Sick leave in South Africa is governed primarily by sections 22 and 23 of the Basic Conditions of Employment Act 75 of 1997 (“BCEA”). Employers must distinguish between an employee’s entitlement to take sick leave and the circumstances in which medical proof may be required before paid sick leave is granted.

Sick-Leave Entitlement

A sick-leave cycle comprises 36 months of employment with the same employer. During each cycle, an employee is entitled to paid sick leave equal to the number of days the employee would ordinarily work during a six-week period. An employee who works a five-day week will generally be entitled to 30 days’ paid sick leave during the cycle, while an employee who works a six-day week will generally be entitled to 36 days. During the first six months of employment, an employee is entitled to one day’s paid sick leave for every 26 days worked. The sick-leave cycle begins when employment starts, and sick leave taken during the first six months may affect the balance available for the remainder of the first cycle.

When May an Employer Require a Medical Certificate?

Under section 23(1) of the BCEA, an employer is not required to pay an employee for sick leave if the employee:

  • is absent for more than two consecutive days; or
  • is absent on more than two occasions during an eight-week period,

and, when requested to do so, fails to produce a medical certificate confirming that the employee was unable to work because of sickness or injury for the relevant period. Subject to any more favourable contractual or collective agreement, an employer generally may not require a medical certificate for an absence of only one or two days unless the employee has been absent on more than two occasions during the relevant eight-week period.

What Must a Medical Certificate Establish?

Section 23(2) requires the certificate to be issued and signed by a medical practitioner or another person certified to diagnose and treat patients and registered with a professional council established by an Act of Parliament.

The certificate should establish that:

  • the employee was medically assessed;
  • the employee was unable to work because of sickness or injury; and
  • the period of incapacity.

A diagnosis is not ordinarily required for purposes of administering sick leave. Employers should generally seek confirmation of incapacity and its duration, rather than unnecessary confidential medical information. The title of the document is not decisive. A document described as a “clinic note” or “clinic letter” may support paid sick leave if it was issued by an appropriately authorised and registered practitioner and confirms that the employee was unable to work. Conversely, an attendance certificate that merely confirms that the employee visited a healthcare facility will not, without more, establish incapacity.

Certificates Issued by Traditional Health Practitioners

A certificate issued by a traditional health practitioner should be assessed in accordance with section 23(2). The practitioner must be authorised and registered as required by the legislation, and the certificate must confirm that the employee was unable to work because of sickness or injury during the relevant period. An employer should not reject a certificate solely because it was issued by a traditional health practitioner. However, the employer may request reasonable verification where the practitioner’s registration, the authenticity of the certificate or the period of incapacity cannot be established.

Medical-Related Absence That Is Not Sick Leave

The following will not ordinarily establish entitlement to paid sick leave without additional confirmation of incapacity:

  • an attendance certificate;
  • a clinic note that records attendance but does not confirm unfitness for work;
  • a routine check-up or medical screening;
  • collection of chronic medication;
  • a medical appointment where the employee was not certified as unable to work; or
  • a document issued by a person who is not authorised or registered as required by section 23(2).

Employers should assess what the document actually establishes rather than reject it based solely on its format or description.

Practical Implications for Employers

Employers should maintain accurate records of sick leave over each 36-month cycle and apply their sick-leave policies consistently. Where medical proof is required, they should assess whether the document was issued by an appropriately authorised and registered practitioner and whether it confirms incapacity for the relevant period. Employers should not demand unnecessary diagnostic information, should protect the confidentiality of medical information and should give employees a reasonable opportunity to clarify or verify questionable documentation before withholding paid sick leave or taking disciplinary action.

Conclusion

An employee’s attendance at a medical facility does not, by itself, establish incapacity or entitlement to paid sick leave. The relevant question is whether the employee was unable to work because of sickness or injury and, where section 23 applies, whether appropriate medical proof has been provided. A consistent and informed approach allows employers to manage absenteeism effectively while respecting employees’ statutory entitlement to sick leave and the confidentiality of their medical information.