The federal Americans with Disabilities Act protects job applicants and employees from workplace discrimination based on their disabilities. The ADA also requires employers to make reasonable accommodations to allow qualified employees with disabilities to do their jobs.

Because medical examinations and questions might reveal the existence or extent of an employee’s disability, they can present complicated issues under the ADA. On the one hand, employers aren’t allowed to make decisions based on an employee’s disability, so they can't go digging around in an employee’s medical records or asking intrusive questions to look for potential problems. On the other hand, an employer may have a legitimate need to learn more about an employee’s medical condition in order to make sure an employee can do the job safely or provide an effective reasonable accommodation.

The ADA tries to balance these concerns by allowing employers to make inquiries about an employee’s disability or require an employee to take a medical exam only if the requirement is job-related and consistent with business necessity. Below, we describe the situations that meet this test. (Note that these rules cover only current employees; applicants are subject to different rules.)

What Questions and Medical Exams Are Restricted Under the ADA?

Not every potentially health-related question or test is regulated by the ADA. Your employer can always ask after your well-being—if you’ve been out sick or are going through a difficult divorce, for example. Your employer can also require you to take a test for illegal use of drugs, as current illegal drug use is not a disability under the ADA.

Your employer, however, is restricted in its right to make disability-related inquiries: questions that are likely to elicit information about your disability, whether posed to you or anyone else, including a coworker, a family member, or a doctor. For example, your employer may not ask whether you take any prescription drugs, whether you have a disability, or whether you carry any genetic markers for particular diseases or conditions.

Employers are also restricted in requiring employees to undergo medical exams—tests or procedures in a medical setting or overseen by a health care provider—about the employee’s physical or mental health or conditions. Examples of these types of tests include eye exams, hearing tests, blood pressure tests, CAT scans, MRI scans, X-rays, and so on.

But as noted above, an employer is not absolutely prohibited from requiring these exams or making these inquiries. An employer can require them only in certain situations.

When Can an Employer Require a Medical Exam?

The Equal Employment Opportunity Commission (EEOC), the federal agency that enforces the ADA and other laws prohibiting discrimination, has regulations that spell out when an employer can ask questions or test you in ways that might reveal your disability. They are:

• If your employer has a reasonable belief, based on objective evidence, that you are unable to perform your essential job duties. For example, say an employee’s productivity has declined over the last few months. When the employee’s supervisor talks to him about it, the employee reveals that he has recently been diagnosed with cancer, and his chemotherapy regimen is causing him to feel fatigued. The employer could legally request more information about the employee’s condition, because it appears to be affecting his ability to perform his job functions. Or, if you were on leave for medical reasons and your employer has reason to believe you may be unable to do your job, this exception can also allow an employer to require you to undergo a fitness-for-duty exam before you return to work.
• If your employer has a reasonable belief, based on objective evidence, that you pose a direct threat. An employer does not have to retain an employee who poses a direct threat to health or safety in the workplace, even if that threat is related to the employee’s disability. For instance, if an employee who operates heavy machinery begins having sudden fainting spells, the employer could legally require a medical exam to determine whether the employee can safely do the job.
• If your employer needs more information to provide a reasonable accommodation. Your employer is allowed to ask you for documentation about your disability and the effect it has on you if you need an accommodation—unless your disability and need for accommodation are known or obvious. If your disability and the modifications you need are obvious, your employer may not make this request. For example, if you use a wheelchair and it won’t fit under your desk, your employer should not be able to require you to undergo a medical exam to prove that you need a modified work area. But if you have pain while sitting at your desk and need an accommodation for your back, your employer could inquire about your back problems to determine if a sit/stand desk would be an appropriate accommodation for you.
• If your employer has another valid justification. Other exceptions may apply depending on the circumstances. For example, an emergency response company might require all ambulance drivers to take an annual vision test. Similarly, other laws may require medical testing, so your employer is allowed to subject you to such tests. For example, federal law requires that flight attendants and pilots meet certain medical requirements.

Can I Go to My Own Doctor for a Work-Related Medical Exam?

If your employer requires you to take a medical exam, you are generally entitled to see your own health care provider. However, you might have to see a health care provider of the employer’s choosing if either of the following is true.

• Your employer believes you pose a direct threat to health and safety.
• The documentation you provide to prove that you need a reasonable accommodation is insufficient because, for example, your health care provider is not qualified or provides information that is not credible, you failed to provide any documentation, or the documentation you provided fails to provide enough information about your disability and how it limits you. However, your employer may have an obligation to give you a chance to provide sufficient and adequate information before sending you to its own provider.

Next Steps

If you believe your employer is violating the ADA by requiring you to provide medical information or take a medical exam, you should talk to an employment lawyer right away. By getting legal advice before you decide whether or not to comply with the employer’s request, you can best protect your privacy and your legal rights under the ADA. If your employer has already taken action against you (such as firing you for refusing to take an exam or treating you differently once you reveal you have a disability), a lawyer can help you assess the facts and figure out whether you have a strong legal claim against your employer.