Medical Documentation: The Role of Doctor Notes in Work Accommodations and Return to Work

Medical professionals have an important role to play when people with disabilities seek accommodation in the workplace. Employers often rely on the expertise of medical professionals to understand the functional limitations and needs associated with a disability to implement appropriate adjustments. Information must be timely and clear about an individual’s disability-related needs, while also still respecting privacy around health information. So how do employers strike this balance in their work accommodation and return to work processes?

*Note that the information provided on this website does not constitute legal advice and is intended for general informational purposes only.

Understanding Medical Documentation Requirements

The Ontario Human Rights Commission’s policy on ableism and discrimination based on disability outlines important information about the role of medical documentation. Section 8.7, “Medical information to be provided,” sets out detailed guidance about the type and scope of medical information to be provided to support an accommodation request. This information should include:

• that the person has a disability;
• the limitations or needs associated with the disability;
• whether the person can perform the essential duties or requirements of the job with or without accommodation;
• the type of accommodation(s) that may be needed to allow the person to fulfill the essential duties or requirements of the job; and
• in employment, regular updates about when the person expects to come back to work, if they are on leave.

The policy states that “where more information about a person’s disability is needed, the information requested must be the least intrusive of the person’s privacy while still giving the accommodation provider enough information to make the accommodation.” To respect employee’s dignity and privacy interests, the focus should always be on the functional limitations associated with the disability. Generally, the accommodation provider does not have the right to know a person’s confidential medical information, such as the cause of the disability, diagnosis, symptoms, or treatment, unless these clearly relate to the accommodation being sought, or the person’s needs are complex, challenging, or unclear and more information is needed.

Case Studies: Legal Implications

In examining recent legal cases surrounding work accommodation and medical documentation, we can gain insights into the complexities and responsibilities inherent in this process.

Rio Tinto Alcan Inc. v UNIFOR, Local 2301 (2017)

In this legal dispute in British Columbia between an employer and the union, an employee objected to providing medical information in order to receive wage loss protection for his disability-related absences. The company had a collective agreement in place that stated the company reserved the right to have an employee examined by a physician of its choice and that the decision of the company’s Occupational Health Department regarding whether an employee is disabled is final. The employee felt that the requirement for medical information was an invasion of privacy. Due to the collective agreement in place and the provided resources from the company, the arbitrator in the case ruled that the company was not out of their rights to request medical documentation for disability leave.

Key Takeaway: Employers have an obligation to ensure absences are legitimate and to request medical information that will aid in the accommodation process.

Joseph v. Tecumseh Community Development Corporation (2019 HRTO 635)

In this accommodation case, the Human Rights Tribunal of Ontario (HRTO) ruled in favour of the employer once it became clear the employee failed to participate in the accommodation process. The employer, on several occasions, requested that the employee, who was on leave at the time, provide medical documentation from their physician. Despite the requests, the employee did not produce the requested information until the human rights complaint against the employer was filed, which occurred shortly after he was fired. The tribunal concluded that the employer satisfied their duty to investigate the employee’s needs in order to provide accommodation measures. The tribunal also concluded that the employee failed to demonstrate that he had a valid need for accommodation by providing the appropriate medical documentation to the employer in a timely manner.

Key Takeaway: Active participation and timeliness from all parties are essential to the accommodation process. Employers and employees must have transparent communication to create effective solutions. Delays in providing necessary medical information can therefore impede the accommodation process and potentially jeopardize legal recourse.

Zimmerman vs. SkyWest Airlines, Inc. (2024)

In this case, a terminated ramp agent employee claimed that his employer had discriminated against him and failed to accommodate for his hearing disability. The employee had disclosed his impairment on his employment application and stated that the only accommodation he needed was closed captioning. After successful completion of training, the employee relations department requested more information from his healthcare provider about his condition and what accommodations he may need to do his job safely. The healthcare provider submitted a form indicating that closed captioning and hand signals would allow him to perform all necessary functions of the job, but that face-to-face communication was necessary to effectively communicate with the employee. After a safety incident occurred when the employee was unable to communicate with his coworkers, more medical information was requested from his audiologist, who recommended that communication occur in a well-lit and quiet setting. As the work environment was often dark and noisy, the company was concerned about safety. They offered the employee another position, which he declined. Ultimately, the court ruled that the company had done their due diligence in making medical inquiries and offering the employee another position.

Key Takeaway: Employers should be aware of the medical inquiries they are allowed to make, during and after the hiring process, to ensure that employees can safely perform the essential duties of the job.

How to Gather Information Regarding Health Conditions

Disability-related documentation is not required in order to approve accommodation, but employers may need to gather additional information about the functional implications of the health condition. Employers may consider various means for obtaining information, including the following suggestions adapted from the Job Accommodation Network:

• Communicate directly with the individual. Ask for specific information about their needs and limitations that require accommodation.
• Focus on function. If your policy requires medical documentation to support an employee’s accommodation request or if you have insufficient information required to determine reasonable accommodations, ensure that information gathered focuses on functional abilities and limitations related to the essential duties of their role. Do not inquire about the employee’s diagnosis, symptoms, or specific treatment. 
• Review existing medical records. Consider whether there is already sufficient information on file about the impairment and limitations for which an accommodation is needed (e.g., from a previous request for an accommodation for the same impairment).
• Accept medical documentation from qualifying healthcare professionals. Forms of medical documentation may include a form or stamped note from a clinic, an email from a healthcare provider, or information from a personal medical record from a past visit with a healthcare provider.
• Seek authorization to liaise with the individual’s healthcare provider. A healthcare provider can confirm the impairment and clarify accommodation needs. Employee’s must provide consent for this communication to occur.
• Accept accommodation requests in good faith. If the employer has a good reason to believe the individual has the impairment for which they have requested accommodation, documentation may not be required. Note that the duty to accommodate is triggered immediately when an accommodation request is made.

What Can Employers Do?

1.  Know what the job requires and any inherent safety risks and judgements that must be made by the employee.  A Physical or Cognitive Demands Analysis can be invaluable to this assessment. A comprehensive assessment by an Occupational Therapist will assess the essential duties of the job to determine if an employee’s cognitive and physical capabilities will impact safety and productivity.
2. Know the employee’s abilities.  What is the employee able to do and how does the employee normally perform on the job?  What does the employee require to be successful on the job in normal circumstances when he/she is healthy?  Ask the employee what tasks they may be concerned about performing and what accommodations that they may require.
3. Ask for medical documentation by a healthcare professional. If an employee’s disability and functional limitations are non-apparent, employers will need more information to implement effective accommodations. Ensure that the documentation requested does not breach OHRC policy.
4. Follow your accommodation policies to develop reasonable accommodations. Consider work adjustments that support alternate ways to perform the role. You may wish to contact an Occupational Therapist for consultation on a detailed accommodation assessment plan.
5.  Follow up, monitor, and follow through on accommodations.  As individual capabilities change, the employee and employer should continually be looking for ways to maximize employee potential, safety, and productivity at work.
6. Educate leaders on all policies and procedures related to medical documentation to ensure employees are functionally able to complete the essential demands of their role.

How Can Gowan Consulting Help?

As these challenges come forward, engaging a professional to assist with the accommodation process can help you find resolutions quickly for your business and the employee’s health and safety. Gowan Consulting’s Occupational Therapists can assist with an objective accommodation assessment to provide recommendations for reasonable accommodations. For more information on how Gowan Consulting can assist with gathering information to support your duty to accommodate an employee with a disability, contact us.