Legal Responsibility for Work Accommodation Letters
Physicians are generally not legally responsible when patients misrepresent their medical needs when requesting work accommodations, as the physician's duty is to document and communicate the patient's reported symptoms and functional limitations based on their clinical assessment—not to verify the truthfulness of patient statements. 1
The Physician's Role in Work Accommodations
The physician's responsibility centers on making competent clinical assessments and providing honest medical opinions based on available information:
Physicians must make careful assessments through adequate history taking, clinical examination, and appropriate investigations, while maintaining detailed clinical records. 1 This documentation protects both the patient and the physician.
When communicating with employers, clinicians should address three specific areas: (1) work ability ("what the patient can do"); (2) work disability ("what the patient cannot do"); and (3) accommodation recommendations. 2 The responsibility for determining whether an accommodation is "reasonable" or feasible rests with the employer, not the physician. 2
Physicians must communicate truthfully with patients and provide honest assessments, but they are not investigators tasked with verifying patient credibility. 1 Your role is to document what you observe clinically and what the patient reports.
Key Protections and Limitations
Accommodation recommendations should be specific to workplace factors and based on expert clinical assessment, avoiding broad, non-specific statements. 2 For example, instead of writing "no exposures to gases, mists, dusts, and fumes," specify the exact limitations based on the clinical condition. 2
Clear and specific recommendations from clinicians carry considerable weight in accommodation decisions, but the ultimate determination of "reasonable accommodation" is the employer's responsibility under the Americans with Disabilities Act. 2
Documentation Best Practices
Maintain detailed clinical records that document your assessment process, the patient's reported symptoms, objective findings, and the reasoning behind your recommendations. 1 This creates a defensible record of your clinical judgment.
Document only diagnosis or health information directly relevant to the job, protecting patient confidentiality while providing necessary information. 2
If you have concerns about a patient's credibility, document your clinical findings objectively and consider whether additional objective testing or specialist consultation is warranted. 2
Common Pitfalls to Avoid
Never write accommodation letters for conditions you cannot clinically verify or that fall outside your scope of practice. 1 Providing care or recommendations beyond your training creates liability.
Avoid making accommodation recommendations when you lack sufficient clinical information to support them. 1 If a patient's reported symptoms don't align with objective findings, document this discrepancy and consider whether you can ethically provide the requested documentation.
Do not allow financial self-interest or pressure from patients to affect your clinical judgment. 1 Your primary obligation is to provide honest medical assessments.
When Patient Deception Occurs
If you later discover a patient misrepresented their condition, your liability is minimal if you:
- Conducted an appropriate clinical assessment 1
- Documented your findings and reasoning 1
- Based your recommendations on the information available at the time 2
- Made honest statements within your scope of practice 1
The legal responsibility for fraudulent accommodation requests falls on the patient who misrepresented their condition, not on the physician who made a good-faith clinical assessment. 1