When an employee needs time away from work to cope with their health, their situation may trigger legal protections. Below, we walk you through the laws that can kick in when someone at your organization takes a medical leave of absence.
The Family and Medical Leave Act
The Family and Medical Leave Act (FMLA) is the federal law that will most often govern your employees’ medical leaves of absence. This law provides employees with 12 weeks of unpaid, job-protected leave. Employees can use this leave to deal with their own serious health condition, which can include mental and physical illnesses.
To access FMLA leave, employees must be eligible. They must have worked for a covered employer for at least 12 months, accumulating more than 1,250 hours. They must also work at a location with more than 50 employees within 75 miles.
The Americans with Disabilities Act
The Americans with Disabilities Act (ADA) may also come into play when employees take a medical leave of absence. The ADA requires employers to offer reasonable accommodations to employees with disabilities. When an employee has a condition that warrants time off, the ADA may require employers to provide it.
Employees may need leave as an accommodation in order to attend appointments, get medical treatment, or receive treatment associated with their disability. The ADA may require employers to allow employees to use accrued leave as an accommodation. Most confusingly, extra FMLA leave can also be an accommodation under the ADA.
The ADA applies to U.S. employers with more than 15 employees. Because its coverage is broad, it’s important that employers understand how to comply with the ADA’s requirements.
The Pregnant Workers Fairness Act
The Pregnant Workers Fairness Act (PWFA) is a newer federal law that covers employees with medical conditions that are related to pregnancy. Like the ADA, the PWFA requires employers to provide accommodations.
While these accommodations can take the form of leave, the PWFA encourages employers to offer it only as a last resort. Employers should engage in the interactive process and attempt to find accommodations that enable employees to remain working, if at all possible.
The PWFA is one of the fastest-growing drivers of accommodations requests. In AbsenceSoft’s 2026 State of Leave and Accommodations report, 33% of HR leaders cited pregnancy-related requests as a top reason for accommodations.
State Medical Leave Laws
A growing spate of state leave laws challenge employers administering medical leaves of absence. More than 20 states maintain their own paid family and medical leave programs. When employers have employees in these states, they must consider their laws in addition to the federal statutes that apply.
State-specific laws come with their own specific requirements, durations, and pay rates. While they vary significantly from each other, they also share striking similarities, creating confusion for HR teams and employers.
This confusion is worse for the 41% of employers that still manage state leave manually, using tools like spreadsheets and email. Multi-state employers face significant complexity in leave administration. Those that choose to manage this complexity with manual tools are creating major compliance risks.
Who Is Eligible for Medical Leave?
Determining an employee’s medical leave eligibility can be challenging. For 31% of HR leaders, eligibility calculation is a top leave challenge, according to AbsenceSoft research.
Eligibility depends on a few factors. First, it’s crucial to consider the mechanism providing the leave. A company policy will lay out its own rules spelling out who can take leave and for what reasons. Often, company policies will offer more generous provisions compared to state and federal laws. Employers use these policies to attract and retain talent.
In addition to employer policies and benefits, employees can also get access to medical leave through legislation. Eligibility for leave provided by state law varies statute by statute. For instance, workers in Connecticut are only eligible for the state’s paid sick leave program if they’ve earned at least $2,325 during their highest earning quarter and have been working for their current employer for at least 12 weeks.
Federal laws like the ADA and FMLA have their own criteria for eligibility, too. The ADA only applies to workers who have qualified disabilities, a physical or mental impairment that substantially limits one or more major life activities.
The Requirements for FMLA Medical Leave
While the ADA does not come with a tenure requirement, the FMLA does. To be protected by the FMLA, employees need to have worked for their employer for 12 months. They can accumulate this time over a seven-year period. They also must have worked 1,250 hours during the 12 months prior to the time of their leave.
There are a few additional qualifications workers must meet to take sick leave under the FMLA. First, they must have what the FMLA calls a serious health condition to take medical leave. The law defines a serious health condition as “an illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider.” These conditions can include physical or mental impairments.
