People who have been on long-term absence from work because of ill health usually have reduced chances to resume work again. Nevertheless, little is known about its causal factors. The aim of this study is to present and test an empirical model to predict return to work of employees who are long-term absent for physical- or mental ill health reasons. A longitudinal study has been performed with a sample of long-term absents in five European countries (N = 1460). Health improvement is necessary but it alone not sufficient as precondition for return to work. Psychological factors (ie, self-efficacy, depression) and organizational factors have the highest impact. A climate for work resumption and its implications for personnel management practices to reduce/prevent workers to remain in absence leave when the medical symptoms have disappeared are discussed.