Briefing Note

Responding to an Employee's Leave Request — A Practical Briefing for Companies with Fewer Than 50 Employees and No Occupational Physician

A systematic guide to initial response when an employee at a small company (under 50 employees) requests leave for health reasons. Covers work rules verification, reading medical certificates, using Chiisanpo (Regional Occupational Health Centers), and sickness allowance procedures, drawing on public data and the practical expertise of an occupational counselor.

Executive Summary

Leave management at companies with fewer than 50 employees operates under structural constraints: no occupational physician, no dedicated HR department. In Japan, 57.5% of all workers are employed at establishments of this size (Japan Society for Occupational Health, 2024), and 12.8% of all workplaces have had employees take extended leave or resign due to mental health issues (Ministry of Health, Labour and Welfare, 2024). Despite this, practical guidance on initial response specifically tailored to sub-50-employee companies is exceedingly rare. The core of an effective initial response comprises six steps: verifying the leave provisions in your work rules, properly interpreting the attending physician's medical certificate, utilizing your regional Chiisanpo (Regional Occupational Health Center), issuing a written leave notification, supporting the sickness allowance application, and maintaining records as evidence of fulfilling your duty of care. When the initial response goes wrong, the company faces simultaneous legal risk from duty-of-care violations and operational risk from losing a critical team member.

Definitions and Current Landscape

Definition: Initial response to a leave request refers to the totality of legal and practical procedures an employer must carry out during the one to two weeks from the day an employee submits a leave request or medical certificate to the start of the leave period. At companies with fewer than 50 employees, there is no legal obligation to appoint an occupational physician or health supervisor, so the business owner or a general affairs staff member handles the process with the support of external resources such as the Chiisanpo (Regional Occupational Health Center).

Typical Scenarios

  • An accounting staff member says, "I've been diagnosed with depression. I need to take leave."
  • An engineer hands over a medical certificate stating "adjustment disorder, two months of home rest required."
  • A site supervisor's mental health deterioration becomes apparent, and you cannot wait for the next scheduled visit from a part-time occupational physician.

Warning Signs That Require an Initial Response — Checklist

  • An employee has expressed "I need time off" or "I need to see a doctor"
  • A medical certificate has been submitted (with diagnosis and recommended rest period)
  • Intermittent absences have been continuing (more than 2 weeks total, or more than 14 days within a 2-month period)
  • The employee's work performance has clearly declined
  • Colleagues or supervisors have reported that "something seems off"

If any of the above apply, it is time to review your work rules and contact your regional Chiisanpo.

Data and Evidence

Prevalence of Extended Leave and Resignation Due to Mental Health Issues

Indicator Figure Source
Percentage of workplaces where employees took extended leave (1+ months) or resigned due to mental health issues 12.8% (Ministry of Health, Labour and Welfare, 2024)
Workplaces where employees took extended leave of 1+ months 10.2% (Ministry of Health, Labour and Welfare, 2024)
Workplaces where employees resigned 6.2% (Ministry of Health, Labour and Welfare, 2024)
Proportion of all regular workers who took extended leave of 1+ months 0.5% (Ministry of Health, Labour and Welfare, 2024)

Incidence by Establishment Size

Establishment Size Percentage with employees on extended leave or who resigned due to mental health issues
10-29 employees 5.7%
30-49 employees 14.4%
50-99 employees 33.1%

(Ministry of Health, Labour and Welfare, 2024)

Mental Health Initiatives by Establishment Size

Establishment Size Percentage implementing mental health measures Stress check implementation rate
Overall 63.2% 65.3%
50+ employees 94.3% 89.8%
30-49 employees 69.1% 57.8%
10-29 employees 55.3% 58.1%

(Ministry of Health, Labour and Welfare, 2024)

Workforce and Occupational Health Infrastructure at Sub-50-Employee Establishments

Indicator Figure Source
Japan's total workforce Approx. 58 million (Japan Society for Occupational Health, 2024)
Proportion working at establishments with fewer than 50 employees 57.5% (Japan Society for Occupational Health, 2024)
Number of Chiisanpo (Regional Occupational Health Centers) nationwide Approx. 350 (JOHAS)
Average number of registered occupational physicians per Chiisanpo 32.4 (Japan Society for Occupational Health, 2024)
Average number of actively practicing occupational physicians per Chiisanpo 18.2 (Japan Society for Occupational Health, 2024)
Total certified occupational physicians (Japan Medical Association certification, valid) 70,208 (as of February 2022) (Japan Society for Occupational Health, 2024)
Of those, actually practicing as occupational physicians 34,166 (approx. 49%) (Japan Society for Occupational Health, 2024)

