On December 19, 2024, Ontario’s Working for Workers Six Act, 2024 (Bill 229) received Royal Assent. Amongst the changes in the bill amending the Employment Standards Act, 2000 (ESA), was the introduction of unpaid long-term illness leave, effective June 19, 2025. While the law provides the duration of leave and medical certification, there are unanswered questions about what serious medical condition means and the length of notice so employers can adequately plan for absences.

Leave Requirements

Employers must provide long-term illness leave totaling up to 27 weeks of leave in a 52-week period to all eligible employees who have worked for their employer for at least 13 consecutive weeks.

To be eligible for the leave:

• The employee must not be able to work due to a serious medical condition (including a condition that is chronic or episodic).
• A qualified health practitioner (i.e., physician, registered nurse or psychologist) must issue a certificate stating that the employee has a serious medical condition and specifying the duration the employee is unable to work due to the serious medical condition.

Additional Guidelines

There are other important guidelines employers must be aware of related to providing long-term illness leave.

Employers can no longer ask for detailed medical information to justify long-term absences. They can only ask for evidence that is reasonable under the circumstances.

The leave is job protected, meaning the employer must hold the employee’s job for them while they are out on leave and reinstate them upon their return.

There are three specific details for employers to remember regarding the 27 weeks of leave employees are entitled to during the 52-week period.

(1) There is no requirement that the weeks be consecutive.

(2) Employees cannot take more than 27 weeks of leave, even if they have more than one serious medical condition.

(3) Employees are entitled to additional leave if they continue to have a serious medical condition after returning to work but before the 52-week period expires under certain circumstances:

• A qualified health practitioner issues another certificate stating a different period of time that the employee will not be able to perform their job duties due to the seriousmedical condition,
• The amount of leave taken plus the amount of leave the employee plans to take cannot exceed 27 weeks in total, and
• The leave ends no later than the last day of the 52-week period. 

Next Steps for Employers

With the effective date of unpaid long-term illness leave quickly approaching, employers should take actions to minimize compliance risks.

• Review existing policies to make sure the new requirements are integrated into them.
• Verify that policies account for all applicable laws, including ESA and Ontario Human Rights Code.
• Create procedures for overseeing intermittent leave usage.
• Rigorously enforce the requirements for leave (i.e., require medical certificates from employees, make sure employees do not exceed the permissible amount of leave).

Uncertainty and Difficulties

Employment lawyers Frank Portman and Rich Appiah told Human Resources Director Canada that it’s uncertain how long-term illness will play out. Additional feedback could be forthcoming if the Ministry of Labour receives complaints or conducts judicial hearings, as clarity is still needed in determining the following.

• What is a serious medical condition? Since the term was not defined in the bill, it allows for broad interpretation of what it means.
• The length of notice period. No specificity on timing currently exists; guidance only states that an employee must provide written notice to their employer when taking long-term illness leave.

In addition to the needed clarity, other factors may also be difficult for employers to manage.

• Medical documentation requirements for long-term illness leave will require employers to communicate and work with employees to access the required documentation. Employees may push back when asked to provide such personal information, and employers must not hesitate to ask for it to meet the leave requirements and be able to adequately plan for absences.
• Understanding the interaction between Ontario’s ESA and Human Rights Code. While both laws protect employees needing time off due to illness or disability and allow employees to take medical leave when dealing with a serious health condition, they operate differently regarding how leave is granted and managed.

Stay tuned to the International Foundation for any developments on long-term illness leave. To keep up to date with other bills impacting employers, visit our Canadian Legislative Scorecard.

Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.