Medical Leave of Absence: What It Means for Employers

What it means in practice

What the term covers. A medical leave of absence is time off for the employee's own health: surgery and recovery, cancer treatment, a mental health condition, a chronic illness flare-up or substance abuse treatment. Several laws shape it. This page follows one from the first call-in to the return to work. For the law itself, see the Family and Medical Leave Act (FMLA); for income replacement, see disability leave; for pregnancy, see maternity leave; for leave types generally, see leave of absence.

Does the condition qualify under the FMLA? FMLA medical leave requires a serious health condition involving inpatient care or continuing treatment by a health care provider (29 CFR 825.113). Treatment includes exams to find out whether such a condition exists, but not routine physicals, eye or dental exams, and over-the-counter medicine or bed rest alone is not a regimen of continuing treatment. The Department of Labor's mental health fact sheet (May 2022) lists anxiety, depression and dissociative disorders as examples of chronic conditions and says a certification must support the need for leave but "a diagnosis is not required." Leave for substance abuse treatment may qualify, but absence because of using the substance does not, and a uniformly communicated substance abuse policy may still be applied (29 CFR 825.119).

Step 1: recognize the request. The first time, an employee need not mention the FMLA but must give enough information for the employer to tell it may apply, such as an overnight hospital stay. Calling in "sick" without more is not enough, and a later absence for the same reason must refer to the reason or the FMLA. A spouse or other responsible person may give notice if the employee cannot (29 CFR 825.303).

Step 2: request and review certification. The employer may require a medical certification, usually requested within five business days of notice, and must explain the consequences of not providing it. The employee has 15 calendar days (29 CFR 825.305). The Department's optional form is WH-380-E. A certification is incomplete when entries are blank and insufficient when answers are vague or non-responsive; the employer must say in writing what is missing and allow seven calendar days to cure it.

Step 3: clarify, authenticate or seek another opinion. Once a complete and sufficient certification is in hand, the employer may not ask the provider for more. It may contact the provider only to authenticate the form or clarify its meaning, through a health care provider, HR professional, leave administrator or management official, never the employee's direct supervisor. An employer with reason to doubt a certification may require a second opinion at its expense from a provider it does not regularly use, and if the two differ, a jointly chosen third opinion that is final and binding. The employee is provisionally entitled to FMLA benefits meanwhile, and the employer reimburses reasonable travel costs (29 CFR 825.307).

Step 4: designate the leave. Within five business days of having enough information, the employer must say whether the leave is designated as FMLA leave (29 CFR 825.300(d)); the optional form is WH-382. A fitness-for-duty certification covering the job's essential functions can be required only if the designation notice says so and includes the list of those functions (29 CFR 825.312).

What a certification may ask. Permitted content is the provider's details, the condition's start date and probable duration, appropriate medical facts (which may include symptoms, diagnosis, hospitalization and medication), information showing the employee cannot perform essential job functions, and, for intermittent leave, its medical necessity and expected frequency and duration. Nothing more may be required, it must relate only to the current condition, and the employee cannot be required to sign a release for direct provider contact (29 CFR 825.306). Under the GINA regulations, an FMLA certification request is a lawful request for medical information, and an employer that includes the safe harbor warning asking providers not to supply genetic information, including family medical history, is treated as receiving any such information inadvertently (29 CFR 1635.8(b)(1)).

Intermittent and reduced schedule leave. Leave for the employee's own condition may be taken in blocks or on a reduced schedule when medically necessary (29 CFR 825.202). For planned treatment, the employee must make a reasonable effort to schedule it without unduly disrupting operations (29 CFR 825.302(e)). The employer may temporarily transfer the employee to an available position with equivalent pay and benefits that better fits recurring absences, but not to discourage leave (29 CFR 825.204). Only time actually taken counts, in the employer's smallest leave increment, no more than one hour (29 CFR 825.205).

Recertification. Recertification may generally be requested no more than every 30 days, in connection with an absence; if the certification gives a longer minimum duration, such as 40 days, the employer waits for it to expire, and every six months is always allowed. Earlier requests are allowed if the employee seeks an extension, circumstances change significantly, or information casts doubt on the leave; the regulation's examples are migraine absences of four days when one to two were certified, and an employee on knee-surgery leave playing company softball. No second or third opinion may be required on recertification (29 CFR 825.308). A new certification may be required each leave year (29 CFR 825.305(e)).

Pay during the leave. FMLA leave is unpaid unless the employee chooses, or the employer requires, accrued paid leave to run at the same time under the employer's normal policy, and paid sick leave used for a condition that is not a serious health condition does not count against the FMLA entitlement (29 CFR 825.207). See sick leave pay. For exempt employees, the salary may be reduced proportionately for unpaid FMLA leave. As an illustration, an exempt employee paid $1,200 for a 40-hour week who takes four hours of unpaid FMLA leave may have 10 percent, $120, deducted, following the regulation's example (29 CFR 541.602(b)(7)).