Chiisanpo Utilization Data

Indicator Figure Source
Total consultations nationwide (2021) 102,029 (Japan Society for Occupational Health, 2024)
Total individuals consulted nationwide (2021) 1,296,922 (Japan Society for Occupational Health, 2024)
Proportion of eligible establishments that used the service 2.06% (Japan Society for Occupational Health, 2024)
Proportion of eligible workers who used the service 8.99% (Japan Society for Occupational Health, 2024)
Proportion whose initial contact was prompted by Labor Standards Bureau guidance 95.6% (Japan Society for Occupational Health, 2024)

Sample Leave Provisions in Work Rules

Item Details Source
Trigger conditions for leave When absence due to non-work-related illness or injury exceeds 2 calendar weeks total, or exceeds 14 days within a 2-month period, and continued treatment is necessary (Kanagawa Occupational Health Promotion Center, 2017)
Exclusions Employees during probation, those with less than 1 year of service, fixed-term employees with contracts of 3 years or less, part-time and other non-regular employees (Kanagawa Occupational Health Promotion Center, 2017)
Leave period (1-3 years of service) 3 months (Kanagawa Occupational Health Promotion Center, 2017)
Leave period (3-5 years of service) 6 months (Kanagawa Occupational Health Promotion Center, 2017)
Leave period (5-10 years of service) 1 year (Kanagawa Occupational Health Promotion Center, 2017)
Leave period (10+ years of service) 1 year and 6 months (Kanagawa Occupational Health Promotion Center, 2017)
Definition of "recovery" Recovery sufficient to perform normal duties at pre-illness levels, with low foreseeable risk of relapse upon return (Kanagawa Occupational Health Promotion Center, 2017)
Cumulative provision If absence due to the same or similar condition reaches 2+ cumulative weeks within 1 year of returning to work, the remaining leave period is the previous maximum minus time already used (Kanagawa Occupational Health Promotion Center, 2017)

Seven Items to Communicate to the Employee at the Start of Leave

# Item Source
1 Focus on rest and recovery first (JOHAS)
2 Leave conditions (salary, sickness allowance, maximum leave period) (JOHAS)
3 Contact arrangements with support staff (JOHAS)
4 Reach out to the designated contact if anxious about anything (JOHAS)
5 Consent for obtaining information from family and attending physician (JOHAS)
6 Contact the company when ready to discuss returning to work (JOHAS)
7 Explanation of the return-to-work support framework (JOHAS)

Overview of Sickness Allowance (Shobyou Teatekin)

Item Details Source
Amount Two-thirds of the Standard Monthly Remuneration daily rate (JOHAS)
Duration Up to 18 months cumulative from the first day of payment (JOHAS)
Application form structure Three sections: employee, employer, and attending physician (Japan Health Insurance Association) (JOHAS)
Submission destination The employee's health insurance society or Kyokai Kenpo (Japan Health Insurance Association) (Japan Health Insurance Association)
Statute of limitations 2 years from the day after each day of work incapacity (Japan Health Insurance Association)
Form types Handwritten and PDF-fillable versions (downloadable from the Kyokai Kenpo website) (Japan Health Insurance Association)
Attachments If the employee changed employers within 12 months before the payment start date, a Health Insurance Enrollment Status Declaration is required (Japan Health Insurance Association)

Return-to-Work Support Framework

Step Description Source
Step 1 Start of sick leave and care during the leave period (Ministry of Health, Labour and Welfare, 2012)
Step 2 Attending physician's determination that return to work is possible (Ministry of Health, Labour and Welfare, 2012)
Step 3 Decision on return-to-work eligibility and creation of a return-to-work support plan (Ministry of Health, Labour and Welfare, 2012)
Step 4 Final decision on return to work (Ministry of Health, Labour and Welfare, 2012)
Step 5 Follow-up after return to work (Ministry of Health, Labour and Welfare, 2012)

Criteria for Assessing Return-to-Work Readiness

Criterion Source
The employee demonstrates sufficient motivation (Ministry of Health, Labour and Welfare, 2012)
Can commute safely and independently during commuting hours (Ministry of Health, Labour and Welfare, 2012)
Can sustain work on scheduled workdays and hours (Ministry of Health, Labour and Welfare, 2012)
Can perform the tasks required by the job (Ministry of Health, Labour and Welfare, 2012)
Recovers sufficiently from work fatigue by the next day (Ministry of Health, Labour and Welfare, 2012)
Has regained the attention and concentration necessary for job performance (Ministry of Health, Labour and Welfare, 2012)

Self-Support Medical Care System (Jiritsu Shien Iryouhi Seido)

