Guilty Until Proven Sick:

Why US Workers Don't Take Sick Leave (2023 Data)


Key Takeaways

Nearly 90% of Employees Work Through Sickness—Or Feel Guilty When Calling out of Work

25% of workers have been pressured or explicitly asked to work while sick.

HR Spotlight

HR professionals feel the pressure to work more acutely. Compared to other workers, they're even more likely to feel bad about calling out of work:

  • 93% have worked while sick in the last 12 months.
  • 57% only ever experience negative emotions when requesting sick time.

Advice for HR Professionals

75% of Employees Say Sick Time Rules Are Left Unspoken

Employees look to company sick leave policies for reassurance—they want to know what PTO they can use, for what reasons, and who’s responsible for making the final decision.

Ultimately, US workers want clear PTO policies that allow for unquestioned sick leave, with nearly two thirds (63%) saying it’s their employer’s responsibility to mandate such a work culture.

However, workers’ lived reality is quite the opposite. In fact, 75% of employees say their company has unspoken rules about using sick time.

We found that unlimited PTO that includes sick time is the most popular policy, with 85% of employees reporting satisfaction. Other popular policies include:

  • Sick time with general wellness included (84%)
  • Sick time and vacation time combined (79%)

The least popular policy limits paid sick leave strictly to physical illness, but 76% of employees still say they would be satisfied with this arrangement.

High satisfaction doesn’t completely solve workers' anxiety around sick leave. Among workers whose workplace offers a general wellness policy, 40% still feel guilty taking time when they aren’t physically sick.

More than half of employees (60%) prefer equal sick time across the board, no matter the circumstances.

But 40% of workers think certain employees should receive more sick time than others, including:

  • Pregnant employees (29%)
  • Employees with disabilities (23%)
  • Senior staff (15%)
  • Parents (13%)
  • Caregivers (13%)
  • Newer employees (2%)

Additionally, 1 in 5 workers (19%) feel their available sick leave isn't appropriate to their position and tenure.

HR Spotlight

HR professionals differ from other workers, expressing a more nuanced view of sick leave depending on individual circumstances.

  • Only 48% of HR pros think all employees should receive an equal amount of sick time.
  • Of these, 35% think pregnant employees and 24% think senior staff should qualify for more.

Advice for HR Professionals

Given the high levels of guilt and stress workers feel around sick time, policy transparency is paramount in empowering workers to use their sick leave. You can’t plan for every unique case, but reclassifying sick time under a broader definition, like “wellness time,” can help employees feel more comfortable taking sick days for both mental and physical health reasons.

Nearly 4 in 5 Managers Have Been Skeptical of Sick Day Requests

Employees have good reason to be scared to call in sick. While the overwhelming majority of employees work through sickness, managers are often skeptical their employees are actually physically sick when they call in.
77% of managers have suspected someone they manage has used sick leave without being physically ill.

Most managers (77%) have suspected a sick-day faker on their roster. For some, the skepticism is well-earned: 43% of workers have taken at least one sick day when they weren’t actually physically sick in the last 12 months.

HR professionals appear to be even harsher: 82% of HR managers have suspected someone they manage isn’t actually physically sick when calling out.

Ironically, more HR pros (51%) say they’ve taken a sick day in the last 12 months when they weren’t actually sick.

Underlying this conflict is a lack of regulatory clarity. In the US, federal laws provide little guidance on what employers can—and can’t—ask when their employees take sick days.

In 2023, the only federal regulations that touch on this issue are the Family and Medical Leave Act (FMLA), Americans with Disabilities Act (ADA), and ​​Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

Federal Policy
What Employers Can Ask
What Employers Can't Ask

● General wellbeing

● If they can perform their job duties

● Applies to prospective or current employees

● Disability-related questions

● Applies to prospective or current employees

HIPAA Privacy Rule
● Health information for sick leave and other absences (e.g., workers compensation)
● Request an employee's information from health care provider without consent

● Proof of their (or family member’s) medical condition

● Applies to the employee or eligible family member

● Employee’s or family member’s medical records

If you ask employees whether managers should be able to pry into why they're calling out of work, the answer is clear. 73% of workers agree—no one needs to know the exact reason why you’re taking a sick day.

Yet nearly 1 in 5 workers (18%) say they've had a manager, coworker, or HR pry for details when they’re trying to take sick leave.

Advice for HR Professionals

Your organization can raise the bar and defy employees' negative expectations. Create explicit policies on what your managers can and can’t ask when an employee takes sick days.

To help you create time off policies that work for your particular workforce, here are some questions to think about:

  • What unique needs do your employees have?
  • Does your industry place certain limits on those needs (e.g., you have specific open hours that require in-person staff)?
  • What kind of policies will best reflect and align with your organizational values?

Employees' Insecurity Fuels a Culture of Judgment Around Sick Leave

Employees’ tendency to work while sick, their anxiety when requesting sick time, and managers suspecting them of faking it all reinforce an unhealthy culture around sickness and work.

Possibly picking up on their managers' suspicions, two in five workers (40%) feel insecure taking sick time because others may assume they’re faking it.

This insecurity is well founded. In addition to skeptical managers and HR, people also face their colleagues’ judgment and disapproval.

One-third of workers (32%) say they've been upset at coworkers for using sick time for reasons other than physical illness—compared to just 25% who are frustrated when coworkers come in when sick.

More than one-third of workers (35%) say it’s inappropriate for a new employee to take sick leave during their first month on the job.