When the FMLA does not apply or runs out. The EEOC treats a request for leave or more leave for a medical condition as a request for reasonable accommodation under the Americans with Disabilities Act (ADA). In its examples, an employee with three months of service who needs four weeks of treatment, and a 25-hour-a-week employee not eligible for the FMLA who needs one day a week for three months, must both get unpaid leave unless it causes undue hardship. A doctor's-note rule that applies to everyone is allowed, but demanding a psychiatrist's note from one employee when the policy requires none violates the ADA. When an employee granted three months asks for 30 more days, the employer may ask the provider about the need and the likelihood of return; with a fixed return date, it may check on progress but not demand periodic updates. The ADA allows an indeterminate amount of leave, barring undue hardship, but requires health coverage during leave only if other employees on leave receive it (29 CFR 825.702(b)).

Returning to work. A fitness-for-duty certification may be required only under a uniformly applied policy, only about the condition that caused the leave, and at the employee's cost. The employer may not delay the return while clarifying it or require a second opinion. For intermittent leave, it cannot be required for every absence, but may be required up to once every 30 days if reasonable safety concerns exist and the employee was told in advance (29 CFR 825.312). The EEOC says refusing to return a clerk with a 20-pound lifting restriction, when the job requires no such lifting, violates the ADA.

If the employee does not return. An employer may recover its share of health premiums paid during unpaid FMLA leave if the employee does not return, unless the reason is a continuing serious health condition or another circumstance beyond the employee's control, which the employer may ask to have certified within 30 days. Returning for 30 calendar days counts as returning (29 CFR 825.213).

Where states differ: Washington. State paid medical leave programs add wage replacement and sometimes separate job protection; these are examples, not a complete list. Washington's Employment Security Department says paid medical leave covers the employee's own serious health condition for workers with 820 hours in the qualifying period: up to 12 weeks in a claim year, 16 combined with family leave, or 18 with a pregnancy-related incapacity, at up to 90 percent of weekly pay with a 2026 maximum of $1,647 a week. Employers may not require other leave first and must give written notice within five days once an employee has been absent seven consecutive days for a possibly covered reason. From January 1, 2026, employers with 25 or more employees must restore employees with 180 days of service and maintain health benefits; ESD lists the threshold falling to 15 in 2027 and 8 in 2028. Employers may count FMLA leave against that job protection with written notice.

Where states differ: Massachusetts. The Department of Family and Medical Leave says employees may take up to 20 weeks of paid medical leave, and 26 weeks combined with family leave, in a benefit year starting the Sunday before leave begins. Eligibility turns on earnings ($6,300 in the previous 12 months), not tenure, and employers not covered by the FMLA may be covered. A 7-day unpaid waiting period counts against the leave, and PTO may be used during it. Employers must maintain health insurance and restore the same or an equivalent position, and a negative change during leave or within six months after is presumed retaliatory.

Example: intermittent treatment. As an illustration, a full-time employee on a 40-hour week takes eight hours of FMLA leave every other Friday for treatment over 26 weeks, or 13 days. Since eight hours out of 40 is one-fifth of a week, that uses 2.6 workweeks, leaving 9.4 of 12. If the employee were normally required to work 48 hours and the condition limited them to 40, the eight lost hours would be one-sixth of a week (29 CFR 825.205).

Example: a Massachusetts benefit. As our own illustration of the stated 2026 formula, an employee with an individual average weekly wage of $1,500 has the portion up to 50 percent of the $1,922.48 state average weekly wage ($961.24) replaced at 80 percent, or $768.99, and the remaining $538.76 at 50 percent, or $269.38, for about $1,038.37 a week, below the $1,230.39 cap. DFML says PTO may top off the benefit only up to the average weekly wage, here no more than $461.63 a week.

Records and confidentiality. FMLA records must be kept at least three years, with certifications and medical histories in separate confidential files (29 CFR 825.500). The DOL fact sheet says supervisors may be told of the need for leave and of work restrictions. Tracking certification deadlines and return dates is part of absence management.

Questions employers ask. Can a supervisor call the employee's doctor? No (29 CFR 825.307(a)). Can leave be denied while a second opinion is pending? No; the employee is provisionally entitled to FMLA benefits (29 CFR 825.307(b)). Must the certification name a diagnosis? The DOL fact sheet says no. Does state paid medical leave reduce FMLA time? Washington's ESD says the two usually run concurrently and FMLA use does not reduce the Paid Leave benefit.

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