Employers Need Dependable, Quality Medical Guidance for ADA, FMLA Decisions

Responding to employee requests for either a disability-related job accommodation or a work leave for family or medical reasons can be a challenging task, especially for employers who don’t handle a steady volume of such requests. Generally, employers understand the need to stay in compliance with the provisions of the Americans with Disability Act (ADA) and the Family and Medical Leave Act (FMLA), as well as relevant state workers’ compensation (WC) requirements. But moving from the general spirit of the ADA, the FMLA, and WC to being able to apply relevant provisions equitably to the employee requests that arise can be trickier.

An employer may need support from a medical peer review provider in cases where medical documentation is involved – just to understand the impact of medical reports and medical terminology to make proper decisions for each case. Here are three examples where medical documentation would likely be needed¹:

• Scenario 1. An employee requests a job accommodation for a disability under the ADA – in this case, an expensive ergonomic chair to relieve what the employee says is unrelenting back pain.
• Scenario 2. An employee needs to take a leave from work under the FMLA for medical treatment. Ultimately that leave will need to be extended even longer, based on a physician’s medical report.
• Scenario 3. An employee who joined the company three years ago falls at work. The case moves forward under both the FMLA and state workers’ compensation requirements.

The medical information an employer has access to under the ADA, FMLA, and WC is narrowly and precisely defined. The ADA specifies that medical inquiries and exams must be job-related, consistent with business necessity, restricted to how the employee’s disability affects the performance of essential job functions, and should only be requested when impairment and limitations are not readily apparent.¹

Similarly, the FMLA limits medical documentation to only what is necessary for medical certification. On a case-by-case basis, the employer may request a second or third medical opinion.

State workers’ compensation provisions limit medical information to the work-related injury or illness, specifically appointment and progress updates, a physician’s summary, and a functional capacity evaluation.¹

While it is common practice for an employer to request medical documentation in processing a request for a disability-related job accommodation, it is not required and often the employee making the request may be the best source of information. “Use logical judgment,” the Job Accommodation Network says. “If the disability and need for accommodation are obvious, move on to identify and implement accommodation solutions.”²

Efficient, cost-effective medical support

“Medical ReviewStream by Concentra® is an attractive option for employers that occasionally need expertise to understand medical documentation, not just in ADA-related disability and work accommodation matters, but also in utilization review and workers’ compensation claims adjustment,” said Mike Southwick, assistant vice president of Medical Advisory Services and Medical ReviewStream.

Sometimes, employers may consider retaining a single physician to provide medical support and understanding of medical documentation. Although this may sound like a simple solution, issues can be complex than they appear at first. All employers – not just the largest companies – should prioritize working with a medical peer review provider that offers a deep well of experience and knowledge about compliance requirements in various jurisdictions and industries.

To get a sense of the potential complexities involved in complying with requirements for employee leaves, work-related injury, or job accommodation/temporary modified duty (TMD) for a disability or following an injury, consider the ADA. The U.S. Equal Employment Opportunity Commission (EEOC) and seven other federal entities that have a defined role in issuing regulations, and enforcing sections of the Americans with Disabilities Act, as well as providing technical assistance.³

Different agencies and jurisdictions are far from the only complexity, though. Employers must be aware of the interplay and overlap of the ADA, the FMLA, and state workers’ compensation programs. Lauren Schipper, a regional accommodation manager for Amazon, clarified some key points for employers to understand in a presentation entitled, “The Intersection of the ADA, FMLA, and Workers’ Compensation.”⁴

Some of these points were:

• Don’t assume federal laws provide stronger employee protections than state laws; the reverse can be true.
• Protection under one law (ADA, FMLA, or WC) does not preclude simultaneous protection under the other laws.
• Employers must always ensure that the reasons for their decisions on employee leaves or job accommodation/TMD are not retaliatory in nature.

Advantages of Medical Review Stream for medical peer review

A deep well of experience and knowledge about compliance requirements in various jurisdictions and industries has already been mentioned as a benefit of working with Medical ReviewStream.

Here are five other benefits:

1. Accuracy – Each case is thoroughly evaluated by an experienced medical advisor and then subject to a quality management program.
2. Timelines – Medical advisors make timely and accurate recommendations a priority.
3. Communication – A clear line of communications is consistently provided and additional consultation is available, if needed.
4. Reporting – A detailed physician advisory report is created, citing appropriate, evidence-based criteria upon which recommendations are based.
5. Savings – Expert medical management result in time and money savings over the long haul.

Quality medical advisory services from Concentra physicians

Employers have long trusted Concentra to provide their employees with prompt quality medical treatment for workplace injuries, to ensure that new hires are physically suited to the job, and to provide medical evaluation to certify drivers for continued time behind the wheel. This expertise has saved employers millions of work hours and worker's compensation claim costs.

“This same expertise and outstanding medical guidance are available through Medical ReviewStream’s medical advisory services,” says Southwick.

Contact Medical ReviewStream for medical guidance and services related to utilization review, disability-related job accommodation/TMD, employee leave requests, workers’ compensation, and other matters related to workplace health and safety. 

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NOTES

1. "The Intersection of ADA, FMLA, and Workers’ Compensation,” a presentation by Regional Accommodation Manager Lauren Schipper.
2. Requests for Medical Documentation and the ADA. Job Accommodation Network
3. Federal Agencies and Resources. ADA National Network.
4. “The Intersection of ADA, FMLA, and Workers’ Compensation: Youtube,” a presentation by Regional Accommodation Manager Lauren Schipper on YouTube.