What is a Medical Leave of Absence?
A medical leave of absence is an extended period away from work for an employee to address their own serious health condition. Unlike a sick day for a cold or minor illness, medical leave typically involves significant health issues requiring multiple days or weeks off work: surgery, cancer treatment, mental health crisis, serious injury, or chronic condition flare-ups.
Medical leave may be protected under the Family and Medical Leave Act, state laws, or employer policy. Understanding when medical leave is legally protected versus discretionary helps managers navigate these situations without legal exposure.
FMLA Medical Leave: The Federal Baseline
The Family and Medical Leave Act provides eligible employees up to 12 weeks of unpaid, job-protected leave for serious health conditions. To qualify:
Employee must:
- Work for a covered employer (50+ employees within 75 miles)
- Have worked 1,250 hours in the past 12 months
- Have worked for the employer for 12 months
Serious health condition includes:
- Inpatient care (overnight hospital stay)
- Incapacity for more than 3 consecutive days plus continuing treatment
- Chronic serious health conditions requiring periodic visits
- Pregnancy complications
- Permanent or long-term incapacity
The DOL provides detailed guidance on what constitutes a serious health condition.
When Employees Don't Qualify for FMLA
Many hourly employees in restaurants and retail don't meet FMLA eligibility requirements:
- New employees (less than 12 months tenure)
- Part-time employees (under 1,250 hours/year)
- Businesses under 50 employees
These employees may still have state law protections or company policy that provides medical leave. Check state requirements, which might have more generous legal benefits than federal FMLA.
How Medical Leave Works in Practice
Step 1: Employee Notice
Your employee (or someone on their behalf) notifies you that they need medical leave. Notice doesn't need to mention "FMLA"; simply saying "I need time off for surgery" or "I'm having a mental health crisis" triggers employer obligations.
Employer responsibility: Provide FMLA paperwork within 5 business days if you think the situation might qualify.
Step 2: Medical Certification
You may require your employee to submit medical certification from their healthcare provider. Form WH-380 is standard, but any documentation with necessary information suffices.
What you can require: Nature of condition, expected duration, whether employee is unable to work, periodic treatment schedule.
What you cannot require: Specific diagnosis, complete medical records, or information beyond what's necessary to verify FMLA need.
Step 3: Designation
You designate the leave as FMLA-protected in writing. Once designated, a 12-week clock starts, and your employee has job protection.
Step 4: Leave Period
Your employee takes their leave. You maintain health insurance for the employee, and they may use accrued paid leave concurrently with FMLA.
Step 5: Return to Work
Your employee returns to the same position or an equivalent role. You cannot terminate or discipline the employee for taking FMLA leave.
Common Medical Leave Scenarios
Continuous Leave: Surgery and Recovery
Restaurant manager needs gallbladder surgery and will be out for 4 weeks total.
Manager's experience: Receives full job protection. Health insurance continues. Position held open.
Business impact: Need temporary coverage for 4 weeks. Promote assistant manager temporarily or hire temp manager.
Intermittent Leave: Chemotherapy
Retail employee undergoing chemotherapy needs every Friday off for 6 months plus occasional absences for side effects.
Employee's experience: Can take FMLA intermittently. Each Friday counts toward a 12-week allotment (36 Fridays = 7.2 weeks used).
Business impact: Unpredictable schedule. Must accommodate the employee, but they can transfer to a similar position where intermittent absence is less disruptive (with employee agreement).
Reduced Schedule: Post-Surgery Recovery
Auto technician returns from medical leave but can only work 4 hours/day for 2 weeks during physical therapy.
Employee's experience: FMLA covers reduced schedule. Four hours off daily counts toward 12-week entitlement.
Business impact: Part-time coverage needed. May need to adjust scheduling across the team.
Managing Operations During Medical Leave
Before leave: Cross-train employees for critical functions. Document processes. Identify backup coverage.
During leave: Communicate with remaining staff about temporary changes. Avoid overworking those covering for the absent employee.
Stay-in-touch: Periodic contact is acceptable to discuss return-to-work timing, but you cannot pressure your employee to return early.
Return planning: Two weeks before expected return, confirm their return date and any restrictions. If your employee needs extended leave beyond FMLA, explore options: unpaid personal leave, disability accommodation, or separation.
What Happens When Leave Exceeds 12 Weeks?
FMLA provides 12 weeks. What if an employee needs more time?
Option 1: ADA accommodation: If extended leave is reasonable accommodation for disability, you may be required to provide it. Courts have found that 2-4 additional months may be reasonable in some circumstances, but not indefinite leave.
Option 2: Company policy: Some employers provide additional unpaid leave beyond legal requirements.
Option 3: Separation: If your employee cannot return, and no accommodation is reasonable, their position may be filled. However, consult legal counsel before terminating anyone who has exhausted FMLA; disability discrimination claims are common, disruptive, and expensive.
Common Employer Mistakes
Discouraging leave requests: "Are you sure you need to take this leave? We're really short-staffed." This is interference with FMLA rights.
Requiring perfect attendance: Attendance policies that don't exclude FMLA-protected absences violate the law.
Retaliating: Any adverse action taken because an employee used FMLA is illegal, even if other reasons exist.
Failing to maintain health insurance: An employer must continue health coverage during FMLA leave on the same terms as if the employee were working.
Not designating leave as FMLA: If you don't designate qualifying leave as FMLA, you lose the ability to count it toward the 12-week limit.
Medical Leave Beyond FMLA: State Laws
Several states provide paid medical leave or extend leave beyond 12 weeks:
Washington: Paid Family and Medical Leave provides for up to 12 weeks paid leave at partial wage replacement.
California: Paid Family Leave provides for up to 8 weeks of partial pay.
New York: Paid Family Leave provides for up to 12 weeks at 67% of average weekly wage.
Check your state requirements to confirm what applies to your business.
Documentation Requirements
Keep detailed records:
- Employee's leave request (date, reason, expected duration)
- FMLA notices provided to employee
- Medical certification received
- Leave designation letter
- Dates of leave taken (for intermittent leave, track each occurrence)
- Return-to-work date
- Any accommodation discussions
Poor documentation is the most common reason employers lose FMLA disputes.
The Bottom Line
Medical leave is a legal right for eligible employees with serious health conditions. Businesses that discretely handle medical leave professionally maintaining communication and planning for temporary coverage minimize disruption while complying with complex federal and state laws.
