Returning to Work in Japan: What to Know after Medical or Child-Care Leave

Taking a leave of absence in Japan—whether for mental health, physical illness, maternity, or family care—is usually straightforward.

But returning to work can be far more challenging. Many foreign employees feel anxious about how coworkers will perceive them, whether they can perform as before, and how much support they will receive from their company.

Employers, meanwhile, often struggle to balance compassion, fairness, and business continuity.

This article explains how the return-to-work process is handled in Japan, focusing on two key transitions: returning from mental-health leave, a sensitive but increasingly common issue, and coming back from child-care leave, a major life transition for families.

This blog covers:

1.        Legal Basics and Company Policy

2.        Returning from Mental-Health Leave

3.        Returning after Physical Illness (e.g., Chemotherapy)

4.        Returning from Maternity and Child-Care Leave

5.        Returning from Family-Care Leave

6.        QA

7.        Wrap Up

1.     Legal Basics and Company Policy

Legal Basics

Under Japan’s Labor Standards Act and related regulations, employees who take medical, maternity, child-care, or family-care leave are legally entitled to return to work.

In other words, an employer cannot refuse reinstatement without a legitimate reason. However, the employee may be reassigned to a different but comparable position, depending on operational needs.

Employers also have a legal duty of care (安全配慮義務) to protect the employee’s health, and dismissal, demotion, or any disadvantageous treatment related to taking or returning from leave is prohibited by regulation and may constitute harassment.

Period of Leave

• Medical Leave: The duration is determined by the doctor’s note. Yet, return-to-work timing is evaluated. (See Returning from Mental-Health Leave, and Returning After Physical Illness (e.g., Chemotherapy)

• Maternity, Child-Care, and Family-Care Leave: The maximum leave periods and extension options are clearly regulated under the Child Care and Family Care Leave Act (育児・介護休業法).

Reference (Japanese): MHLW – Child Care and Family Care Leave Act Overview

Company Policy

Company-specific rules define how these statutory rights are implemented in practice. Typical variations include:

• Paid or Unpaid Leave: Depending on tenure and internal benefit policy, medical or maternity leave may be paid, partially paid, or unpaid.

• Short-Time Work Arrangements: Especially for maternity or rehabilitation cases, companies may offer reduced-hour or phased return systems (時短勤務 or リハビリ勤務).

• Remote Work: Post-pandemic policies vary widely; hybrid or remote arrangements can ease the transition but must align with medical advice and internal policy.

See also:

Paid and Unpaid Leave in Japan, Vol. 1 – Make the Best Use of It

Paid and Unpaid Leave in Japan, Vol.2 – Make the Best Use of It

2. Returning from Mental-Health Leave

Returning after a mental-health-related leave—such as for depression, adjustment disorder, or bipolar disorder—is particularly delicate. Unlike physical recovery, mental readiness is hard to measure, and even doctors may underestimate workplace stressors.

Successful reinstatement depends on careful coordination between the employee, HR, manager and doctor.

Step 1: Medical Assessment and Doctor’s Certificate

You cannot return to work without a doctor’s note (診断書) confirming you are fit to resume duties.

However, it’s important to note that this certification often reflects recovery in daily life, not necessarily the ability to handle workplace stress or performance standards.
For this reason, the company’s doctor may review the doctor’s note and assess whether you are ready for actual work duties.

Tip for foreigners: Always keep a copy of your doctor’s note in English (or a bilingual version) for HR records and potential visa renewals. There’s usually no need to worry—even during unpaid leave, your status is not “unemployed”.

However, immigration may occasionally request confirmation (especially for Engineer/Specialist in Humanities/International Services visa holders).
In that case, a brief letter from your employer stating that you are on medical leave and remain employed is sufficient.

Step 2: Company’s Return-to-Work Evaluation

The final decision to reinstate is made by the employer, based on a comprehensive review by HR, your direct manager, and the company doctor, if applicable. The timing of reinstatement varies by individual, and returning too early can lead to relapse or re-leave.

A formal “return-to-work evaluation” is conducted to evaluate:

• The employee’s motivation and readiness to work

• Functional ability to perform job tasks

• A stable daily rhythm (sleep and activity pattern)

• Input from your doctor, company doctor, and possibly family members

• The match between the employee’s current condition and workplace environment

Note: According to research by Japan’s Ministry of Health, Labor and Welfare (MHLW), around 20% of employees who return from depression-related leave relapse within six months, 30% within one year.
(MHLW Study, 2016–2017).

