Medical leave of absence

Medical Leave of Absence Explained

Life can take unexpected turns, and sometimes health needs must come first. In the U.S., when employees face illness, injury, or family member care responsibilities, they may be eligible for protected time off—a medical leave of absence—to recover or care for a loved one. Understanding these protections is essential for both employees and employers to safeguard jobs, rights, and well-being.

This article explains medical leave of absence as it applies to the United States. If you are an employee or employer in a different country, consult local laws or official resources for country-specific guidance.

Types of Medical Leave and Eligibility

Type of Leave	Eligibility Criteria	Duration (Typical)	Governing Entity / Program
FMLA (Family and Medical Leave Act)	12 months of employment, 1,250 hours worked in last 12 months, works for covered employer	12 weeks (unpaid)	Department of Labor (federal)
Parental Leave	Varies by employer and state; often overlaps with FMLA	6–12 weeks (often unpaid)	Employer/state
Disability Leave	Medical certification required; often tied to short-term/long-term disability (STD/LTD) policies	Varies by policy	Employer/insurance
Military Family/Caregiver Leave	FMLA-eligible, active duty military member, or injured/ill service member	Up to 26 weeks (caregiver)	FMLA/Department of Labor
Workers’ Compensation	Work-related injury/illness, medical certification	Varies	State government
Paid Family Leave	Meets state program criteria (e.g., CA, NY, WA, NJ, RI, MA, CT, CO, DC, OR, MD)	4–12 weeks (paid)	State programs

FMLA provides up to 12 weeks of unpaid, job-protected leave per year for eligible employees of covered employers (private sector employers with 50+ employees, public agencies, schools). Reasons include serious health condition, childbirth, adoption, foster care, or care for a spouse, child, or parent with a serious health condition. Health insurance must be maintained during leave if normally provided.
Parental leave is sometimes offered by employers beyond FMLA, and some states mandate paid family leave for bonding with a new child.
Disability leave is not a federal entitlement; it is typically employer-provided (STD/LTD) or state-mandated (in some states). The federal Americans with Disabilities Act (ADA) requires reasonable accommodations, which may include leave, for employees with disabilities.
Military caregiver leave under FMLA allows up to 26 weeks of unpaid leave to care for a covered service member with a serious injury or illness.
Workers’ Compensation is state-regulated and covers leave for work-related injuries/illnesses, often with partial wage replacement.
Paid Family Leave and Paid Medical Leave are available in several states (CA, NY, NJ, RI, WA, MA, CT, CO, DC, OR, MD); benefits, eligibility, and duration vary by state.

Governing Policies and Regulations

Federal law (FMLA) sets the baseline, but many states supplement or exceed these minimums, especially regarding paid leave. Employers must comply with both federal and state laws where they overlap. The Department of Labor enforces FMLA compliance, while state agencies manage paid leave and workers’ compensation programs.

Leave requests typically require documentation, such as a medical certification for FMLA, and must be made in advance when possible. Employers may have internal leave policies that offer additional benefits (e.g., paid time off, extended leave) but cannot provide less than what federal or state law requires.

The Leave Process

Request Submission: Employees notify their employer of the need for leave and provide required documentation.
Eligibility Review: Employers confirm eligibility under FMLA, state law, and company policy.
Notification: Employers inform employees of approval, terms, and expectations for benefits continuation.
Leave Period: For FMLA, health insurance continues under the same terms as if the employee were working, provided premium payments are maintained.
Return to Work: Employees are generally entitled to return to their same position or an equivalent one, with some exceptions. Medical clearance may be required in certain cases.

Compensation and Employment Impact

FMLA Leave: Unpaid, but job-protected. Health benefits continue if premium payments are maintained.
Paid Leave: Available in some states (e.g., CA, NY) and through some employer policies.
Disability Leave/Workers’ Compensation: May provide partial wage replacement, depending on the program.
Employment Status: Generally protected during leave, but not guaranteed if leave entitlement is exhausted or documentation requirements are unmet.

Employer Obligations and Compliance

Employers must adhere to FMLA and relevant state laws, maintain confidentiality, and avoid retaliation. They are required to provide notice of rights and obligations and must restore employees to their position or an equivalent one after leave.

Special Considerations

ADA Accommodations: If an employee’s condition qualifies as a disability under the ADA, employers must engage in an interactive process and may need to provide leave as a reasonable accommodation beyond FMLA.
Intermittent/Reduced Schedule Leave: Allowed under FMLA with proper certification.
Health Benefits: Continuation during protected leave is required under FMLA; state paid leave programs may also require benefits continuation.
Nontraditional Family and Military Cases: FMLA covers a defined set of family member relationships and military situations.
State/Local Variations: State laws can provide more generous benefits than federal law; employers must comply with the most favorable applicable law.

Conclusion and Best Practices for Medical Leave of Absence

Employees should review both federal and state regulations, plus their employer’s policies, before requesting leave. Timely communication and documentation are key to a smooth process. Employers benefit from clear, compliant policies and supporting employees through leave. By staying informed and proactive, both parties can manage medical leave confidently.