Handling Disability Management Cases - Medical Assessment
Disability Management in the Federal Public Service
As much as possible, the employee's treating medical practitioner should be the primary source of information. In unusual circumstances (for example, if the employee does not have a medical practitioner, or if the medical practitioner is unable to provide sufficient information), consult with Human Resources for the best available options.
Managers must respect the employee's right to privacy throughout this process. Proceed to Protecting privacy.
In pursuing a medical assessment or reassessment, managers should:
- Discuss the purpose and benefits associated with a medical assessment, and confirm the employee's consent to attain this information. Proceed to Purpose and benefits of a medical assessment.
- What if the employee does not consent to a medical assessment. Proceed to Medical assessment: Employee does not consent to a medical assessment?
- Consult with Human Resources to help you complete the documentation required so that the medical practitioner can provide sufficient and effective information regarding abilities, functional limitations and restrictions related to the employee's job duties.
- If required, reimburse costs incurred to complete a medical assessment by the employee's treating medical practitioner. Proceed to Reimbursing medical assessment costs.
Note: Costs for medical certificates (to support leave requests) are not reimbursed.
Once the medical practitioner or service provider has assessed the employee and provided information about limitations, abilities and a possible return-to-work date:
- If necessary, consult with Human Resources for assistance in reviewing medical information and for guidance in obtaining related support for its interpretation.
Note: If an employee is receiving workers' compensation or disability insurance plans, the manager can normally obtain this same type of assistance by working with the case manager.
- Review the information with the employee with or without the union present, according to the preference of the employee, to reach a common understanding of the information that has been provided.
- Document discussions in the case file, using factual, objective language. Ensure that all documents are dated and signed.
If more information is needed in order to successfully accommodate the employee or to facilitate the return to work:
- If required, get the employee's signed consent to obtain additional information about abilities, functional limitations or abilities from the employee's medical practitioner.
- Follow up with the employee's medical practitioner to request clarification or additional information. Consult with Human Resources for assistance in developing correspondence that will let the practitioner know what is required. Ensure that the employee is aware of, and provided with copies of, all communications with the medical practitioner.
- If after following the above process you do not receive sufficient information from the employee's treating medical practitioner, you may decide to use a Fitness-to-Work Evaluation, provided by Health Canada. If there is conflicting information, consult with Human Resources for further guidance in requesting an Independent Medical Evaluation.
When you have sufficient medical information, proceed with the accommodation process. Proceed to Accommodation.
- Determining whether an employee needs a new medical assessment
- Employee does not consent to a medical assessment
- Purpose and benefits of a medical assessment
- Reimbursing medical assessment costs
- Fitness-to-work evaluation
- Job analysis
Medical Assessment: Employee Does Not Consent to a Medical Assessment
- Consult Human Resources for advice and guidance.
- If applicable, consult EAP or the Conflict Resolution Advisor for support in managing difficult conversations.
- Remind the employee that they have the duty to facilitate the search for accommodation, which may include the determination of abilities, functional limitations, and restrictions.
- Discuss the reasons for your request with the employee to address any concerns that the employee might have regarding the assessment. You may consider asking if the employee would like to involve a union representative or a third party in discussions.
- Reassure the employee that medical information will be kept confidential.
- Inform the employee of the job expectations and potential consequences of the observed behaviours that may have led to the request. If required, consult with Human Resources for more information.
- If applicable, document (and keep in the case file) the reasons why returning to work represents a significant risk for the employee or others in the workplace.
Determining Whether an Employee Needs a New Medical Assessment
In some cases, the employer may request a new medical assessment before an employee returns to work or to support accommodation efforts. New assessments are most often requested because the information available from prior assessments is outdated or not sufficient to support efforts to accommodate the employee.
For assistance in determining whether to request a new medical assessment, managers should ask:
- Is there sufficient medical information regarding the employee's abilities and limitations to support effective accommodation?
- Has the employee been away from the workplace for an extended period of time?
- Is there an expiry date on the previous assessment?
- Has the situation or condition changed?
- Have there been changes in the employee's behaviour?
The treating practitioner is best positioned to make an assessment or provide a referral. Alternative mechanisms include a referral by the workers' compensation board, or an assessment by a third-party physician or a regulated health care professional, as agreed to by the employee and employer.
Consult with Human Resources to resolve any questions or concerns.
Purpose and Benefits of a Medical Assessment
The purpose of a medical or occupational fitness assessment is to obtain information needed to assist an employee to remain at work or to determine when an employee will be able to return to work, and to obtain information about the abilities, functional limitations and restrictions of the employee in order to provide appropriate accommodation.
