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Workplace accommodations

Jeff Bezos loves these. Hurt your back bending and twisting at the warehouse? Well, we can move you elsewhere in the warehouse, but you’ll have to get your doctor’s permission. What a waste of time and money for everyone.

In these cases, I just ask the patient what accommodation they think would help them work. They usually have something in mind, and it’s rarely controversial. Your job is to (1) say “sure”; (2) tell the patient the risks of not following corporate policy — steel-toed boots are required for a reason; and (3) write a nondescript letter restating the employee’s request, confirming they’d benefit from an accommodation. Since you don’t work there, you can’t decide whether an accommodation is “reasonable.” That word has a lot of wiggle room, and it’s up to the employer. If the request is denied, it’s up to the employer, the patient, and their lawyers to sort out. Your job is done.

Sometimes, the patient can not think of a reasonable accommodation. In these cases your job is to document your patient’s functional limitations. It’s the employer’s job how to accommodate those limitations. The employer may then come up with a plan, and then request your blessing.

A few points of law worth knowing:

  • The ADA applies to employers with 15 or more employees. The employer is obligated to engage in an “interactive process,” which is why they keep sending things back. They may ask for documentation of the limitation and the need, but not for your entire chart.
  • Write about function, not diagnosis. “Should avoid lifting more than 20 pounds and should be permitted to alternate sitting and standing” is useful and discloses nothing. “Has ankylosing spondylitis” discloses a great deal and helps no one.
  • Pregnancy has its own law now. The Pregnant Workers Fairness Act (effective June 2023, with the EEOC’s rule effective June 2024) requires employers with 15+ employees to accommodate known limitations related to pregnancy, childbirth, or related conditions — and, importantly, the limitation does not have to rise to the level of an ADA disability. Water, bathroom breaks, a stool, lighter lifting, time off for appointments. The EEOC published guidance specifically for health care providers (https://www.eeoc.gov/wysk/what-you-should-know-about-pregnant-workers-fairness-act). Keep documentation minimal; the EEOC has been explicit that extensive medical documentation should not be required. The PUMP Act separately covers lactation breaks and space.

Sample letter:

To whom it may concern,

Mr. Smith has been a patient at our office for many years, and I am familiar with his medical issues. It is my medical opinion that the following reasonable accommodation(s) would be in the best interest of Mr. Smith’s health and of his ability to continue as a capable and productive employee: [list].