Why Employers Should Consider Using Post-Offer Medical Questionnaires

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Due to the nature of the work that they perform, many employers want to be able to determine if their candidates are medically or physically fit to perform the job-related duties of the position being offered.

In general, these medical evaluations fall into three stages:

  • Pre-offer (prior to the offer of employment)
    • During this stage, the ADA prohibits all medical evaluations, even if they are related to the job.
  • Post-offer (after a candidate is given a conditional job offer, but prior to starting work)
    • An employer may make disability-related inquiries and conduct medical examinations, regardless of whether they are related to the job, as long as it does so for all entering candidates in the same job category, and it considers reasonable accommodation of an individual’s disabilities, as the job permits.
  • After employment
    • An employer may require medical evaluations only if they are job-related and consistent with business necessity.

Since medical evaluations intend to help ensure someone is medically fit for the job, let’s take a closer look at that second, post-offer stage, since this stage is legally permissible and where the evaluation has the most benefit from a risk mitigation perspective.

A Powerful Tool to Make Informed Decision

According to American Disability Act (ADA) regulations, the post-offer evaluation does not have to be job related; however, if an adverse hiring decision is to be made based on this evaluation, the disqualifying criteria must be job-related and consistent with business necessity and performance of the essential job functions cannot be accomplished with reasonable accommodation.

Traditionally, post-offer medical inquiries are done by having the candidate go to a clinic for a physical examination. This examination can be both expensive and time-consuming. Some forward-thinking employers have now started using medical questionnaires as their post-offer medical evaluation. In these situations, the questions act as either the entire post-offer evaluation or part of a post-offer evaluation that may lead to or require further medical services. Either way, critically evaluating the medical history of a candidate will help ascertain the candidate’s ability to perform the basic job function.

In my experience of 15 years of clinical practice performing literally thousands of these evaluations, it is the medical history that is the most telling factor regarding a person’s ability to safely perform a specific job task.  The medical history tells the evaluator the following:

  • Pre-existing injuries and illnesses
  • Ongoing medical conditions
  • Current medications
  • Immunization or disease immunity status
  • Suitability for vaccinations or Tuberculosis testing after receiving the COVID-19 vaccine.
  • Capturing the medical clearance questions as required by OSHA to wear a respirator.

Pinpointing Red Flag Conditions

Evaluation of the above historical elements via a medical questionnaire is a powerful tool.  The critical evaluation of the questionnaire will allow the evaluator to note “Red Flag” conditions (medical issues that may impact a candidate’s ability to perform the essential job duties) and obtain further medical clearance.  Here are some examples of Red Flag conditions:

  • Impairing medication use
    • Such as opioids or benzodiazepines (Valium type medications)
  • Previous worker’s compensation injury
    • Particularly if they are still under care for that injury.
  • A current or chronic injury or medical condition that could impact safe performance of the candidate’s basic job functions.
    • Like a person who suffers from rheumatoid arthritis (since that person may have a lifting restriction that cannot be accommodated based upon the job requirements)

Beyond Red Flag Conditions

In addition to the conditions noted above, the use of questions can also be used for the following:

  • Suitability for work at a given position and/or to wear a respirator for work.
  • Obtaining information on a candidate’s immunization status to dictate if further occupational health services are required.
  • Gathering information on timing of additional occupational health services
    • Such as the delay required for vaccinations and Tb testing after someone receives his/her Covid-19 vaccine.

Most red flag conditions can be medically cleared by working with the candidate and his/her treating physician to determine whether the condition is amendable to reasonable accommodation or not.

When to Use Post-Offer Medical Questions

The advantages of a post-offer medical questionnaire vs. a post-offer medical examination are many and include:

  • Cheaper price point
    • Typically, no need for an expensive exam
  • Better candidate experience
    • Candidate does not need to take time off to have an examination performed.
  • Faster turnaround time
    • Questionnaire can be completed and medically reviewed in a quicker timeframe than scheduling and going to a clinic for an exam.

Post-offer medical inquiries are not for all employers.  Employers that may want to consider using post-offer evaluations (such as medical questionnaires) are ones that have the following:

  • Safety-sensitive laborers whose pre-existing medical issues could cause them to pose a safety hazard.
  • Laborers whose essential job function requires “medium work.” Medium work is defined by the Social Security Administrations as lifting no more than 50 lbs. at a time with frequent lifting or carrying of objects weighing 25 lbs. These laborers are the ones most at risk for occupational lifting injuries.

When it comes to employee satisfaction and retention, maintaining a safe and productive work environment is important, and it begins with determining a candidate’s fitness for job duty. Proactively ensuring that a candidate’s physical capabilities are in line with the physical demands of the job not only protects a company’s integrity but also helps ensure the safety of all workers and their clients.

How HireRight Can Help

HireRight offers several medical questionnaire templates to choose from based on the employer’s specific needs – OSHA Respirator, Vaccinations, COVID-19 and Tuberculosis. Questions are presented electronically through HireRight’s Applicant Center (a mobile application for candidates to manage their background checks) and follow the recommended guidelines from the Occupational and Safety Health Administration (OSHA) and Centers for Disease Control and Prevention (CDC).

Employers can select the questionnaires that best apply to their candidates or combine them to create a custom package.  Responses from candidates will be used to create a report for employers to help assess their next steps in the health screening process.  In my experience, medical questionnaires help employers better understand a candidate’s medical history when it is most relevant for mitigating hiring risk.

For information on HireRight’s Electronic Medical Questionnaires, visit our website or contact us today!

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Dr. Todd Simo

Dr. Simo is the Chief Medical Officer and the Managing Director of Transportation at HireRight. He served as HireRight’s medical director starting in 2009 and was promoted to chief medical officer in 2015. Dr. Simo was also appointed to the role of managing director of transportation and drug & health screening in 2018. Dr. Simo came to HireRight with a decade of experience in the medical consulting arena. Before that he was the medical director for an occupational health clinic in Virginia and owned a consulting firm providing medical director services to employers across the United States

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