We are a small insurance agency with 14 employees and do not fall under the FMLA guidelines. We are in need of sample verbage regarding an "unpaid leave of absence". Can anyone help us?

You might consider something to this effect:

Medical Leave of Absence. Employees who have exhausted their paid sick leave and need additional time to recuperate or deal with an illness or disabling condition can submit a written request for an unpaid medical leave of absence. EMPLOYER attempts to honor such requests and ordinarily approves them for an initial duration of up to four months. During this period, EMPLOYER continues to cover and make contributions for employees under its group health and life insurance programs and retirement plans, but employees on medical leave do not earn any vacation or sick leave.

EMPLOYER can temporarily replace employees who are on a medical leave of absence, but when they return such workers are reinstated to either their former position or a position of equivalent pay and status, assuming no significant downsizing or reduction-in-force has occurred in the interim. EMPLOYER also attempts to grant requests for extensions of such leave, although it cannot guarantee workers returning from an extended leave reinstatement to a former or equivalent position. Employees who request a medical leave of absence are required to provide medical documentation of their illness or disability and can be required to submit to initial and periodic medical examinations by a physician designated by EMPLOYER.

Let me know if I can be of further assistance.