Common qualifying conditions include:
- Cancer
- Recovery from surgery
- Chronic conditions like diabetes, asthma, and arthritis
- Mental health disorders like depression and anxiety
- Pregnancy complications
It’s worth noting that mental health remains a significant driver of leave requests. In 2026, more than a third of HR leaders said it was one of the top three reasons employees requested leave. Mental health was the top driver for accommodations, however. They may ask for leave as an accommodation to their mental health.
How Long Can You Take Medical Leave?
The answer to this question is not straightforward. The length of an employee’s medical leave almost always depends on their particular situation: the policies and laws that apply to them, the details of their employment, the prognosis of their health condition.
Here’s a quick breakdown of how much medical leave employees can take under common categories of leave:
- FMLA: The FMLA provides up to 12 weeks of leave in a 12-month period.
- ADA: The ADA does not impose a fixed limit on leave. In fact, the ADA sometimes provides additional FMLA leave as an accommodation. It’s all based on what’s reasonable, determined on a case by case basis.
- State laws: The length of medical leave provided by state leave laws vary, though 12 weeks is a common length. The California Family Rights Act gives eligible employees access to 12 weeks of leave, for example. Similarly, the Maine Paid Family and Medical Leave also grants employees up to 12 weeks of leave.
It’s important to remember that employees can often take sick leave intermittently. Employees with conditions that flare up from time to time often need to take leave in small episodes, rather than one continuous period.
Intermittent leave is notoriously difficult to track. In fact, it’s one of HR’s top management challenges, according to AbsenceSoft’s 2026 report. To make intermittent leave easier to administer, consider using leave management software. Platforms like AbsenceSoft can track intermittent leave down to the minute, automatically and accurately decrementing time from an employee’s allotment.
What Does a Medical Leave of Absence Process Look Like?
Even in straightforward cases, HR needs to complete a lengthy set of steps to administer an employee’s medical leave. From taking care of intake tasks to executing an employee’s return-to-work plan, leave managers must check off seven distinct steps for each case.
- Step 1: Employee requests leave
This step isn’t as simple as it seems. Forty-four percent of employees go to their manager to request leave, according to AbsenceSoft’s data. The remaining employees contact HR in any number of ways: email, slack, word of mouth, to name a few. - Step 2: HR determines applicable laws and eligibility
For most HR professionals, this step is one of the hardest. The ever-changing leave law landscape in the U.S. makes determining eligibility both difficult and risky, especially if you’re managing leave manually. - Step 3: Required notices and paperwork sent
The FMLA and other laws include specific timelines that regulate when employees must receive certain pieces of information regarding their leave request. It can be tricky to manage these deadlines, but leave management software can automate that process. - Step 4: Medical certification collected and reviewed
Different laws impose different requirements regarding medical certification. Under the FMLA, employers can require an employee to complete a medical certification that verifies their need to take medical leave. - Step 5: Leave tracked
Whether an employee is taking leave continuously, intermittently, or through a reduced schedule, it’s essential that HR track their time off. Employees’ time away must be decremented from each worker’s time bank properly, something leave management platforms can do automatically. - Step 6: Pay calculated
A whopping 44% of employees in 2026 reported confusion or issues with pay and benefits during their leave. Employers can avoid these problems by using software that includes payroll calculations. - Step 7: Return-to-work planned
HR can’t forget about an employee’s return to work. Accommodations are a key consideration during this step. Physical illness and injury is the No. 1 reason for leave and a top driver of accommodation requests. That means it’s common for HR to continue following up with employees to ensure they have the support they need as they transition back to office life.
What Makes Medical Leave Management So Hard?
Medical leave is challenging to administer for several reasons. When you receive a request for medical leave, it joins your ever-increasing caseload. Leave requests are up for the third year in a row, according to AbsenceSoft data. Of the HR leaders who reported an increase in their cases, 66% said their load grew by more than 20%.
