What are the guidelines for implementing work restrictions for an individual with a medical condition?

Work Restrictions for Medical Conditions

Work restrictions must be individualized based on the specific medical condition, actual job duties, and documented functional limitations—not on generalized assumptions about disease states. 1

Core Principles for Implementing Work Restrictions

Safety-Based Assessment Framework

Evaluate whether safety concerns are reasonable in light of the actual job duties the individual must perform. 1 For most employment settings (office, retail, food service), medical conditions pose no inherent safety risk to employees or the public. 1

For safety-sensitive positions (operating dangerous machinery, carrying firearms), the primary concern is whether the employee could become suddenly disoriented or incapacitated. 1 This requires:

• Review of blood glucose test results (for diabetes) or relevant biomarkers for other conditions 1
• History of acute episodes that could cause sudden incapacitation 1
• Presence of condition-specific complications that interfere with actual job performance 1
• Assessment by specialists with expertise in the specific medical condition 1

When to Exclude from Work

Active infectious conditions require exclusion until non-infectious. For tuberculosis, healthcare workers must be excluded until receiving adequate therapy, cough has resolved, and three consecutive negative sputum smears on different days are documented. 1

For shingles, immunocompetent patients with localized disease may return immediately with proper lesion coverage, but must avoid contact with high-risk individuals (immunocompromised, pregnant women, neonates) until all lesions are completely dried and crusted, typically 7-10 days after rash onset. 2

For diabetes, recurrent unexplained episodes of severe hypoglycemia may warrant restrictions from certain safety-sensitive jobs, but a single episode should never automatically disqualify someone from employment. 1

Required Workplace Accommodations

Employers must provide reasonable accommodations unless they create undue burden. 1 These accommodations are typically simple, cost-free, and cause minimal workplace disruption. 1

Daily Management Accommodations

• Breaks for medical monitoring: Allow brief breaks (minutes) for blood glucose testing, medication administration, or symptom management at the workstation without restricting location. 1

• Food and beverage access: Permit consumption at desk/workstation to respond to medical needs (hypoglycemia, hydration), except in rare situations creating actual safety hazards—then provide alternative site. 1

• Flexible scheduling: Accommodate medical appointments, rotating shifts that complicate disease management, and unanticipated medical events. 1

• Storage for medical supplies: Provide appropriate storage when work conditions (extreme temperatures) prevent carrying supplies. 1

Accommodations for Established Complications

Long-term complications are relevant only when established and interfering with actual job performance—never based on potential future development. 1 Examples include:

• Visual impairments: Large screen computers, visual aids 1
• Neuropathy/nerve pain: Reduced walking distances, ability to sit, ergonomic modifications 1
• Kidney disease: Flexibility for dialysis treatment 1
• Heavy lifting restrictions: For uncontrolled diabetes with hypoglycemia risk, reassignment away from heavy lifting duties is medically justified due to increased risk of sudden incapacitation and exercise-induced hypoglycemia. 3

Medical Documentation Requirements

Medical evaluations must be conducted by healthcare professionals with expertise in the specific condition and based on sufficient, appropriate medical data—never a single data point. 1

Collect only medical information relevant to current capacity for safe performance of the specific job. 1 Avoid:

• Urine glucose tests or A1C/eAG results for employment decisions (these measure long-term control, not acute incapacitation risk) 1
• All past laboratory values unrelated to current functional capacity 1
• General assessments of disease control rather than job-specific functional limitations 1

Return-to-Work Clearance

For infectious conditions, verify specific clearance criteria before return:

• Tuberculosis: Documentation of adequate therapy, cough resolution, three consecutive negative sputum smears, and ongoing treatment compliance 1
• Shingles: All lesions completely dried and crusted 2
• Healed skin lesions: No moist, exudative, or draining lesions present; use ICD-10 code Z09.0 for follow-up after treatment 4

Healthcare workers with localized shingles may continue working if lesions are completely covered, but must avoid caring for immunocompromised patients, pregnant women, and neonates until lesions crust. 2

Common Pitfalls to Avoid

Never base employment decisions on:

• Assumptions that all individuals with a condition pose safety risks 1
• Potential future complications that have not yet developed 1
• Single episodes of acute complications without proper evaluation 1
• Outdated testing methods (urine glucose) or inappropriate biomarkers (A1C for acute risk) 1

Always ensure:

• Accommodations are tailored to the individual, not generic disease-based restrictions 1
• Input from specialists in the specific complication when complications exist 1
• Periodic documentation of treatment compliance for ongoing conditions requiring therapy 1
• Assessment of whether workplace accommodations can mitigate identified risks before imposing restrictions 1