What Is Sick Leave?

Sick leave (also called sick time or sick days) is paid or unpaid time off from work that employees can use when they are ill, need medical care, must care for sick family members, or face domestic violence, sexual assault, or stalking situations. Sick leave allows employees to recover from illness without losing income or jeopardizing their jobs. Unlike vacation time or personal leave, sick leave is specifically designated for health-related absences.

Key takeaways

Set accrual, carryover, and usage rules; track hours accurately.
Define allowable uses and documentation with privacy in mind.
Comply with state/local mandates; audit policies regularly.
Related: Time-off request and personal leave.

Research from the Bureau of Labor Statistics shows that 79% of private sector workers have access to paid sick leave, averaging 8 days per year for full-time workers. However, access varies dramatically by wage level: 95% of highest-wage workers have paid sick leave versus only 51% of lowest-wage workers. State and local mandates are closing this gap, with 18 states now requiring paid sick leave for all covered employees.

Types of Sick Leave

Warehouse team gathered for morning briefing near loading dock

Paid sick leave: Regular wages during illness. Sources: state/local mandate (18 states + DC), employer-provided, or union contracts. Typical: 5–10 days/year (employer) or 40–80 hours (state mandates). Reduces financial hardship, encourages staying home when contagious, prevents presenteeism.

Unpaid sick leave: Time off without pay via FMLA (12 weeks for serious conditions), state family leave laws, or employer discretion. Provides job protection, continued health benefits (FMLA), and reinstatement rights.

Short-term disability: 50–70% wage replacement for 3–6 months. Waiting period: 7–14 days (sick leave bridges gap). Funded by employer insurance or 11 state-mandated programs. Covers extended illness vs. sick leave’s short absences.

FMLA: Federal law providing 12 weeks unpaid for serious health conditions, childbirth, adoption, or military family leave. Eligibility: 1,250 hours worked in 12 months for 50+ employee organizations. Guarantees job protection and health insurance continuation.

State Paid Sick Leave Laws

18 states + DC mandate paid sick leave: Arizona, California, Colorado, Connecticut, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington. Common features: 1 hour per 30–40 hours worked, 40–80 hour caps, covers illness/family/DV, retaliation prohibited.

Sample requirements: California (1/30 hours, 48 accrual/24 use cap), New York (caps by size: 40 unpaid for 0–4 employees, 40 paid for 5–99, 56 paid for 100+), Washington (1/40 hours, 40 use limit), Colorado (1/30 hours, 48 cap, includes public health emergencies).

Local ordinances: Cities like Chicago, Dallas, Austin, NYC, Seattle exceed state law or fill gaps. Multi-jurisdiction employers need leave management systems for compliance tracking.

Sick Leave Accrual and Caps

Accrual methods: Hourly (1 hour per 30 worked = ~69/year for full-time), lump sum (full allotment upfront, simple but risky for early terminations), or hybrid (partial upfront, remainder accrues).

Cap types: Annual accrual cap (max earned per year), total balance cap (max carried, accrual stops when reached), and usage cap (max used per year, excess carries over). Example: 48-hour annual accrual, 80-hour balance cap, 40-hour usage cap.

Carryover: Required by most state laws (with balance caps); allows building bank for serious illness. Use-it-or-lose-it prohibited in mandate states, discouraged elsewhere (incentivizes presenteeism). Best practice: allow carryover with reasonable balance cap.

Allowable Uses of Sick Leave

Employee illness/injury: Acute illness (cold, flu, COVID), chronic conditions (diabetes, asthma), injury recovery, mental health (some jurisdictions). Doctor’s note may be required after 3+ days (no diagnosis disclosure).

Medical appointments: Doctor, dental, vision, mental health, preventive screenings. Advance notice required for scheduled appointments when possible.

Family care: Child, spouse/partner, parent (most states); some include grandparents, grandchildren, siblings. Covers illness, appointments, school/childcare closure due to health emergency.

Domestic violence/stalking: Medical care, counseling, legal proceedings, relocation, safety planning. Privacy protected; general statement sufficient.

Public health emergencies: School/childcare closure, quarantine orders, care facility closures (some states like Colorado). Check current state law for COVID-related provisions.

FMLA vs. Sick Leave

Sick leave: Short-term (hours to days), 5–10 days/year (employer) or 40–80 hours (state), paid, covers any illness/appointment/family care.

FMLA: Extended (weeks to months), 12 weeks/year, unpaid, serious health conditions only (incapacity 3+ days, chronic conditions, pregnancy complications). Eligibility: 1,250 hours worked, 50+ employee organization.

Job protection: FMLA guarantees restoration to same/equivalent position. Sick leave laws prohibit retaliation but may not ensure job restoration after extended absence.

Coordination: Paid sick leave may run concurrently with FMLA. Some employers require, others allow employee choice whether to use accrued leave or preserve it.

Sick Leave Compliance and Best Practices

Healthcare worker resting in clinic break room during shift break

Written policy: Include accrual rate/method, caps, allowable uses, covered relationships, notice/documentation requirements, carryover rules, coordination with FMLA/other leave. Publish in handbook, onboard, post notices, train managers.

Accurate tracking: Use automated systems for multi-state accrual, part-time/variable hours, exempt/non-exempt calculations. Provide self-service portals showing real-time balances.

Prevent retaliation: Cannot deny protected leave, discipline for use, count in attendance points, or require finding coverage. Document legitimate reasons for any adverse action near sick leave use. Distinguish protected from unprotected absences.

