From the desk of Matthew McCord, M.S., CRC, Consultant – Mobility Team
A topic that we talk about daily here at JAN is medical documentation. This is an important topic to understand. When an employee requests an accommodation, employers have the right to request sufficient medical documentation to assist them in determining whether the employee meets the ADA’s definition of disability and needs the requested accommodation because of the disability. Of course, medical documentation may not be requested if the disability and need for the requested accommodation are already documented or obvious to the employer. However, one portion of this topic that can be difficult to understand is what makes medical documentation “sufficient.” To that end, let’s discuss this topic and break it down into simple terms.
Before we dive into the details, we need to discuss two things. First, as medical documentation is used to help the employer determine that the individual meets the ADA’s definition of disability, we should briefly go over this definition. The ADA’s definition of disability is defined simply as a physical or mental impairment that substantially limits one or more major life activities. There is a JAN Consultants’ Corner article that describes the definition of disability and the process of determining whether an individual meets it in more detail. It is a very helpful tool to have in your toolkit should you be rusty or new to the process.
Second, we need to discuss what the Equal Employment Opportunity Commission (EEOC) has said on the topic of sufficient medical documentation. Under question 10 of the EEOC document titled, Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act (ADA) it states that, “Documentation is sufficient if it: (1) describes the nature, severity, and duration of the employee's impairment, the activity or activities that the impairment limits, and the extent to which the impairment limits the employee's ability to perform the activity or activities; and, (2) substantiates why the requested reasonable accommodation is needed.” With this information in mind, let’s talk about this in more manageable pieces and describe what each part means.
Nature, severity, and duration
As you likely noticed, the description of what makes medical documentation sufficient is broken into two numbered portions. The portion listed under #1 is intended to help the employer make the determination that the individual meets the definition of disability. To describe the nature of the impairment, the medical provider may give a general description of the impairment. For example, an anxiety disorder could be described as a mental health impairment or multiple sclerosis as a neurological impairment. To describe the severity, the medical provider will normally try to simply gauge how acute the individual’s manifestation of the impairment is in comparison to the general population. Finally, describing the duration explains how long the impairment is expected to last, or when the individual’s condition will likely improve.
Activities that the impairment limits
This portion of the description refers to the major life activities that the individual is limited in performing. An individual’s impairment can impose several different limitations, but to meet the definition of disability, the individual only needs to show that he or she is substantially limited in one. Because of this, it is typical for the information provided here be brief and not an all-inclusive list of limitations that the individual may experience.
Extent impairment limits ability to perform activities
Where the previous piece of the description identified relevant activities that the impairment will limit, this section strives to explain how much the impairment limits the individual in performing those activities. Usually, this section and the previous section will be addressed simultaneously. For example, a medical provider stating that an individual is “limited in lifting no more than 20 pounds” is stating the activity being limited (lifting) and also the extent the ability to perform that activity is limited (no more than 20 pounds). An important thing to note is that when you are comparing the extent of these limitations to others to determine if a substantial limitation exists, the individual is not to be compared to similarly situated individuals. Compare individuals with disabilities to the general population rather than one another.
Substantiates why the accommodation is needed
This is the only portion listed under #2 in the description. This is because this portion is not needed to make the determination that the individual meets the definition of disability. However, this portion is still very useful as it explains how the accommodation that the individual is requesting will assist them. Employers are only required to provide accommodations that are needed due to disability-related needs. Therefore, this portion shows the link between the requested accommodation and how it helps the individual manage the needs imposed upon them by their disability. For example, medical documentation stating that an individual needs “a noise canceling headset to help minimize distractions while working” is providing the link between the requested accommodation (the headset) and how it helps the individual (to minimize distractions).
When reviewing medical documentation, it is important to remember why it is part of the process. Sometimes, employers get caught up in the procedure of how an accommodation request is normally handled. It is helpful to have consistency, but it is critical to remember that medical documentation’s purpose is to help make the determination that an individual meets the ADA’s definition of disability and needs the requested accommodation. Therefore, if you have not been provided everything that the EEOC describes as sufficient medical documentation, but you feel you have enough information to make that determination, then you are permitted and encouraged to move forward. If it helps, then think of the sufficient medical documentation description as a benchmark for how much medical information the employer is permitted to request if needed, rather than the amount that all individuals have to provide before the request is reviewed.