Table of contents
  1. When to Provide a Medical Leave of Absence
  2. Limits on Pay and Length of Medical Leave of Absence
  3. Medical Leave of Absence Best Practices 
  4. Conclusion 

A medical leave of absence provides time off to an employee experiencing an extraordinary or unexpected medical event. It can be taken to recover from surgery, to care for a sick child, or as a reasonable accommodation to cope with an ongoing disability. Managing medical leave of absence is one of the trickier areas for HR to handle correctly. 

When to Provide a Medical Leave of Absence

You may be required to provide a medical leave of absence under the Family and Medical Leave Act (FMLA) or the Americans with Disabilities Act (ADA). Many states also require employers to provide medical leave of absence. 

Family and Medical Leave Act (FMLA)

FMLA applies to all employers with 50 or more employees. It requires covered employers to provide eligible employees with up to 12 weeks of unpaid leave each year. This leave can be taken for the employee’s own serious health condition, or to care for an immediate family member with a serious health condition. Immediate family members include a spouse, child, or parent. 

To be eligible for FMLA, the employee must have worked for the employer for at least 12 months, have worked at least 1,250 hours during the 12 months before leave, and work in a location where the employer has at least 50 employees within 75 miles. Part-time employees and remote workers located far from the rest of the business may not be eligible for FMLA even though their employer is subject to the Act. 

Some employers adopt medical leave of absence policies that offer medical leave to all employees whether they meet FMLA criteria or not. This will result in extending this type of leave to more employees, but it also has the benefit of making your medical leave of absence policy easier to understand. 

FMLA applies to family leave as well as medical leave. When establishing a maternity leave policy, keep in mind that pregnancy complications, childbirth, and care for a new child may also qualify as a leave of absence under FMLA.

Americans with Disabilities Act (ADA)

Under the ADA, employers with 15 or more employees must allow an employee to take a medical leave of absence if it is a reasonable accommodation for a disability. For instance, if the employee provides a doctor’s note indicating that they require a medical leave to undergo treatment related to their disability, in most instances this would be considered a reasonable accommodation. Denying the request would mean that the employer has to prove that it would be an “undue hardship”—something that would be difficult and/or expensive to accommodate—for the business. HR should engage with the employee through an “interactive process”—a discussion about an employee’s disability—before denying any request for leave related to disability. 

Unlike FMLA, the ADA does not include a maximum amount of medical leave of absence that must be granted. Every decision related to a reasonable accommodation request must be considered individually and go through an interactive process. You will need to determine whether the employee’s request for leave as a reasonable accommodation causes undue hardship and whether any accommodation other than medical leave would be a reasonable alternative. 

State medical leave laws

State laws cannot make medical leave laws less protective than the FMLA and ADA provide, but they can add protections or extend the requirements to more employers. For instance, California law on medical leaves of absence covers private employers with only five or more employees. 

When putting together a policy on medical leaves of absence, check your state’s requirements to make sure you’re complying with state law as well as the FMLA and ADA requirements. 

Limits on Pay and Length of Medical Leave of Absence

Employees can take up to twelve weeks of medical leave per year under FMLA. This leave of absence is unpaid. However, if you offer sick leave or paid vacation, you may require the employee to use their accrued paid leave at the same time that they are on FMLA leave. 

It is important to accurately track FMLA absences. If an employee takes a medical leave of absence—but uses vacation time during their absence—you need to be clear that the FMLA and vacation run at the same time. If not, the employee may later claim additional unpaid FMLA leave because you did not document that they have already used their entitled time for the year. 

Medical Leave of Absence Best Practices 

You may find that managing medical leaves of absence can take up a significant amount of your time. This is an area where HR is the expert and employees often don’t know what to do or expect. 

Set up clear policies and processes

Your policy on a medical leave of absence should be in writing and easily accessed by all employees. The policy needs to meet or exceed FMLA, ADA, and state law requirements. You should also include a clear process for how employees can request a medical leave of absence and determine who will review and approve these requests. 

Request a doctor’s note

Both the FMLA and ADA allow employers to request a doctor’s note to substantiate a need for a medical leave of absence. Doing so is an important step because it puts the decision about what the employee needs from a medical perspective into the hands of a doctor. It also provides guidance as to how long the employee likely needs to be away from work. These records should be maintained separately from the employee’s general employment file to prevent improper sharing of the employee’s medical information. 

Don’t forget your interactive process for ADA accommodations

If an employee requests a medical leave of absence due to a disability, it is best to start an interactive process. This process is meant to be a dialogue between you and the employee to determine whether their request is a reasonable accommodation and whether any alternative accommodations are possible. 

Keep in mind that the ADA requires individual consideration for reasonable accommodation requests. If you find yourself stuck—for instance with an employee who says they need time off to deal with a disability but does not have a doctor’s note stating they need this—it’s ok to allow leave as a temporary measure. You can approve a short leave while they seek a doctor’s evaluation of their condition.  

Conduct manager training

A medical leave of absence request is often confused with sick leave by managers. It is important to provide training on what the company allows in terms of medical leaves of absence. It is also important to give reminders to reach out to HR for help with these requests so that managers don’t approve or deny a request for leave out of line with policy. 

Don’t discount mental health conditions

Mental health conditions can be serious health conditions under FMLA, and disabilities under ADA. They also do not always manifest in ways that are obvious signs of illness. As a result, managing requests for a mental health medical leave of absence can be particularly tricky. It is important to avoid assuming that you know what is best for the employee. Defer to doctor requests where reasonable and engage in an interactive process if the employee’s condition requires a reasonable accommodation. 


Medical leaves of absence are protected by a patchwork of federal and state laws across the US. This can make establishing and sticking to a policy difficult. Educating yourself on the requirements for medical leave in your business can go a long way toward ensuring an effective and straightforward leave process.