Rework Programs (リワークプログラム)

Based on my observation, rework programs run by medical institutions may not always be business-oriented. However, they can be very effective in supporting recovery and return-to-work readiness. It’s important to choose a program that best fits your situation and needs.

Main Types of Rework Programs in Japan:

• Medical Rework (医療リワーク):
  Programs conducted by hospitals or clinics as part of psychiatric or psychosocial rehabilitation.

• Vocational Rehabilitation Rework (職リハリワーク):
  Programs offered by Regional Vocational Centers for Persons with Disabilities (地域障害者職業センター). These focus on rebuilding work skills and employability.

• Workplace Rework (職場リワーク):
  Programs independently organized by companies to support employees returning to work. The cost is typically covered by the employer.

• Private Rework (民間リワーク):
  Programs operated by private organizations, companies, or NPOs, often offering flexible or specialized support

Tip for foreigners (Culture):

• If you’re working in a Japanese company, communication tends to be group-oriented—HR/Manager notify your team that you will be on leave without telling the reason, and colleagues might reach out during your leave to show support.
  While this can feel intrusive to non-Japanese employees, it’s usually intended as a gesture of concern.

• In international firms, conversations about mental health may remain more private, but you’ll be expected to self-manage and deliver results once you return.

Case Example: When Returning Isn’t the Best Option

In smaller organizations, it can be difficult to transfer when conflicts arise. One employee I knew developed an adjustment disorder after being assigned to a new manager. He received a doctor’s note just before his performance review and extended his medical leave three times, exhausting both paid and unpaid leave.

He eventually decided to resign, realizing that returning to the same environment would likely worsen his condition.

Later, I heard he had found a new position at another company, and I truly felt that was a healthier outcome. We had tried to mentor his manager, but he simply lacked the capability to improve. In cases like this, protecting mental health should take priority—sometimes leaving is not giving up, but starting again under better conditions.

Step 3: Return-to-Work Support Plan

Once reinstatement is confirmed, HR and the manager create a return-to-work plan to clarify key details:

• Return date

• Position and duties: Adjustments may be made to workload or job content

• Trial period / reduced hours: Commonly six hours per day, with salary prorated accordingly

• Workplace accommodations: e.g., no overtime, no business travel, flexible start time

• Communication: Inform relevant team members and ensure they understand support expectations

Step 4: Ongoing Follow-Up

After returning, regular check-ins with HR and/or your manager are essential.
Discussion points may include:

• Progress and adaptation to workload

• Gradual return to full-time hours and full responsibility

• Any recurring symptoms or early warning signs of stress

Performance and Evaluation

When you return, focus first on stability, not performance.
A good HR team will separate your recovery phase from standard performance evaluation.
Rebuilding confidence and rhythm at work is part of recovery.
Once stability is achieved, productivity will follow naturally.

See also:

Psychiatry in Japan vs. the U.S.: What Expats Should Know About Mental Health & Medical Leave

3. Returning after Physical Illness (e.g., Chemotherapy)

Navigating a return to work after something as tough as chemotherapy or managing a chronic illness can feel overwhelming, especially in Japan where work culture emphasizes perseverance.  But here's the encouraging part: Many people here successfully balance treatment and their jobs, thanks to growing support systems.

Don’t rush to Quit

As a foreigner, you might worry about language barriers or unfamiliar rules, but public resources are accessible through English-friendly hubs like local municipal offices or cancer support centers.

Don't rush to quit—medical pros often advise sticking with your job while using available helps to make it work.

Some offices even have thoughtful perks, like quiet rest areas or adjustable beds for those low-energy days. Remember, your health comes first, and "good days" vary, so flexibility is key.

Here's a quick snapshot of practical steps to ease back in:

• Talk Openly with Your Boss and HR Early: Share what you know about your treatment schedule, energy levels, and needs—like shorter hours, remote work, or time off for clinic visits. Be upfront about what you can handle to build understanding. In Japan, this transparency helps them adjust your tasks without awkwardness.

• Get a Doctor's Note and Use Official Forms: Companies often ask for a simple doctor's certificate outlining your condition and any tweaks needed (e.g., no heavy lifting).

• Tap Into Support for Money and Time Off: If you're wiped out, check whether you're eligible for injury and sickness allowance (傷病手当金) — available only through employer-provided health insurance, it typically covers about two-thirds of your pay after several days off work.