Privacy: General illness statement sufficient; can’t require diagnosis. Doctor’s note only for 3+ days or suspected abuse patterns (dates/fitness only). ADA: engage in accommodation process for disability-related absences.

Attendance policies: Exclude protected sick leave from no-fault point systems. Track separately from unprotected absences.

Culture: Normalize appropriate use, discourage presenteeism. Address abuse through investigation/documentation, not assumptions. Train managers on supportive responses and objective pattern tracking.

Sick Leave for Different Workforce Types

Full-time: 5–10 days (employer-provided) or 52–69 hours annually (state accrual at 1/30–40 hours). Low scheduling impact.

Part-time/variable-hour: Prorated by hours worked. State laws apply to all; track actual hours for accurate accrual using employee roster systems.

Shift workers: Last-minute call-offs disrupt coverage. Mitigate with cross-training, on-call pools, staggered shifts, and clear call-in procedures (time-off request for planned, phone for emergencies).

Exempt vs. non-exempt: Hourly employees accrue on actual hours. Salaried: assume 40 hours/week, grant lump sum, or pro-rate. Can’t dock exempt pay for partial-day absences except FMLA/first/last week.

Sick Leave Payout and Separation

Payout at termination: Most states don’t require (use-it-or-lose-it). Some require payout (California with unlimited PTO combining vacation/sick). Employer policy controls if law silent. Clearly state in policy; distinguish from vacation; track separately.

Rehire reinstatement: Some jurisdictions require restoring balance if rehired within 6–12 months. Document balance at termination; track rehire dates.

Sick Leave Trends and Future Outlook

Mandate expansion: 18 states + DC as of 2025; more expected. Multi-state employers face growing complexity. National standard would simplify but remains politically stalled.

COVID legacy: FFCRA (expired 2020) raised awareness of paid sick leave for public health, demonstrated feasibility, and set employee expectations. Some state COVID provisions continue.

Paid family leave integration: States adding comprehensive wage replacement programs (weeks to months) alongside sick leave (days). Employers must coordinate multiple leave types and eligibility rules.

Unlimited PTO compliance: State laws require tracking/carryover for sick leave. Unlimited policies must designate portion as sick or grant lump sum equivalent. California concern: unlimited PTO combining vacation/sick may require vacation payout at termination.

The Bottom Line

Sick leave is paid or unpaid time off for illness, medical appointments, family care, or domestic violence situations. No federal mandate exists (FMLA provides 12 weeks unpaid for serious conditions), but 18 states plus DC and numerous cities require paid sick leave, typically 1 hour per 30–40 hours worked with 40–80 hour caps.

Allowable uses include employee illness/injury, medical/preventive appointments, caring for sick family (child/spouse/parent; some states include grandparents/siblings), and DV/stalking situations. Documentation: doctor’s note only after 3+ days; can’t require diagnosis.

Best practices: create clear policies (accrual, caps, uses, notice, documentation), track accurately with automated systems, prevent retaliation, respect privacy, exclude protected leave from attendance points, and encourage appropriate use while documenting abuse patterns. Distinguish from FMLA (short-term paid vs. extended unpaid with job restoration).

Challenges: multi-jurisdiction compliance, FMLA coordination, part-time accrual calculations, payout at termination (varies by state). Trends: expanding mandates, paid family leave integration, unlimited PTO requiring careful sick leave compliance.

Try ShiftFlow’s leave management tools to track sick leave accrual across jurisdictions, manage time-off requests, coordinate coverage via employee rosters, and ensure compliant documentation.

Sources

U.S. Department of Labor – FMLA Fact Sheet
Bureau of Labor Statistics – Employee Benefits Survey
National Partnership for Women and Families – Paid Sick Days Statutes
National Conference of State Legislatures — Paid Sick Leave Overview: https://www.ncsl.org/labor-and-employment/paid-sick-leave
U.S. Department of Labor — State Labor Offices (official directory): https://www.dol.gov/agencies/whd/state

Frequently Asked Questions

What is sick leave?

Sick leave is paid or unpaid time off from work for personal illness, medical appointments, caring for sick family members, or addressing domestic violence/stalking situations. It may be required by state/local law (18 states mandate paid sick leave) or provided voluntarily by employers.

Is sick leave required by law?

No federal law mandates paid sick leave (FMLA provides unpaid leave for serious conditions). However, 18 states plus Washington DC and numerous cities require paid sick leave with typical accrual of 1 hour per 30–40 hours worked. Requirements vary—check state and local laws for your jurisdiction.

How much sick leave do employees get?

Varies by law and employer policy. State mandates typically require accruing 1 hour per 30–40 hours worked, capping at 40–80 hours per year. Employer-provided sick leave averages 5–10 days annually for full-time workers. FMLA provides up to 12 weeks unpaid for serious conditions.

Can sick leave be used for family members?

Yes, in most jurisdictions with paid sick leave laws. Allowable uses typically include caring for ill children, spouses, parents, or domestic partners. Some states also allow use for grandparents, grandchildren, or siblings. Check specific state law for covered relationships.

Can my employer require a doctor’s note for sick leave?

Generally yes, but with limitations. Most jurisdictions allow requiring doctor’s note only for absences exceeding 3 consecutive days. Cannot require disclosure of specific diagnosis (general statement of illness and dates sufficient). Cannot deny legally protected sick leave for failure to provide note if absence is short.

Does sick leave carry over to the next year?

Depends on law and policy. Many state sick leave laws require carryover (though may cap total balance at 40–80 hours). Use-it-or-lose-it policies are prohibited in states with mandatory sick leave. Employers in states without mandates may set own carryover or use-it-or-lose-it policies.