Leaves of Absence and Medical Issues: What Employers Need To Know Before Problems Escalate

May 14, 2026
By Michele Schechter

Employers today are navigating a workplace that looks very different from the one that existed even five years ago:

At the same time, employers are trying to balance compassion with operational realities. Businesses still need people to show up, customers still expect service, and managers still have deadlines to meet. That tension is exactly why laws like the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA), state paid leave laws, workers’ compensation statutes, and OSHA regulations continue to evolve.

Charles Krugel of the Law Offices of Charles Krugel explains that employers often underestimate how quickly a leave or medical issue can turn into a legal issue if policies are unclear or inconsistently applied. Krugel emphasizes the importance of practical compliance and clear communication between employers and employees.

Why Leave Laws Exist in the First Place

“People get sick, people have families, they experience life events,” notes Max Barack of Garfinkel Group. “Historically, the workplace treated those as liabilities, not understandable realities of life.”

That philosophy is at the heart of modern employment leave laws.

The FMLA provides eligible employees with up to 12 weeks of unpaid, job-protected leave for qualifying medical and family reasons. The ADA requires employers to provide reasonable accommodations to qualified employees with disabilities unless doing so would create an undue hardship.

The two laws frequently intersect. An employee with a serious medical condition may

qualify for FMLA leave while simultaneously being protected by the ADA. For employers, that overlap creates both opportunity and risk. Employers must carefully distinguish between leave obligations under the FMLA and accommodation obligations under the ADA because the laws impose different eligibility standards and different employer duties.

Who Is Covered by the FMLA?

The FMLA applies to private employers with 50 or more employees. Eligible employees generally must have worked for the employer for at least 12 months, have logged at least 1,250 hours during the previous 12 months, and work at a location where the employer has at least 50 employees within a 75-mile radius.

Qualifying reasons for leave under the FMLA include the employee’s own serious health condition, caring for a spouse, child, or parent with a serious health condition, birth or adoption of a child, and certain military-family leave situations.

The phrase ‘serious health condition’ is one of the most important concepts in the statute.

Under the FMLA, a serious health condition generally involves either inpatient care or continuing treatment by a healthcare provider. Continuing treatment may include chronic conditions, pregnancy-related incapacity, multiple treatments, or an incapacity lasting more than three consecutive days combined with ongoing medical treatment.

Who Is Covered by the ADA?

The ADA applies to private employers with 15 or more employees, along with state and local government employers, employment agencies, and labor organizations.

Unlike the FMLA, which focuses primarily on leave rights, the ADA is designed to prevent discrimination against qualified individuals with disabilities and to require employers to provide reasonable accommodations when necessary.

To qualify for protection under the ADA, an employee generally must:

  • Have a physical or mental impairment that substantially limits one or more major life activities;
  • Have a record of such an impairment; or
  • Be regarded as having such an impairment.

Major life activities can include walking, seeing, hearing, concentrating, communicating, lifting, breathing, working, and caring for oneself. Helen Bloch of the Law Offices of Helen Bloch, P.C. notes that the ADA reaches far beyond obvious physical disabilities. Mental health conditions such as anxiety, depression, PTSD, and substance abuse disorders may also qualify under certain circumstances.

One of the most important concepts under the ADA is the idea of a ‘qualified individual.’ That means the employee must still be able to perform the essential functions of the job, with or without a reasonable accommodation.

Reasonable accommodations can include:

  • Modified work schedules;
  • Remote work arrangements;
  • Specialized equipment;
  • Additional unpaid leave;
  • Reassignment of non-essential job duties; or
  • Changes to workplace policies.

The ADA does not require employers to eliminate essential job functions or create entirely new positions. Employers are not required to approve accommodations that fundamentally alter the nature of the job.

The Interactive Process

Once an employer becomes aware that a medical issue may be affecting an employee’s ability to work, the employer may have a legal obligation to begin what is known as the ‘interactive process.’ This process requires employers and employees to communicate in good faith to determine whether a workable accommodation exists.

One of the biggest mistakes employers make is assuming employees need to use specific legal language before the company’s obligations under the ADA begin. They do not. Katie Rinkus of the Prinz Law Firm warns employers not to wait for employees to formally ask for a ‘reasonable accommodation’ under the ADA. Rather, employers should train supervisors to understand when an employee may be requesting an accommodation without necessarily using that exact term.

According to the Equal Employment Opportunity Commission (EEOC), employers must engage in this process in good faith when evaluating accommodation requests under the ADA. The EEOC has also emphasized that ADA and FMLA obligations frequently overlap and should be analyzed together rather than in isolation.

The process itself is highly fact-specific. Employers may request medical documentation, discuss alternative accommodations, assess whether the employee can perform essential job functions, and evaluate whether the accommodation would create an undue hardship.

But employers cannot simply dismiss requests without discussion. They have to engage.

Hot Topics

Remote Work and Reasonable Accommodation

Remote work remains one of the most heavily litigated accommodation issues following the pandemic. Courts generally focus on whether physical presence is truly necessary to perform the essential functions of the job. Factors such as the employee’s duties, the need for in-person collaboration, supervision requirements, access to equipment or confidential materials, and customer interaction may all play a role in the analysis.

That does not mean every remote-work request must be granted. Employers still retain the right to define essential job functions and determine whether in-person attendance is necessary for operational reasons. However, employers should be prepared to clearly explain why a requested accommodation would create operational difficulties, reduce productivity, interfere with teamwork, or otherwise impose an undue hardship on the business.

Vaccination Policies

Generally speaking, employers can require vaccinations in many workplace settings, particularly when workplace safety is involved. Healthcare employers often face additional regulatory obligations from agencies like OSHA or the Centers for Medicare & Medicaid Services. But mandatory vaccination policies also create accommodation issues. Employees may request exemptions based on medical conditions or sincerely held religious beliefs.

This issue became more complicated after the Supreme Court’s 2023 decision in Groff v. DeJoy, which strengthened protections for religious accommodations under Title VII. This decision heightened the burden on employers attempting to prove ‘undue hardship’ when denying religious accommodations.

Final Thoughts

As laws and regulations continue to evolve, employers must be prepared to respond thoughtfully, consistently, and legally when employees raise medical or accommodation concerns.

The key takeaway for employers is simple: proactive compliance matters. Clear policies, trained managers, consistent documentation, and a willingness to engage in the interactive process can significantly reduce legal risk while also supporting employee retention and workplace stability.

Employees also have responsibilities. They generally must provide sufficient notice of the need for leave, cooperate with certification requirements, and comply with reasonable employer procedures for requesting leave.

Ultimately, employers who approach leave and medical issues with both flexibility and structure are far better positioned to avoid disputes before they escalate into costly litigation.

To learn more about this topic, view Leaves of Absence & Medical Issues. The quoted remarks referenced in this article were made either during this webinar or shortly thereafter during post-webinar interviews with the panelists. Readers may also be interested to read other articles about Employment & Labor Dynamics.

This article was originally published on May 14, 2026.

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