As HR manages more cases, it’s also fielding cases that are more complicated. Often, it’s the cases themselves that are complex. When employees take sick leave for chronic conditions, for example, their leave doesn’t come with a predictable end date. When they do return to work, they may need more time off, intermittent leave, a reduced schedule, an accommodation, or a combination of these resources.
As if the details of each case aren’t complicated enough, there’s also the legal landscape to contend with. On a federal level, HR must tease out how laws like the FMLA, ADA, and PWFA apply to each case, as they often overlap. It’s important to consider state laws, too. Employers operating in multiple states have some of the most difficult situations, as they have to keep up with legal developments in several jurisdictions at one time. Despite these challenges, 41% of employers track state leave with manual tools like spreadsheets.
Then there are the finer details. Your team is responsible for determining employees’ pay, planning their return to work, and keeping their manager in the loop. These small details often give way to big problems. Forty-four percent of employees reported confusion with their pay and benefits during their leave of absence, for example.
These issues don’t just cause frustration. When employees have poor experiences with a leave of absence, they’re more likely to quit. AbsenceSoft research found that 40% of employees who were dissatisfied with how their leave went considered quitting their job.
How AbsenceSoft Helps HR Teams Manage Medical Leave
Medical leaves of absence are contributing to your caseload and your stress levels. When employees ask you about taking a leave of absence for their cancer, their chronic pain, or their depression, you’re happy to help. But you’re also worried about when the process will break down. Without more resources, it’s almost inevitable.
When you implement leave management software like AbsenceSoft, you get the efficiency and expertise you need to manage every case with consistency and compassion. AbsenceSoft offers:
- Built in compliance: ACE Policy Library tracks 200+ federal and state leave laws, with automatic updates that track ever-changing legislation. With AbsenceSoft, there’s no manual tracking required.
- Automatic eligibility calculations: Instant and automatic eligibility calculations eliminate one of HR’s top pain points while also reducing costly errors.
- Intermittent leave tracking: Now-and-then leave is some of the hardest to track. AbsenceSoft’s platform tracks it automatically and manages in one place.
- Pay calculation module: AbsenceSoft coordinates state benefits and company pay and generates payroll files with one click, directly addressing the No. 1 driver of poor leave experiences.
- End-to-end visibility: Our platform gives you insight from intake through return to work. This includes any accommodations needed post-leave, as medical leave and accommodations are increasingly intertwined.
What Is A Medical Leave of Absence? It’s Easy, With AbsenceSoft
Medical leave is one of the most common types of leave HR manages. It’s also one of the most complex, and it’s only getting more complicated with time.
It’s more important than ever to get medical leave right. Employers are facing an increasingly challenging legal landscape, making compliance both challenging and important. Employers also can’t afford to let medical leave sour their relationship with employees. Simple mistakes can ruin an employee’s leave of absence, causing them to disengage from their work and even seek new employment.
With AbsenceSoft, you can optimize your approach to medical leave and every other type of leave. Schedule a demo today to see how AbsenceSoft can help your team handle medical leave, all the way from intake to return to work.
FAQs
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Medical leave can be the same thing as FMLA. The FMLA provides workers unpaid, job protected leave for a variety of reasons, including the need to recover from their own serious illness or injury. The FMLA provides leave for other reasons, however, including bonding with a new child and caring for a family member with a serious health condition. Workers can also take medical leave outside of the FMLA. A number of states provide medical leave, and many employers also maintain policies with medical leave provisions.
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Yes. If an employee isn’t eligible for medical leave under federal law, state law, or company policy, an employer may be able to deny their request. But employers should remember that they may be required by laws like the ADA and PWFA to provide medical leave as an accommodation, even if the employee isn’t otherwise eligible.
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It depends. Some employers maintain policies that provide paid medical leave. Workers may also be eligible for paid medical leave under state law. Currently, however, there is no federal law that provides paid medical leave.