Hi, Ginger. Medical issues and leave of absences are probably the most complicated part of my job because every one is case by case situation. My company outsources STD, LTD and FML, so ADA is the most challenging aspect of leave for me. It's much easier to accommodate ADA when an employee is eligible for FML because our third party administrator handles it through an established process. But it's tricky when the person does not qualify for FML and we have to go outside of the normal process. Determining what qualifies under ADA is difficult -some issues that I do not think should be covered are covered, and others that I do not think are covered are actually covered. The Job Accommodation Network has been a great resource. I always try for FML first, but when the employee is not eligible or does not follow up by the required date, what do you do??  Also, determining when to end employment after a leave is a PAINFUL process. We can't set strict guidelines, but do have general check in points during a leave of absence. We want to do the right thing, but do we keep people on leave too long? or not long enough?  Are we as consistent as we can be across the organization, while balancing the specific situation? Again, case by case and tricky based upon the medical condition and the job that the person performs. 

Unfortunately I have no answers - just that the realization that complexity increases with experience because I realize just how complicated and unique every situation is.

We outsourced our approval process for leaves.  It still makes our job busy but we aren't given the burden of making the big decision on iffy things like some reasons for "leave".  Best decision we made.