Letter Requesting Information re Disability Status

[Date]

[Health Care Provider’s Address]

[Employee’s Name]

Dear [Name]:

I am the [state position within company (e.g., Human Resources Manger)] for [Company]. [Employee], a patient of yours, is employed as a [state position]. I am writing to you, with [employee’s] consent, to request your input regarding her employment at [company].

As I believe you already know, on __________ __, 1999, [state basis for belief that the employee’s performance related problem is disability driven (e.g., [employee] became severely disoriented while at work. She was incoherent, had slurred speech and was not able to respond to offers of assistance. In fact, given her condition, [employee] was taken to the emergency room at a local area hospital. On her return to work, I met with [employee] to discuss what had occurred and whether she required any assistance in performing her job. )

Obviously, this situation has raised concerns vis-à-vis [employee’s] ability to perform her job and whether she can do so in a safe manner. [Employee] has told us that she is under your care and therefore we seek your assistance. Specifically, [Company] would like your input to verify whether [employee] suffers from a disability under the Americans With Disabilities Act ("ADA"), and if one exists, the need for reasonable accommodation.

In accordance with the ADA, [employee] reasonably accommodates the functional limitations of disabled employees who request accommodation. Currently, we have insufficient [and/or inconsistent] information to adequately determine whether [employee] is disabled as defined by the ADA; namely, whether [employee] has a physical or mental impairment that substantially limits a major life activity.

Attached is a questionnaire we would like you to complete to assist us in making this determination. We have developed this questionnaire merely as a device to solicit your input. Please do not feel bound by the questions we have asked or the manner in which they are presented. We are more than willing to discuss this matter with you directly, which may become necessary. However, we believe that the questionnaire will facilitate the process in determining the appropriate course of action.

As stated in the questionnaire, if you determine that [employee] is disabled, please also provide us with information regarding whether you conclude that [employee] is in need of an accommodation so that she can perform the essential functions of her job. Enclosed for your consideration is a copy of [employee]’s job description. Should you feel that any accommodation is necessary, please provide me with the specifics. If you require more information regarding [employee]’s job duties, the recent episodes, or other information regarding this request, please call me. (For example, you may determine that you need to visit the job site to see how [employee] job is done before you can make an informed evaluation).

[Employee] has signed the limited release below, which allows you to provide us with the requested information. Please send your response to my attention at the above address, in an envelope marked personal and confidential. Thank you in advance for your cooperation. Should you have any questions, please call me.

[Company Official]

You are hereby authorized to disclose and deliver to [name of company official], in her capacity as [position with company], or her authorized designee, any and all medical records, documents or information that would adequately respond to the above-request. Please respond to the above request promptly upon receipt of this authorization.

Dated: ____________________

______________________
[employee]

Introduction

To be disabled under the ADA, [employee] must suffer from a physical or mental impairment that substantially limits a major life activity.

Under the ADA regulations, a physical or mental impairment means (1) any physiological disorder, or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genito-unirnary, hemic and lymphatic, skin and endocrine; or (2) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.

Major life activities include, but are not necessarily limited to, functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, thinking and working.

As stated, to rise to the level of a disability, an impairment must substantially limit one or more major life activity of the individual. The ADA does not define substantially limits, but it has been decided that substantially suggests considerable or specified to a large degree. Whether the limitation rises to that level, you should assess: (i) the nature and severity of the impairment; (ii) the duration or expected duration of the impairment; and (iii) the permanent or long term impact, or the expected permanent or long term impact of or resulting from the impairment.

Of course, substantial is a relative term and, therefore, [employee] may be substantially limited if you determine that she is (i) unable to perform a major life activity that the average person in the general population can perform; or (ii) significantly restricted as to the condition, manner or duration under which she can perform a particular major life activity as compared to the condition, manner, or duration under which the average person in the general population can perform that same major life activity.

Please note, however, that in determining whether the condition substantially limits a major life activity you should evaluate the limitations in a treated state. That is, you should assess the effects, both positive and negative, of any mitigating measures (like medication) that can be used to lessen a limitation. By way of example, a near-sighted pilot whose vision is normal when wearing corrective lenses is not disabled under the ADA.

If [employee] does not suffer from a physical or mental impairment that substantially limits a major life activity, she is not disabled under the ADA. Conversely, if she does suffer from such an impairment, she is disabled. However, as set forth in our letter to you, our interest is much more limited than determining whether [employee] is or is not disabled under the ADA. Notwithstanding the recent incidents involving [employee], she may suffer from a disability that is unrelated to the episodes or that has no impact on her ability to do her job at [company]. We are not interested in learning about any such disability. We are interested in knowing whether [employee] has any impairment-produced limitation that led to the recent episodes or is otherwise the cause of her poor job performance. In sum, if [employee]’s current job difficulties are a result of an ADA disability, we must know that in order to determine how to proceed.

[Add if legitimate safety issue is present] Lastly, given [employee]’s position as a [position] and the nature of the recent episodes, we are interested in determining whether she can perform her job without posing a direct threat to her own health and safety, and/or the health and safety of those with whom she works (both her co-workers and her our patients). We are not interested in remote or speculative risks; rather, we would like to know whether you believe that [employee] poses an identifiable, current specific risk that poses a significant threat of substantial harm to herself or others. Obviously, you should base your determination on objective medical or other factual evidence regarding [employee].