Medical Leave Requests: What Employers Need to Know (FMLA, ADA, and Beyond)

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11/8/20253 min read

When an employee asks for time off to have surgery or recover from a serious health condition, it’s natural for business leaders to worry about coverage, productivity, and how long they’ll need to hold the job open.

But here’s the reality: medical leave isn’t just a matter of policy — it’s a matter of compliance and care. Whether you’re legally required to hold the position depends on several factors, including your company size, the employee’s eligibility, and the nature of the condition.

This guide breaks down what you need to know.

Start with the Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act (FMLA) provides eligible employees with up to 12 weeks of unpaid, job-protected leave per year for certain medical and family reasons — including major surgery, childbirth, or caring for a seriously ill family member.

To qualify:

  • Your company must have 50 or more employees within a 75-mile radius.

  • The employee must have worked for you for at least 12 months.

  • They must have logged at least 1,250 hours in the past 12 months.

If all criteria are met, here’s what you must do:

  • Approve up to 12 weeks of unpaid leave for the medical condition.

  • Continue their group health insurance under the same terms as active employees.

  • Reinstate the employee to their same (or equivalent) position when they return.

Important: You cannot terminate or penalize an employee for taking protected FMLA leave. Doing so could lead to serious legal exposure.

If You’re Not Covered by FMLA

If your business has fewer than 50 employees, FMLA doesn’t apply. But that doesn’t mean you can deny the request without risk.

You still need to consider your obligations under the Americans with Disabilities Act (ADA) — and, in North Carolina, the North Carolina Persons with Disabilities Protection Act (NCPDPA), which mirrors federal protections.

Under the ADA, employers with 15 or more employees must provide reasonable accommodations to qualified employees with disabilities — and that can include a short period of unpaid medical leave.

So, even if FMLA doesn’t apply, denying time off could still violate disability laws if:

  • The surgery or recovery relates to a medical condition that qualifies as a disability.

  • The employee can perform their essential job functions after recovery.

  • The leave wouldn’t cause undue hardship to your business.

In plain terms: granting a few weeks off for recovery is often both legally and ethically the right move.

What About Paid Time Off or Disability Benefits?

If your organization offers paid time off (PTO) or short-term disability coverage, employees can typically use those benefits to cover their income during medical leave.

Here’s how they often work together:

  • PTO can be applied first, according to your company’s policy.

  • Short-term disability insurance may replace a percentage of wages during recovery.

Make sure your policies clearly explain how PTO, sick leave, or disability benefits interact with FMLA or unpaid medical leave.

Best Practices for Managing Medical Leave

Even when you’re not legally required to approve leave, it’s good practice to handle these requests with consistency and compassion.

Here’s what to do:

  1. Request medical documentation. Ask for a written statement from the employee’s healthcare provider confirming the need for leave and expected recovery timeline.

  2. Document everything. Keep a record of the request, your response, and any supporting documentation. This protects both your business and the employee.

  3. Be consistent. Handle all medical leave requests the same way, regardless of position or performance. Inconsistency can lead to discrimination claims.

  4. Communicate clearly. Outline expectations for check-ins, benefits continuation, and return-to-work plans.

  5. Plan for coverage. Cross-train team members or use temporary staff to ensure business continuity during the leave period.

North Carolina Employers: A Quick Note

North Carolina doesn’t have its own family or medical leave law for private employers, but it does follow the federal FMLA and ADA standards.

However, the state does require employers to comply with its Wage and Hour Act, meaning any time-off policy you create must be followed exactly as written.

If your handbook says you’ll consider unpaid leave “on a case-by-case basis,” you must do so consistently to avoid potential claims of unfair treatment.

Compassion and Compliance Can Coexist

You can protect your business and your employees at the same time. When handled properly, medical leave situations reinforce your culture of trust and respect. They show employees that your organization values people—not just productivity.

Remember, the goal isn’t just to follow the law; it’s to lead with integrity.

The Bottom Line

If the employee qualifies for FMLA, their job is protected. If they don’t, evaluate the situation under the ADA or as a reasonable unpaid leave request.

When in doubt, document, communicate, and get guidance before making a final decision. The right approach protects your organization legally—and strengthens your culture long-term.

Next Step

If you’re unsure whether your business is handling leave requests properly or your policies need a refresh:

📅 Schedule a call with me and let’s review your leave practices together. I’ll help you build a compliant, compassionate system that supports your people and protects your business.

About Cultivate HR Consulting

At Cultivate HR Consulting, I help leaders take the guesswork out of HR. With the right policies and processes, you’ll not only stay compliant—you’ll also create a workplace where employees thrive.

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