You can also apply for high-cost medical expense relief (高額療養費制度), which helps cap out-of-pocket medical costs under both national and employer-provided health insurance.

In addition, short-time work, flexible hours, or trial return shifts are common options—talk with your HR about what arrangements are possible.

• Lean on Free Consults for Advice: Reach out to cancer consultation support centers (found at major hospitals).

As a foreigner, start with English resources on the MHLW site or apps like the Cancer Information Service.

• Prep Your Comeback Smartly: Before jumping in, test the waters with a "rehab routine"—like short walks or mock workdays—to gauge your stamina. Propose simple changes, such as staggered start times or a quieter workspace, and review how you're feeling after the first week or two.

No fancy formal rehab programs exist yet for physical illnesses, but these steps fill the gap and show Japan's system is evolving to support folks like you.

With an aging workforce, more companies are getting on board—many report feeling empowered and back to a steady rhythm within months. You've got this; small talks and tools can make a big difference.

Quick Resources for Foreigners:

• MHLW Guide on Treatment and Work Balance (PDF with Forms) – Download the handy templates here (Japanese, but Google Translate works well).

• Balancing Treatment and Work (MHLW site in English)

• Cancer Counseling and Support Center — Keio University Hospital

• Maggie’s Tokyo

• The Cancer Institute Hospital of JFCR (JFCR) — Hospital / International Patient Services

4. Returning from Maternity and Child-Care Leave: Plan ahead!

For maternity or child-care leave (産休・育休), reinstatement is protected by law. However, timing is crucial. Discuss your return date early with both your family and employer. Make sure someone can handle childcare during working hours, and check:

• Short-time work systems (短時間勤務): Legally available until the child turns three, and often extendable by company policy.

• Remote or hybrid options: Increasingly common, but still depend on job type.

• Gradual transition: Some mothers choose to come back part-time for a few months before full-time.

Real Story: When Family Plans Meet Work Reality
Having your first baby is one of life’s biggest turning points. One foreign employee I knew took her maternity and childcare leave as planned. But when the time came to return, she found there were no daycare spots available — a common challenge in Japan. She extended her leave for a few more months, then faced the same problem again.

It wasn’t an easy situation. Balancing career, family, and childcare options can be overwhelming, especially in a new country. But what this story really shows is how important it is to talk with your family early — before the baby arrives — about how you’ll manage those first few years. Whether you choose to return to work or focus on parenting for a while, making a clear, timely decision helps you move forward with confidence and reduces stress for everyone involved, including your employer.

Support for New Parents

• Mother’s Tree Japan – NPO helping foreign mothers during pregnancy and child-rearing. mothers-tree-japan.org

• Japanese Midwives Association – Info on pregnancy, childbirth, and midwife services in English. midwife.or.jp

• Mom Garden Resort – Private postnatal care hotel offering rest and nursing support. mom-garden.jp

• Local resources – Your city office, workplace parents, and friends can be great sources of practical information and support.

5. Returning from Family-Care Leave

Family-care leave (介護休業) is another form of legally protected absence under Japan’s Child Care and Family Care Leave Act (育児・介護休業法).
Employees can take up to 93 days per eligible family member who requires continuous care. This leave can be divided into up to three separate periods, depending on the situation.

Family-care leave can be used to care for elderly parents, a spouse, or children in need of support.

Upon return, employees may use short-time or flexible working arrangements to balance caregiving and work. While family-care leave is less common than maternity or medical leave, it serves as a vital lifeline for employees supporting elderly or ill family members.

Purpose and Preparation During Leave

Family-care leave is designed not only for hands-on care but also to establish a long-term care system before returning to work. During this period, employees are encouraged to:

• Consult with local authorities or care managers (ケアマネジャー) to identify suitable nursing and home-care services.

• Coordinate responsibilities with family members and colleagues.

• Arrange paperwork for long-term care insurance (介護保険), medical visits, or home modifications.

Each municipality operates a Community General Support Center (地域包括支援センター) where you can consult free of charge.

The center assigns a care manager who designs a care plan. Available services—such as doctor’s home visits, day-care programs, and home nursing—depend on the family member’s certified care level (要介護度) under Japan’s long-term care insurance system.

Note: To use long-term care insurance, your family member must be officially enrolled.
Premiums apply from age 40 onward, and foreign residents with valid visas are also required to contribute. Check with your city or ward office for details.

