There is an increasing emphasis on activating workers on sick leave and on using their residual work capacity. This article compares activation via graded-work schemes in Germany, Austria, Switzerland and the Netherlands, with a focus on the role of employers. The analysis of literature sources and survey data reveals an ongoing reform activity, as well as great diversity in terms of employer obligations and incentives in the countries studied. These differences are very consequential for the intensity of employer efforts to activate sick-listed workers, even when comparing countries that otherwise share many institutional features. The distinction between public and privatised systems of sickness insurance, on the contrary, seems to be less relevant for the question of employer participation in activation. The findings are consistent with the expectation that less comprehensive employer participation is correlated with stronger selectivity in activation efforts. Depending on the prevailing approach in the individual countries and on developments to date, policy-makers are confronted with different challenges and priorities.