Item Details Source
Reduced co-payment Out-of-pocket medical costs reduced from 30% to 10% (JOHAS)
Application office Municipal government (JOHAS)
Renewal Annually (JOHAS)

Communication and Social Insurance During Leave

Item Details Source
Recommended contact frequency Approximately once per month (JOHAS)
Contact method May go through family members if direct contact is difficult (JOHAS)
Employee's share of social insurance premiums Continues during leave. Options: monthly transfer, lump-sum payment upon return, or company advances and settles later (Kanagawa Occupational Health Promotion Center, 2017) (JOHAS)
Salary during leave Unpaid (per work rules) (Kanagawa Occupational Health Promotion Center, 2017)

Return-to-Work Support Structure at Sub-50-Employee Establishments

Establishment Size Three-Party Meeting Composition Source
50+ employees Occupational physician, department head, HR representative (Ministry of Health, Labour and Welfare, 2012) (JOHAS)
Under 50 employees Attending physician, department head, HR representative (Chiisanpo occupational physician may also participate) (Ministry of Health, Labour and Welfare, 2012) (JOHAS)

Analysis and Implications

Key Terms: duty of care (anzen hairyo gimu), psychological safety, desensitization to distress, cognitive distortions, learned helplessness, emotional exhaustion, presenteeism, health promotion officer (eisei suishinsha), autonomous management, occupational health service gap

Axis A: Mechanism Analysis — Why Initial Response Fails at Sub-50-Employee Companies

The difficulty of managing employee leave at sub-50-employee companies stems from a dual structure of institutional gaps and concentrated psychological burden.

The structure of institutional gaps. Japan's Industrial Safety and Health Act draws a line at "50 employees" for the obligation to appoint an occupational physician and health supervisor. This threshold means that 57.5% of the entire workforce operates at establishments with no internal occupational health professional (Japan Society for Occupational Health, 2024). Chiisanpo centers serve as a complementary function, but their utilization rate among eligible establishments is only 2.06% (Japan Society for Occupational Health, 2024). The fact that 95.6% of initial contacts were prompted by Labor Standards Bureau guidance indicates that employers are not finding this resource on their own. Of the 70,208 certified occupational physicians in Japan, only 34,166 (roughly 49%) are actively practicing (Japan Society for Occupational Health, 2024). Even if the appointment obligation were extended to sub-50-employee establishments, there would be an immediate manpower shortage. The gap is structural.

Concentrated psychological burden on the person handling the response. At companies with fewer than 50 employees, there is often no HR department. Leave management falls on the business owner personally or a single general affairs staff member. This person simultaneously faces the duty of care ("I must protect this employee") and the pressure of business continuity ("We can't stop operations"). This is especially acute when the situation involves the only accounting staff member, or when there are regulatory staffing requirements. In these cases, granting leave can directly threaten the viability of the business itself. Making decisions under this cognitive overload is a breeding ground for missteps.

In EAP (Employee Assistance Program) counseling, business owners bewildered by the initial response process are a recurring pattern. The common refrain is: "I don't know what to do or in what order." The lack of a clear procedure itself becomes a stressor, accelerating the emotional exhaustion of the person responsible.

Axis B: Institutional and Environmental Analysis — The Full Picture of Available Resources

The 50-employee threshold in the Industrial Safety and Health Act. Establishments with fewer than 50 employees have no obligation to appoint an occupational physician or health supervisor. Instead, a health promotion officer (eisei suishinsha) or safety and health promotion officer is designated to fill that role (Ministry of Health, Labour and Welfare, 2012). In practice, however, these officers rarely possess specialized knowledge of leave management.

Leave provisions in work rules. Leave of absence is not a statutory obligation but a system governed by the company's work rules. A common problem at sub-50-employee companies is the wholesale adoption of templates designed for large enterprises. Settings like "maximum leave period of 2 years" or "3 years" are misaligned with the reality of small businesses that struggle to find replacement staff. The model provisions organized by years of service (1-3 years = 3 months, 3-5 years = 6 months, 5-10 years = 1 year, 10+ years = 1 year 6 months) represent realistic benchmarks for sub-50-employee companies (Kanagawa Occupational Health Promotion Center, 2017).

Chiisanpo (Regional Occupational Health Centers). Approximately 350 centers nationwide provide services free of charge to establishments with fewer than 50 employees (JOHAS). Services include health consultations with physicians and public health nurses, mental health consultations, on-site occupational health guidance, and specialist visits coordinated with the broader Occupational Health Promotion Centers (Sangyou Hoken Sougou Shien Center) (JOHAS). While the utilization rate stands at just 2.06%, the primary cause is low awareness rather than any deficiency in the system itself. For sub-50-employee companies without an occupational physician, Chiisanpo should be the first public resource to call.