Practical Tips for Foreign Employees

• Language and paperwork: Most care insurance procedures are handled in Japanese. Ask HR, a Japanese colleague, or the municipal support center to help with forms.

• Care for parents abroad: The Family-Care Leave Act only covers family members living in Japan. For overseas caregiving, you can use annual leave or unpaid leave instead.

• Visa status: Family-care leave does not affect your visa, as you remain employed. Keep HR documentation proving official leave approval in case of immigration inquiries.

• Financial support: While family-care leave is typically unpaid, you may qualify for a Caregiver Leave Allowance (介護休業給付金) under Japan’s employment insurance, covering about 67% of regular wages if you meet eligibility conditions.

• Mental health and isolation: Caregiving can be emotionally demanding. Seek support from community networks or English-speaking organizations such as Tokyo English Lifeline (TELL) and international caregiver forums.

Returning to Work

Before returning to work, discuss with HR:

• Reduced working hours (短時間勤務) or flexible schedules for hospital visits.

• Occasional remote work or staggered hours to reduce commuting strain.

Key Takeaway

Returning from family-care leave isn’t just about resuming work—it’s about balancing two full-time responsibilities: work and caregiving.

Japan’s caregiving system is well developed, but the first step is to ask for help early, both at work and in your local community.

See Also:

Senior care leave (MHLW site in Japanese)

6. QA

Q1. Can I refuse to return to the same position if it caused my stress?
A1: You can discuss a transfer or duty change with HR and your doctor’s input. However, smaller companies may not always have alternative positions available. In that case, focus on phased return options or consider future job changes once your health stabilizes.

Q2. Will my visa be affected if I take a long mental-health leave?
A2: No, as long as you remain employed and the leave is company-approved, your visa status stays valid. Immigration only becomes concerned if you are unemployed for more than three months without a justifiable reason. Keep an HR letter confirming your employment and leave period.

Q3. What if my boss or coworkers treat me differently after returning from mental-health leave?
A2: Subtle stigma can exist, but harassment or disadvantageous treatment due to leave is prohibited by law. If problems continue, consult HR, an industrial physician, or external resources like Tokyo English Lifeline (TELL) or local labor consultation centers (労働局).

Q4. Can I look for a new job while on medical leave?
A4: Yes, you can quietly prepare for your next step — update your resume, research potential employers, or talk confidentially with a recruiter. Just make sure you don’t work elsewhere while still on leave.

For foreigners, exploring new opportunities can also be a smart safety net in case returning to your current workplace doesn’t feel right.

When interviewing, you’re not required to disclose your medical condition or reason for resignation, and HR is not allowed to share any medical information during reference checks.

However, if you’re in a small industry or worry that your situation might be recognized through informal networks, being open about your experience can sometimes work in your favor. If you choose to mention your past illness, focus on the fact that you’ve recovered and are ready to contribute fully again.

In cases where the work environment or relationship with a manager has caused significant stress, starting fresh in a new workplace can be both healthy and empowering. I’ve seen 3 employees who went on medical leave due to a difficult boss–subordinate relationship find new jobs during their leave — and ultimately thrive in a more supportive environment.

Q5. What if my doctor says I’m fit, but I still don’t feel ready?
A5: That happens often. The doctor’s note means you are medically “able,” but mental readiness can differ. Talk with HR and your company doctor about a gradual return plan (リハビリ勤務) or delayed reinstatement. It’s better to wait a bit longer than to relapse and start over.

Q6: Can a company refuse an employee’s return from medical leave?
A6: Not necessarily. If an employee is able to return to work with reasonable adjustments—such as lighter duties, reduced hours, or other workplace support—the company has a legal obligation to allow reinstatement.

On the other hand, some employees rush back to work out of financial pressure or fear of losing their job. It’s important to discuss your situation carefully with your doctor, HR, and manager to decide on the right timing for your return, both for your health and long-term success.

7.Wrap up

Returning to work can be challenging. But with good planning and open communication, it can also be a turning point for growth.

I once heard a psychiatrist told us, “Many mental health issues can be treated like a textbook, if caught early.”  It’s a good reminder that seeking support isn’t weakness—it’s wisdom.

Japan’s laws protect your right to reinstatement, but true success comes from staying connected with your doctor, HR, and manager.

Coming back isn’t about proving anything—it’s about reclaiming your rhythm and confidence, step by step. You’ve earned this return—take it kindly and make it yours.

Reference:

Guide to Supporting Employees Returning from Mental Health Leave