Medical Documentation and Accommodation
The role of medical professionals in the accommodation process
 
Medical professionals have an important role to play when people with disabilities seek accommodation to allow them to benefit equally from and take part in services (such as education), housing or the workplace. To implement appropriate accommodations, schools, employers and other organizations covered by the Code often rely on the expertise of medical professionals to understand the functional limitations and needs associated with a disability. People seeking accommodations often rely on physicians or other medical professionals to provide clear, timely information about their disability-related needs, while still respecting their privacy interests.
In September 2016, the Ontario Human Rights Commission (OHRC) released its newly updated Policy on ableism and discrimination based on disability. The new policy sets out important information about the role of medical documentation in the accommodation process.
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[1]
  • the limitations or needs associated with the disability
  • whether the person can perform the essential duties or requirements of the job, of being a tenant, or of being a service user, 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, of being a tenant, or of being a service user, etc.
  • in employment, regular updates about when the person expects to come back to work, if they are on leave.
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 organization enough information to make an informed decision about the accommodation.
To implement appropriate accommodations that respect the dignity and privacy interests of people with disabilities, the focus should always be on the functional limitations associated with the disability, rather than a person’s diagnosis.
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.
What Policies and Procedures Will You Require?
Note that although the OHRC has indicated what is appropriate for medical documentation it is NOT required that all of this information be asked.  We generally suggest that asking for a return to work date from the medical practitioner is not a valid question as there are many things that you as an employer can do to support work accommodations that will change that potential date.
As an employer does this change your return to work policies?  Has there been additional information requested on forms from health care providers that is not required?  This new policy also brings to question how a medical professional determines return to work function.
A recent discussion on the work fitness round table indicates that health care providers (doctors, physiotherapists, chiropractors, occupational therapists) without the use of standardized assessments are not accurate in the ability to predict return to work capabilities and time lines.
This may indicate that information that is asked for on the medical documentation should be supported by other testing, assessments or tools that will standardize the information.
If your process does not ask MORE than what is requested above then you may still have a valid medical documentation process.  Other assessments or information gathering may be necessary and is still allowed as long a personal medical information is not requested.
What Employers Need to Know!
1. The first step for every employer is to know what the job requires and any inherent safety risks and judgements that must be made by the employee.  A Physical  or Cognitive and Behavioural Demands Analysis can be invaluable to this assessment.  What information will the health care provider be provided in order to assist with the workplace return process?
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.  Ensure that if the employee shows signs of risk in being able to perform the safety sensitive role (temporarily) adjust the work environment or tasks to ensure employee, co worker and public safety.
4. Does the employer require further documentation by a medical/health care professional? Ensure that the documentation requested does not breach OHRC policy.  Note that if you are asking the medical professional to comment on return to work then they will need to know the job requirements.  Consider a form that does not ask RTW date (This is a decision made based on your ability as an employer to provide accommodation).
5. If the employee has a documented accommodation need due to disability ensure that you follow your accommodation policies in place to develop reasonable accommodation. You may wish to contact Gowan Consulting for a detailed accommodation assessment plan.
6.  Follow up, monitor and follow through.  As capabilities change with many individuals it is the employee and employer that should continually be looking for ways to ensure that the employee can maximize his/her potential, safety and productivity at work.
There are assessment and policy solutions:
  • Ask that the employee be assessed by an Occupational Therapist. A comprehensive cognitive and functional assessment can provide details on how the disability has impacted the cognition and function of the employee.  The Occupational Therapist can then assess the essential duties of the job to determine if cognitive and physical capabilities will impact the employee’s safety and capabilities.
  • If the employee operates machinery, vehicles or has a safety sensitive position ensure that there are supports in place to manage changes to function that will impact safety.
  • Consider work adjustments that support alternate ways to perform the role.
  • Follow up with the employee regularly to ensure the validity of the accommodation plan.
  • Educate managers and supervisors in procedures when they suspect changes in function at work.
  • Educate employees on all policies and procedures related to medical documentation and return to work processes

For more information on how Gowan Consulting can assist you with getting the right amount of information to support return to work or your duty to accommodate an employee with a disability, contact us at gowanhealth@gowanhealth.com

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