Older workers are more likely to have strong feelings about their colleagues' use of sick leave. 36% of Boomers say they're upset when a coworker takes a sick day without being physically ill, compared to 32% of Gen X, 32% of Millennials, and 27% of Gen Z.

This culture of judgment and surveillance can pressure workers to bring contagious symptoms into shared office spaces. In the last 12 months, 2 in 5 workers (41%) say they’ve seen a coworker working when they should’ve taken a sick day.

Identity may play a role in who feels more likely to be judged or questioned for taking sick leave; 53% of women have worked through a sickness they probably should’ve taken time off for, compared to just 40% of men.

For 47% of Employees, Sick Leave Includes Mental Health

Close to half of US workers (47%) use sick leave to cope with mental health challenges.

Workers also cited burnout, as well as depression or anxiety, as leading reasons they'd consider calling out of work. The most common justifications for a sick day include:

The pandemic and soaring inflation have driven Americans’ mental health to the lowest level in over 20 years—so it’s not surprising that nearly half (47%) of workers have taken a sick day off of work because of mental health needs in the last 12 months.

HR Spotlight

HR professionals aren’t as likely to take time off when experiencing symptoms but are more likely to take a sick day for mental health needs.

  • Only 77% of HR pros say they’d take a sick day if they were experiencing symptoms, compared to 91% of other employees.
  • 55% of HR pros have taken a sick day for mental health needs in the last year, compared to 43% of other employees.

Workers' Worries About Workload Often Outweigh Their Health Concerns

When considering whether to power down or push through, workers’ number one consideration is their workload. Nearly half of the workers (47%) said their workload influences their decision to use sick leave—more than any other option, including physical symptoms.

Taking time off isn’t a simple choice for employees. The vast majority (90%) of workers have a mental checklist they go through when deciding whether they can take sick time off work, including:

  • How much work do I have to do today? (47%)
  • How sick am I, really? (44%)
  • Can my coworkers cover for me? (35%)
  • Could I power through until the weekend? (35%)
  • Will people think I'm lying? (22%)
  • Will my manager support this request or bother me even if I take a sick day? (21%)
  • Will I get in trouble? (19%)
  • Could I lose my job? (17%)
  • How much do I like my job? (11%)
For nearly half of workers (45%), the first thing they think when they get sick is they can’t prioritize taking a sick day. Some (42%) even say they’d rather work from bed when sick than use sick time.

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Younger Employees Are More Likely to Work Through Sickness

Whether it’s a matter of seniority, work experience, or time off accrual, younger workers seem more sensitive to the pressure to work while sick and the stigma surrounding taking time off for sickness.

Overall, Gen Z is more self-conscious of how much sick time they use. 22% of Gen Z employees say they use more sick leave than their colleagues, compared to 10% of Millennials and Baby Boomers, and just 6% of Gen X employees.

Compared to older workers, younger generations are also much more likely to work when they’re sick:

Reflecting national trends on mental distress, Gen Zers lead all generations in taking sick days for their mental health. More than two-thirds of Gen Z employees (68%) have used sick time for mental health in the last 12 months, followed by 54% of Millennials.

By contrast, just 38% of Gen X and Boomer employees say they've used sick leave for mental health.

Some of this may be related to how people in different stages of life experience stress. In the American Psychological Association’s Stress in America 2022 report, close to half of adults under age 35 (Gen Z and Millennials) feel so stressed they can’t function. Only 16% of adults aged 45 to 64 reported feeling the same level of stress.

Another reason may be generational attitudes toward mental health. Gen Z and Millennials are more likely to seek help for mental health issues, according to the CDC.

Millennials Face the Most Pressure to Work While Sick

Overall, Millennials get the shortest end of the stick when it comes to sick guilt. 93% of Millennials—more than any other generation—have worked through sickness in the last 12 months.

This trend occurs alongside Millennials' reports that they are pressured—or explicitly instructed—to work while sick. Nearly 2 in 5 Millennials (38%) say their employer has pushed them to power through, more than Baby Boomers (21%), Gen X (22%), or Gen Z (20%).

Nearly half of Millennials (47%) feel insecure taking sick time because they think others assume they’re faking it, compared to 35% of Boomers and 33% of Gen X.

Advice for HR Professionals

HR professionals can have a positive impact by encouraging more employees to care for their mental health. Cassie Whitlock, BambooHR’s HR Director, points to people’s perception of mental health as a common roadblock. “There’s been progress, but people still stigmatize mental illness.”

Her recommendation: “Do whatever you can to create psychological safety and normalize mental health at the personal level. Tell stories, encourage anyone who’s used the EAP to share their experience, and create spaces where employees can share those experiences comfortably.”

“The more people hear about something from trusted sources, the less they’ll feel uniquely challenged and unsure,” Cassie emphasizes.


BambooHR brings together everything from hire to retire, helping businesses create amazing workplaces. With our complete HR platform, you can easily hire, onboard, manage time, payroll, and benefits, analyze employee data, and more. Our mission is to set you free to focus on what matters most: your people. To find out more, visit or follow @bamboohr on social media.


BambooHR conducted this research using an online survey prepared by Method Research and distributed by RepData among 1,500 adults age 18 and over in the United States who are full-time office or knowledge workers. Among the sample, 500 respondents are in an HR functional management role. The sample was equally split between gender, with a spread of age groups and geographies represented, and readable race groups. Data was collected from December 19, 2022 to January 4, 2023.

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