A medical assessment can benefit the employee and the employer in a number of ways:
- It can help the employee get medical advice, if he or she has not already done so.
- It can provide information and services to help the employee recover from an injury, illness or medical condition.
- It can give the manager information that is effective in determining appropriate accommodation in the workplace, which in turn can support the employee's safe and productive return to work.
- It can yield information needed to support long-term leave claims, as appropriate.
There are limits to what a manager should request and what employees are required to reveal regarding his or her medical situation. Managers are not permitted to ask for a diagnosis or confidential personal health information. They are entitled to information about how the employee's condition will affect the employee's ability to do the job. This may include details about the employee's limitations and abilities in performing normal, modified or alternative job duties and whether the condition is temporary or permanent.
Best practice tip: Employees should be reassured that the standard practice is to keep medical information confidential.
Reimbursing Medical Assessment Costs
Managers who request a medical assessment or information about limitations from the employee's medical practitioner should consult the regional Finance and Administration Advisor for information on how to process reimbursement in accordance with organizational policy.
Fitness-to-Work Evaluation
The purpose of the fitness-to-work evaluation, provided by Health Canada, is to investigate and determine the ability of an individual to carry out the duties of his or substantive position with or without accommodation. There are obligations for both employers and employees in supporting a fitness-to-work evaluation and the subsequent accommodation of the employee. The employee's explicit and written consent is a requirement for the evaluation. The employer is obliged to explain to the employee why this information is required and how it will be used.
A fitness-to-work evaluation is often undertaken when an employee is returning to work after medical leave and there is concern about fitness for duty. In requesting the evaluation, the employer should focus on how the illness, injury or disability will affect the employee's ability to conduct duties effectively and safely, and what restrictions or limitations might require accommodation for a successful return to work.
When a Fitness-to-Work Evaluation Might Be Required
Fitness-to-work evaluations can be requested when the employer has reasonable grounds for concerns about safety, or when the employee's actions appear to be affected by health-related factors, even if no medical leave has been taken. A fitness-to-work evaluation can also be requested if an employer is unclear about how to best accommodate an employee's illness, injury or disability. An employer is entitled to seek information from a medical practitioner to ensure that the employee is able to work safely and poses no hazard to himself or herself or to others. The employer is entitled to know what limitations the employee has, how these limitations affect the employee's ability to perform the job, and whether the limitations are likely to be temporary or permanent. The employer is not entitled to know the employee's diagnosis.
Preparing for the Evaluation
With the employee's consent, medical information is normally obtained from the employee's medical practitioner. This information, in conjunction with the detailed job analysis and other relevant information provided by the employee's manager, is provided to the health professional conducting the fitness to work evaluation. This health professional does not provide confidential medical information. Rather, the evaluation tells the employer only what is needed so that the manager can fulfill the duty to accommodate—specifically, information concerning the employee's functional limitations and any other restrictions that need to be accommodated in order for the employee to work safely. If requested, the information can also include suggestions for assisting the employee in the workplace. In situations where the employer has reasonable grounds for concerns about safety, an employee has an obligation to provide fitness-to-work information to the employer when requested. Labour Relations should be consulted if an employee refuses to cooperate and will not provide this information.
Special Circumstances
Departments and agencies do not request fitness-to-work evaluations from Health Canada when a return-to-work plan has already been developed and is satisfactory to the employee and employer. Referrals are made to Health Canada, with the employee's written consent, when there is not sufficient information from an employee's health practitioner to support either the return to work (with or without modified duties) or a job change.
Health Canada will not conduct fitness-to-work assessments if an individual is receiving workers'compensation, as the workers' compensation boards can provide this service. Health Canada may conduct a fitness-to-work assessment if an employee is receiving DI or PSMIP-LTD benefits.
When a fitness-to-work evaluation may be necessary, contact Human Resources for more information.
Job Analysis
Job analysis is the process by which information relative to a specific job, position or occupation is collected, analyzed and interpreted. The purpose of job analysis is to identify specific job requirements and work environment factors that could affect job performance. It is used in assessing the worker's ability as well as to identify reasonable accommodation required for effective job performance. Employers must provide accommodation so that qualified people with disabilities have the opportunity to perform essential job functions. Job analysis is done by an occupational health professional.
Typical functional job requirements include the following:
- Methods, techniques, tools and equipment to complete a task;
- Physical and mental requirements;
- Degree of physical effort;
- Complexity of mental requirements;
- Duration of time required to perform a task; and
- Frequency with which a task is performed.
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