Sickness allowance (Shobyou Teatekin). Health insurance members receive two-thirds of their Standard Monthly Remuneration daily rate for up to 18 months (JOHAS). The application form has three sections; the employer fills in attendance records and wage payment details during the leave period (Japan Health Insurance Association). The statute of limitations is 2 years from the day after each day of work incapacity (Japan Health Insurance Association). Managing this deadline is part of the employer's responsibility.

Duty of care (Anzen Hairyo Gimu). Under Article 5 of the Labor Contract Act, employers are obligated to ensure the safety of workers' lives and physical well-being. This "safety" includes mental health. The obligation applies equally regardless of company size — having fewer than 50 employees is not a defense.

Self-Support Medical Care System (Jiritsu Shien Iryouhi Seido). For employees receiving outpatient treatment for psychiatric conditions, out-of-pocket medical costs are reduced from 30% to 10% (JOHAS). Applications are submitted to the municipal government and must be renewed annually. Informing the employee about this system alongside the sickness allowance helps alleviate their financial burden.

Axis C: Impact Analysis — What Happens When the Initial Response Goes Wrong

Legal risk. Requiring an employee to continue working after a medical certificate has been submitted may constitute a duty-of-care violation and grounds for a damages claim. Statements like "We can't manage without you" or "Are you really that unwell?" may qualify as harassment. Disclosing the employee's diagnosis to colleagues or clients is a privacy violation.

Organizational impact. At sub-50-employee companies, losing one person ripples across the entire operation. This is especially true for roles with concentrated knowledge — accounting, HR, site supervision. In industries with regulatory staffing requirements (nursing care, childcare, etc.), falling below the threshold risks losing your operating license.

Impact on the person handling the response. Business owners and general affairs staff who manage the leave process can themselves become emotionally exhausted. Their fatigue impairs judgment and leads to secondary mistakes in handling.

Limitations of the attending physician's return-to-work assessment. Even when an attending physician determines that an employee is "fit to return," this assessment is often based on recovery to the level of daily living, not necessarily to the level of job performance required at the workplace (Ministry of Health, Labour and Welfare, 2012). This gap in perception directly increases the risk of a second leave. Because sub-50-employee companies structurally lack the double-check of an in-house occupational physician, using a Chiisanpo physician to review return-to-work readiness is essential.

Integrated Assessment

The fundamental difficulty of leave management at sub-50-employee companies lies in the convergence of an institutional gap (no occupational physician) and a resource constraint (no HR department). Drawing on over 30 years of working alongside organizations in the EAP field, much of this difficulty is attributable to the absence of clear procedures. When procedures are well defined, a minimum standard of response is achievable even without an in-house specialist, and documented adherence to those procedures serves as evidence of fulfilling the duty of care. At the same time, the reality that only 55.3% of establishments with 10-29 employees have implemented mental health measures (Ministry of Health, Labour and Welfare, 2024), and that Chiisanpo utilization stands at just 2.06% (Japan Society for Occupational Health, 2024), shows that many workplaces are at the stage of "thinking about a response only after a problem occurs." Advance preparation — specifically, establishing leave provisions in work rules and knowing your local Chiisanpo contact information — is what determines whether the initial response succeeds or fails.

Phase 1 (Initial Response — Within 3 Days of the Request)

Responding to the employee:

  • Accept the medical certificate and review its contents (diagnosis, recommended rest period, any work-related opinions)
  • Tell the employee: "Please focus on your recovery first. We will handle the work handover on our end."

Internal actions:

  • Review the leave provisions in your work rules (check five items: trigger conditions, exclusions, leave period, conditions during leave, return-to-work requirements)
  • Call your regional Chiisanpo (provide your company name, number of employees, absence of an occupational physician, and the nature of your inquiry)

Phase 2 (Procedures — 1-2 Weeks)

Explaining to the employee:

  • Walk through the JOHAS-recommended seven items and issue a formal leave notification in writing
  • Agree on how social insurance premiums will be collected (three options: monthly transfer, lump-sum upon return, or company advance and later settlement)
  • Inform the employee about sickness allowance and the Self-Support Medical Care System

Documentation:

  • Record the date, time, content, and attendees of every interaction in writing (this constitutes evidence of fulfilling your duty of care)

Role-Specific Action Items

Business owners: Confirm that the leave provisions in your work rules match your company's actual circumstances. Consult a Chiisanpo or a labor and social insurance consultant (sharoushi) to check whether the provisions are borrowed wholesale from a large-company template.

