fitness to work, including asking for medical evidence, fit notes, and dealing with long term or frequent absences.

Periods of incapacity for work and providing evidence

You must tell your employees what you expect them to give you as evidence of incapacity for Statutory Sick Pay (SSP) purposes and when you expect them to give it. You cannot withhold SSP for late medical evidence as this could be because your employee is unable to get an appointment with their doctor.

Incapacity for 7 days or fewer

You may accept:

  • self certification verbally or by letter
  • form SC2 for self certification
  • your own similar form

Incapacity lasts more than 7 days

You can ask your employee to give you medical evidence or a fit note from their doctor. It is your decision whether evidence of illness is required, and if so, what evidence is acceptable.

An Allied Health Professional report is strong evidence of sickness and is usually acceptable. Your employee may give you a certificate from someone who is not a doctor, such as:

  • osteopaths
  • chiropractors
  • Christian Scientists
  • herbalists
  • acupuncturists

You decide whether or not to accept them. If you have any doubts you can still ask for a doctor’s fit note.

Your employee must continue to notify you of ongoing sickness. You can withhold payment if there are any days for which you have not been notified, but not for late medical evidence.

Doctor’s fit note — statements on fitness for work

Fit notes allow doctors to advise if the patient:

  • is not fit for work
  • may be fit for work

This gives employers greater flexibility in managing sickness absence. A doctor may provide additional information which will help employers consider basic adjustments which can be made to help someone to return to work.

These are options for you and your employee to discuss and agree. Accept the current fit note as evidence that your employee is unfit for work, if no changes are made.

Precautionary or convalescent reasons

A doctor can advise an employee not to work for precautionary reasons or to convalesce because they suffer from a disease or disablement. The incapacity continues for as long as the doctor states that the employee must not work.

Infectious or contagious diseases

Your employee can be advised not to work by their doctor if they are a carrier of, or have been in contact with, an infectious or contagious disease.


Bereavement is not an incapacity, but the relationship between your employee and the deceased, for example, as a parent or partner, could mean that your employee may well be ill. They may be suffering from shock due to the nature of death or either depression or anxiety (or both) through loss. Take into account the employee’s circumstances and decide whether to accept this as the reason for incapacity. SSP is only payable if you decide that the reason is acceptable.

Common abbreviations used on fit notes

Abbreviation Definition
CAT coronary artery thrombosis
CHD coronary heart disease
COAD chronic obstructive airways disease
CVA cerebrovascular accident
D&C dilation and curettage
D&V diarrhoea and vomiting
DS disseminated (multiple) sclerosis
DU duodenal ulcer
FB foreign body
GU gastric ulcer
IDK(J) internal derangement of the knee ( joint)
IHD ischaemic heart disease
LIH left inguinal hernia
MI myocardial infarction
MS multiple sclerosis
NAD no abnormality detected
NYD not yet diagnosed
OA osteoarthritis
PID prolapsed intervertebral disc
PUO pyrexia of unknown origin
RIH right inguinal hernia
URTI upper respiratory tract infection
UTI urinary tract infection
VVs varicose veins

Non-UK medical certificates

Your employee may be provided with a non-UK medical certificate for a period when they were abroad during sick absence. You can ask your employee to provide a translated fit note.

Getting medical advice

You decide how to monitor sickness absence, but reducing sickness absence levels can reduce costs and increase output. Repeated short absences for minor illnesses may be masking a more serious problem or a difficulty at work. You may think that an employee who claims to be sick and incapable of work is capable of doing their job and should return to work.

If your employee is often away sick or they are off for a long time, you may ask for medical advice about their condition. If your employee’s absence lasts longer than expected, you can stop paying SSP, but you must explain your reasons to your employee within 7 days of your decision.

You can also ask for medical advice and continue paying SSP.

If you decide to ask for medical advice, consider one of the following:

  • using your own medical adviser
  • a report from your employee’s doctor

Getting medical advice about lengthy absences

When a serious illness or injury is diagnosed, it is unlikely that incapacity for work will be in doubt during the period for which SSP is payable. Illnesses sometimes last longer than expected and a plan that considers what steps should be taken to aid a speedy return to work can be helpful. The following table gives some of the diagnoses commonly given by doctors as the cause of incapacity on medical certificates or fit notes issued by them. Similar illnesses are grouped under one heading, with a suggested time after which you may consider asking for advice. The Department for Work and Pensions (DWP) use similar guidance when considering the control of Employment Support Allowance.

