Fitness for Duty examinations are asked for in my practice relatively frequently, and Threat Assessments when needed. I have performed more than a thousand, for both public and private entities. Sometimes the exam is requested as a pre-employment evaluation because there is a past history of psychiatric illness including drug or alcohol problems. On other occasions, an employee has been taken off of work by a treating mental health professional, and the employer wants an independent evaluation of the employee before returning the person to work. If the employee currently is working, then the employer must have a reasonable belief based on objective evidence, that the employee is able, or unable, to perform the requirements of the job and if a medical condition is causing or contributing significantly to this problem.

A threat assessment may be an aspect of a return-to-work examination where violent threats, violent behavior, or concern about the potential for violence, caused an employee to be taken off of work. Threat Assessments are a unique type of forensic psychiatric examination different from a fitness for duty exam. See Risk/Threat Workplace Violence Assessment.

Independent Fitness for Duty (FFD) evaluations are at the employer’s discretion and are permitted because of the employer’s need to maintain a safe workplace. Under the ADA and FEHA, an employer may require a FFD Examination if the employer can show the examination is job-related and “consistent with business necessity.” The EEOC identifies “reasonable belief” and “essential job functions. It usually is prudent to obtain such an independent evaluation if the employee is in a position of great responsibility, or where the job involves security or safety issues (e.g. work with hazardous chemicals). Often an employee goes off of work because of serious interpersonal problems at the workplace.

When I conduct a psychiatric evaluation I may recommend treatment, in which case a reevaluation by an independent evaluator after the treater has cleared the employee for work is then indicated in order to make sure the employee can return to the workplace where the alleged work stress first occurred.

I believe it is necessary for the evaluating psychiatrist to be familiar with employees’ legal rights under the Americans with Disabilities Act (ADA) and to be prepared to recommend reasonable accommodations if such are needed.

Independent psychiatric exams—and independent medical exams (IMEs) in general— often are prudent for the employer because the treating doctor often will “go along” with the patient’s request to return to duty in order to maintain the treating alliance that exists between them. Treaters as a group tend not to appreciate the subtlety of workplace stresses and the rights of employees for reasonable accommodations, as well as not being familiar with information obtained from other employees or other sources. Sometimes doctors recommend unreasonable accommodations that the employer cannot fulfill, or they may not know what defines “reasonable accommodation” within the context of Title VII and the ADA. In such cases independent examination by an experienced forensic medical examiner is prudent. The result of my Fitness for Duty examination is my rendered medical opinion and recommendations, and is made in a written report.

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CategoryEmployment Law