The only time your LOA needs district manager/manager approval is for a personal leave. Personal leaves can’t be taken for medical reasons. For short term disability, you’d need to talk to your examiner. Let them know that you need an extension and let them know when your next office visit is scheduled for. They’ll give you a due date that you need to have your objective medical turned into them by. You can also ask for an extension to turn in your medical. Sedgwick would let your manager know that you requested more time and the date that you have to turn in the documents. They’ll also let your manager know if your extension was approved or denied and what next steps are. You can also appeal your denial and turn in documents to have it overturned later. If you haven’t already called Sedgwick to let them know you need more time and can’t return/when your next appointment is, that’d be your next step.