General affairs / HR staff: Verify how to complete the employer section of the sickness allowance application form. The form is downloadable from the Kyokai Kenpo (Japan Health Insurance Association) website.

Managers: Read the medical certificate as procedural information — do not fixate on the specific diagnosis. Inform colleagues that "the employee is taking time off for health reasons," without sharing the diagnosis.

Sample Phrases

  • Speaking to the employee: "Please focus on getting better. You don't need to worry about work."
  • Calling your Chiisanpo: "We are a company with [X] employees. An employee has requested leave due to a mental health condition. We don't have an occupational physician and would like to discuss how to handle this."

Resources

Public Consultation Services

  • Chiisanpo (Regional Occupational Health Centers) — Search "Regional Occupational Health Center" plus your area name. Free occupational health services for establishments with fewer than 50 employees (JOHAS)
  • Kokoro no Mimi Telephone Counseling (Ministry of Health, Labour and Welfare) — 0120-565-455 (Weekdays 17:00-22:00, Weekends 10:00-16:00)
  • Yorisoi Hotline — 0120-279-338 (24 hours)

Application Forms and Tools

  • Sickness Allowance Application Form — Downloadable from the Kyokai Kenpo (Japan Health Insurance Association) official website (handwritten and PDF-fillable versions)
  • Sample Leave Provisions for Work Rules — The model provisions from the Kanagawa Occupational Health Promotion Center are a useful reference
  • Documentation Checklist — Record the date, time, content, and attendees of each interaction as an extension of routine business records

Conclusion

Initial response to an employee's leave request at a sub-50-employee company operates under the structural constraint of having no occupational physician, but an appropriate response is fully achievable when procedures are clear and the Chiisanpo public resource is utilized. Following the six initial-response steps — verifying work rules, reviewing the medical certificate, consulting Chiisanpo, issuing the leave notification, supporting the sickness allowance application, and maintaining records — protects both the employee's health and the company's legal standing. As advance preparation, we recommend establishing leave provisions in your work rules and noting the contact information for your local Chiisanpo. The first step is to open your work rules.

Frequently Asked Questions (FAQ)

Q: If we have fewer than 50 employees and no occupational physician, who handles the leave process?

The business owner or a general affairs/HR staff member handles it. As a substitute for an occupational physician, you can consult the physicians and public health nurses at your regional Chiisanpo (Regional Occupational Health Center) free of charge. There are approximately 350 centers across Japan, and they handle mental health consultations as well (JOHAS).

Q: What if our work rules don't include any leave provisions?

It is possible to grant leave even without formal leave provisions. However, handling situations without clear criteria invites disputes, so this is a good opportunity to establish them. We recommend consulting your Chiisanpo or a labor and social insurance consultant (sharoushi).

Q: Which takes priority — the rest period on the medical certificate or the leave period in the work rules?

If the medical certificate's recommended rest period is shorter than the leave period in the work rules, start with the certificate's period and extend if necessary. If the certificate's period exceeds the maximum leave period in the work rules, the work rules' maximum takes priority.

Q: Does the company or the employee file the sickness allowance application?

The application form has three sections — employee, employer, and attending physician — each completed by the respective party. The form is then submitted to the employee's health insurance society or Kyokai Kenpo (Japan Health Insurance Association). The employer fills in attendance records and wage payment details during the leave period.

Q: How often should we contact an employee who is on leave?

Approximately once a month is the standard guideline (JOHAS). Depending on the employee's condition, communication through family members is also acceptable. Calling daily to check on their status should be avoided, as it can interfere with recovery.

Sources and References

Government Publications

Academic Papers and Proposals

Related Content and Author Information

About the Author

Kazuhiko Ehara

Occupational Counselor (certified by the Japan Industrial Counselors Association). Director of Kazuna Research Institute. After approximately 25 years in corporate roles, he became independent in 2018. He combines the analytical thinking cultivated as an IT engineer with practical expertise gained through EAP (Employee Assistance Program) counseling to support mental health initiatives at small and medium-sized enterprises. In his own twenties, he experienced 200-250 hours of monthly overtime and later recognized his own desensitization to distress — an experience that informs his work today. His guiding philosophy is "It's okay to stop. Every time you start walking again, that step changes the future." He practices Brief Coaching grounded in SFBT (Solution-Focused Brief Therapy), walking alongside businesses and the people who work in them.

This document is intended for general informational purposes only and does not constitute medical diagnosis or treatment advice. If symptoms are serious, we recommend consulting a medical professional. Data cited is current as of each source's publication date; please refer to each organization's official website for the latest information.

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