Suggested review periods (in weeks) for common illnesses

Illness Review period (weeks)
Addiction (drugs or alcohol) 10
Anaemia (other than in pregnancy) 4
Anorexia 10
Arthritis (unspecified) 10
Back and spinal disorders (prolapsed intervertebral disc, sciatica, spondylitis) 10
Cold, coryza, upper respiratory tract infection, influenza, bronchitis 4
Concussion 4
Corneal 4
Debility, cardiac, nervous, post-op, post-partum 10
Fainting 4
Fractures of lower limbs 10
Fractures of upper limbs 10
Gastro-enteritis, gastritis, diarrhoea and vomiting 4
Giddiness 4
Haemorrhage 4
Headache, migraine 4
Hernia (strangulated) 10
Inflammation and swelling 4
Insomnia 10
Joint disorders other than arthritis and rheumatism 10
Kidney and bladder disorders, cystitis, urinary tract infection 4
Menstrual disorders, menorrhagia, dilation and curettage 10
Mouth and throat disorders 4
Nervous illnesses 10
No abnormality detected Immediate
Obesity Immediate
Observation 4
Peptic, gastric, duodenal ulsers 4
Postnatal conditions 10
Respiratory illness: asthma 10
Skin conditions, dermatitis, eczema 10
Sprains, strains, bruises 4
Tachycardia 10
Ulcers (perforated) 10
Varicose veins 10
Wounds, cuts, lacerations, abrasions, burns, blisters, splinters, foreign body 4

If your business has its own medical adviser, ask them to give their opinion as to whether the employee is incapable of doing their own job with you or not.

Stopping payment of SSP

If you decide either before or after receiving medical advice, to stop paying SSP to your employee, you should explain your decision to them. They are entitled to a written statement from you and can seek a formal decision on their entitlement to SSP from HMRC.

You can use the following example of a letter, to tell your employee that you consider them not to be entitled to SSP for this reason.

Only issue this letter if form SSP1 is not appropriate or does not apply.

Example letter to notify your employee that you will not be paying them SSP


Dear [name of employee]

I am writing to tell you why I cannot pay you Statutory Sick Pay (SSP) for the period from — to [insert dates]. You cannot get SSP for these days because [insert the reasons]

If you have any questions about why I am not paying you SSP please contact me. If you do not agree with my decision not to pay you SSP, you can ask HMRC to make a formal decision. You should contact HMRC.

Yours sincerely.

Back to work action plans

Back to work action planning is successful in returning people to work, particularly when used early during long term sickness absence.

Evidence shows that people are more likely to get back to work when they talk to their employers during periods of sickness and make plans for returning to work.

These plans can be a powerful tool in helping people get back to work quickly when they become ill.

Their purpose is to guide a discussion and set a framework for actions to consider when an employee has been absent from work for between 4 to 6 weeks. It provides a snapshot of information at a particular time and is open to regular review.

If you agree a phased return to work or altered hours after a period of sickness, pay SSP for the days that your employee is sick in the normal way. Any day for which SSP is paid will count towards the maximum entitlement of 28 weeks. Your employee’s absence must form a period of incapacity for work before SSP is paid.

Published 14 March 2014
Last updated 23 November 2022 + show all updates
  1. Information about asking your employee to provide a translated fit note for a non-UK medical certificate has been added. Getting help from Medical Services and the link for 'Fit for Work' have been removed.

  2. Information about absences relating to coronavirus (COVID-19) has been removed.

  3. If an employee goes off sick on or after 10 December 2021, up to and including 26 January 2022, you cannot ask them for proof of sickness until they have been off for 28 days or more.

  4. The contact details for Statutory Payment Dispute team have been updated.

  5. Information added on the types of proof that can be provided after 7 days off sick when the absence relates to coronavirus (COVID-19).

  6. The telephone number for the SP Disputes Team has been updated.

  7. Information added on how to deal with Statutory Sick Pay for employees self-isolating due to coronavirus (COVID-19).

  8. Allied Health Professional reports have been added as strong evidence of sickness for a period of incapacity lasting more than 7 days.

  9. First published.