A Physician, an Ergonomist, and a Functional Capacity Evaluator Walk Into a Juice Bar…Part I

mold-pro-job-analysis-blue-blouseI often feel like a tour guide as I walk my daily journey of answering questions about the roles of various professionals involved in return to work decisions under Title I of the Americans with Disabilities Act.

A week or so ago I received an inquiry from an individual who wanted to know the gravitas of his opinion in an interactive conversation about a return to work plan which included a reasonable accommodation. This degreed physical therapist is an ergonomic evaluator (not an ergonomist) who provides wellness support at a large multi-function facility in the mid-west. He had just come from a discussion with the company’s disability and absence manager who expressed the opinion that a physician’s suggestion of a specific accommodation precluded input from other professionals such as himself. And, in fact, the manager believed that the company would be out of compliance with Title I of the ADA if the company did not implement the suggestion offered by the physician.

Here’s a look at how the roles of the players mentioned in the inquiry flow and change as the interactive conversation proceeds:

Once the employer has determined that a request for RA has been received the employer is responsible for the interactive process and resolution of the request. The employer is encouraged by the EEOC and the federal courts to reach out to medical personnel including physicians, occupational therapists, and physical therapists and to on-site personnel such as members of a safety team, work supervisors with direct knowledge of the demands of the job, and the worker himself.

The goal of reasonable accommodation under Title I of the amended Americans with Disabilities Act is to remediate the differences between the physical demands of the essential functions of a worker’s job and his safe and sustainable abilities. It is not too far out to say than an employer must have an array of medical and work evaluation personnel qualified to give input to identification of a safe and effective accommodation solution.

The Physician’s Role

It is important to note that the physician’s role begins with identification of the worker’s impairment and, potentially, expression of an opinion as to the existence of a work-related disability triggered by the impairment. This second step is an important technicality as the absence of a link between a disability and the physical demands of the worker’s job remove the employer’s responsibility relative to provision of an RA solution.

Also keep in mind that, in many cases, because the physician does not have sufficient information about either the essential functions of the job nor the physical demands linked to one or more affected essential function, the physician is often not in a position to contribute an informed opinion as to either the ability of worker to safely perform his job with accommodation or the exact accommodation solution that will enable him to work. This notwithstanding, the employer cannot turn its back on the opinion of the physician (an application of arbitrary and capricious behavior) just as it is not allowed to hide behind a physician’s opinion or finding. (see: GUCKER v. U.S. STEEL CORPORATION, No. 2:2013cv00583 – Document 56 (W.D. Pa. 2015).

The physician’s opinion as to a reasonable accommodation solution carries the same weight as other qualified work evaluation professionals. The key here is knowledge of the link between a medically derived work restriction and the essential function of the job. Once that link is established, the physician is on safe ground to comment on the degree to which a disability results from this link. Going further, the physician may also comment on a possible reasonable accommodation based on accurate knowledge of the demands of the job and the limitations of the disability. (The physician must be careful to not simply suggest an accommodation that the patient/worker favors.)

To summarize a physician’s role in the RA process: (1) The physician is relied upon to identify the existence of the impairment and, if present, attendant medical restrictions. (2) The physician may contribute to the interactive conversation with an opinion about a range of accommodation solutions. The physician’s opinion as to a safe and effective RA solution is neither binding on the employer nor is it exclusive of other effective and reasonable solutions.

Space limitations in the blog world limit the number of words I can use here. Join me on January 11th for a 45 minute discussion of the roles of the other individuals involved in the interactive conversation. Go to my website to register for the event.

2 Comments:

  1. Basically, an impairment alone does not an occupational disability make. As a Florida physician specializing in work disability evaluations, this topic cuts to the quick. I always link my impairments to limitations, then to restrictions, then to occupational and/or vocational disabilty with the caveat that my opinion is but one of many and not written in stone. I see it as food for thought and a talking point for HR and the disabled evaluee.

    • Thanks for your comment, Dr. Gerken! My only feedback would be that you do not need to indicate that your opinion is one of many. You are taking the correct approach in linking the identified impairment to a reasonable anticipation of a limitation before moving on to medical restrictions. If this is all under the umbrella of a return to work decision, or employ ability in general, then you should indicate that a reasonable accommodation may be available to bridge the gap between the physical or cognitive demands of an essential function of the job. For all those physicians who are learning about ADA Title I by following Dr. Gerken’s comments, be advised that in order to answer the question, “Is Mrs. Smith able to safely perform the job which she holds or desires?” you have to consider a reasonable accommodation to bridge the gap between medical restriction, work limitation, and status as a qualified worker for the position in question. Ignoring your responsibility to address the reasonable accommodation issue leaves the legal question unanswered.

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