Title I of the ADA limits an employer’s ability to make disability-related inquiries or to require medical examinations at three stages of employment: pre-job offer, post-job offer, and during employment. This publication provides information regarding the limitations on medical inquiries and examinations during employment, specifically when an employee requests a reasonable accommodation.
Disability-related inquiries and examinations of employees must be “job-related and consistent with business necessity.” According to the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing the ADA, a medical inquiry or examination is job-related and consistent with business necessity when:
- an employer has a reasonable belief, based on objective evidence, that an employee’s ability to perform essential job functions will be impaired by a medical condition, or
- an employer has a reasonable belief, based on objective evidence, that an employee will pose a direct threat due to a medical condition, or
- an employee asks for a reasonable accommodation and the employee’s disability or need for accommodation is not known or obvious, or
- required in positions that affect public safety, such as police and fire fighters.
For additional information, visit: Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees under the Americans with Disabilities Act (ADA).
Although the ADA limits the scope of medical inquiries, it does not include forms for requesting medical information. The following pages discuss the scope of medical inquiry allowed in response to an accommodation request and provide a sample medical inquiry form that can be used as a starting point when an employee requests a reasonable accommodation.
Please note that the information contained in this publication is to be used as a guide only and is not legal advice. If legal advice is needed, contact a legal service. Much of the information contained in this publication is from guidance provided by the EEOC.
SCOPE OF MEDICAL INQUIRY IN RESPONSE TO AN ACCOMMODATION REQUEST
When an employee requests an accommodation and the disability or need for accommodation is not obvious, an employer may require that the employee provide medical documentation to establish that the employee has an ADA disability and needs the requested accommodation.
A. Determining whether an employee has a disability.
1. What is the definition of disability?
Under the ADA, a person has a disability if they 1) have a physical or mental impairment that substantially limits one or more major life activities, 2) have a record of such an impairment, or 3) are regarded as having such an impairment. Only people in the first or second categories are entitled to reasonable accommodation.
Note: In September 2008, the ADA’s definition of disability was amended. One of the changes was making the substantially limited standard an easier one to meet. In March 2011, the EEOC released regulations further explaining the new standard. These regulations became final in May 2011. For more information regarding the amendments to the definition of disability, see Accommodation and Compliance: ADAAA.
2. Can employers request medical documentation?
To determine whether a particular employee has a disability, an employer may request medical documentation that shows whether the employee has an impairment and whether that impairment substantially limits one or more major life activities.
An employer may require that the documentation about the disability and limitations come from an appropriate health care or rehabilitation professional. Appropriate professionals include, but are not limited to, doctors (including psychiatrists), psychologists, nurses, physical therapists, occupational therapists, speech therapists, vocational rehabilitation specialists, and licensed mental health professionals.
3. What is an impairment?
The first step in determining whether an employee has a disability is to determine whether the employee has a physical or mental impairment. A physical impairment means any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more body systems, such as neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, immune, circulatory, hemic, lymphatic, skin, and endocrine. A mental or psychological disorder includes conditions such as intellectual disability (formerly termed "mental retardation"), organic brain syndrome, emotional or mental illness, and specific learning disabilities.
4. What are major life activities?
Major life activities include functions such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, interacting with others, and working.
Major life activities also include the operation of a major bodily function, including functions of the immune system, special sense organs and skin; normal cell growth; and digestive, genitourinary, bowel, bladder, neurological, brain, respiratory, circulatory, cardiovascular, endocrine, hemic, lymphatic, musculoskeletal, and reproductive functions. The operation of a major bodily function includes the operation of an individual organ within a body system.
These lists are not exhaustive lists; they are representative of the types of activities that are major life activities.
5. How does an employer determine whether an impairment substantially limits a major life activity?
If the employee has an impairment, the next step is to determine whether that impairment substantially limits the employee in one or more major life activities. When examining whether an impairment substantially limits a major life activity:
- Compare the employee to most people in the general population.
- Remember that the impairment need not prevent, or significantly or severely restrict, the employee from performing a major life activity.
- Consider the limitations as if the condition is in an active state.
- Ignore the ameliorative effects of mitigating measures.
For more information, see Accommodation and Compliance: ADAAA.
6. What are mitigating measures?
Mitigating measures include things such as medication, medical supplies, equipment, hearing aids, mobility devices, the use of assistive technology, reasonable accommodations or auxiliary aids or services, prosthetics, learned behavioral or adaptive neurological modifications, psychotherapy, behavioral therapy, and physical therapy. Mitigating measures do not include ordinary eyeglasses or contact lenses.
B. Determining whether an accommodation is needed.
Under the ADA, an employee is entitled to an accommodation only when the accommodation is needed because of the employee’s disability; employers are not obligated to provide accommodations that an employee requests for some other reason. Therefore, an employer can ask for medical documentation to show that the requested accommodation is needed because of the employee’s disability.
Keep in mind, the limitations that need accommodating do not have to be the same ones that established disability. Once it is determined that an employee has a disability, they are entitled to accommodations for any limitations resulting from the disability.
For more information, visit: Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act, EEOC.
C. Determining effective accommodation options.
If an employee has a disability and needs an accommodation because of the disability, the employer must provide a reasonable accommodation, unless the accommodation poses an undue hardship. In general, an accommodation is any modification or adjustment in the work environment or in the way things are customarily done that enables an employee with a disability to enjoy equal employment opportunities. A modification or adjustment is "reasonable" if it seems reasonable on its face, meaning feasible or plausible. In addition to being reasonable, an accommodation also must be “effective” in meeting the needs of the individual. An accommodation is effective when it enables the employee to perform the essential functions of the job or to enjoy equal access to the benefits and privileges of employment that employees without disabilities enjoy.
In many cases, a reasonable accommodation will be obvious and can be made without difficulty and at little or no cost. Frequently, the individual with a disability can suggest a simple change or adjustment based on their life or work experience. An employer should always consult the person with the disability as the first step in considering an accommodation. In many cases the employee will be able to provide accommodation ideas. However, when an employee does not know what accommodations are appropriate, the employee’s doctor may be able to provide useful accommodation suggestions.
For more information regarding the accommodation process, visit Accommodation and Compliance: Interactive Process.
In addition, employers can contact JAN for information about any accommodation issue, regardless of whether an employee meets the ADA’s definition of disability.
D. Other questions from the employer or comments from the medical provider.
In some cases, an employer may have specific questions related to an employee’s accommodation request. For example, if an employee says she is has vision problems and is having trouble seeing the computer screen, the employer may need to know whether the employee will benefit from screen magnification or whether she should avoid looking at the computer screen altogether. This type of specific question can be included on the medical inquiry form. In addition, the medical provider may have additional comments that would be useful in the accommodation process and these can be included on the form as well.
E. A note about the Genetic Information Nondiscrimination Act of 2008 (GINA).
When an employer makes a request for health-related information (e.g., to support an employee’s request for reasonable accommodation under the ADA or a request for sick leave), it should warn the employee and/or health care provider from whom it requested the information not to provide genetic information. The EEOC suggests language such as the following:
The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
Sample Medical Inquiry in Response to an Accommodation Request Form