In early April 2025, the Seventh U.S. Circuit Court of Appeals recognized that employers could be held liable for monetary damages and other relief for violating the medical inquiry and examination limitations of the Americans with Disabilities Act (ADA), even if the employee involved is not disabled. As a result, employers must understand their obligations under the ADA.
The ADA restricts employers from requiring medical examinations or asking about medical conditions at three different stages:
Stage #1: Pre-Offer – Before Making a Job Offer to an Applicant
Before making a job offer, employers are prohibited from:
- Requiring applicants to undergo medical or physical examinations, including certain personality tests;
- Requiring applicants to take an alcohol test;
- Inquiring whether an applicant is disabled, including the severity of the disability;
- Asking about the applicant’s medical history; or
- Inquiring about workers’ compensation claims.
However, employers may inquire about an applicant’s ability to perform specific job functions, provided these inquiries do not elicit disability-related information. For instance, employers can ask applicants whether they:
- Have a driver’s license;
- Are able to lift a certain weight; and
- Can meet the attendance requirements for the position.
Stage #2: Post-Offer – After Making a Conditional Job Offer, But Before the Applicant Begins Work
After making a conditional job offer, employers may only make disability-related inquiries or require medical examinations or tests if:
- The employer applies these requirements to all entering employees in the same job category;
- The results are kept confidential; and
- The examinations are not used to discriminate against disabled individuals unless the disability prevents the individual from performing the essential functions of the job.
In sum, an employer may condition a job offer on the satisfactory results of a post-offer medical examination or medical inquiry, provided this requirement applies to all new employees in the same job category. A post-offer examination or inquiry does not need to be related to the job or consistent with business necessity. However, any decision to withdraw the job offer based on the medical examination results must be “job-related and consistent with business necessity.” Additionally, if a job offer is withdrawn due to the examination or inquiry results, the employer must demonstrate that:
- A reasonable accommodation is unavailable;
- A reasonable accommodation would impose an undue hardship on the employer; or
- The results of the examination or inquiry indicate that the individual poses a “direct threat,” as defined by the ADA, to the health or safety of the individual or others.
Stage #3: During Employment – Medical Examinations and Testing of Current Employees
The ADA imposes stricter requirements regarding medical examinations and inquiries for current employees than for applicants or those who have received conditional offers. Imperatively, after employment begins, an employer can make disability-related inquiries and require medical examinations only if:
- The examination and/or inquiry is job-related and consistent with business necessity; and
- The employer has a reasonable belief, based on objective evidence, that:
- A medical condition impairs the employee’s ability to perform the essential job functions; or
- The employee poses a direct threat, as defined by the ADA, due to a medical condition.
A medical examination in Stages #2 and #3 can disqualify an individual if the employer can show that the individual would pose a “direct threat” in the workplace, meaning a significant risk of substantial harm to themselves or others that cannot be mitigated below the “direct threat” level through reasonable accommodation. Conversely, such medical examination cannot disqualify an individual with a disability who is currently able to perform essential job functions simply based on speculation that the disability may lead to a future risk of injury.
Once an employee begins working, any medical examination or inquiry must be job-related and consistent with business necessity, such as:
- When there is evidence of a job performance or safety issue that they reasonably believe is caused by a medical condition;
- After an injury or illness and the employee wishes to return to work;
- When an employee requests a reasonable accommodation when the need for accommodation is not obvious;
- When medical examinations and screenings are mandated by applicable laws; and
- During a pandemic (e.g., COVID-19).
Things to Remember
It is important to note that the ADA classifies all information obtained from medical examinations and inquiries involving applicants and employees as “medical records.” As such, this information is subject to strict confidentiality requirements. Indeed, the law dictates that information gathered from these medical examinations and inquiries must be kept confidential and used only for limited purposes. For example, all such information should be collected on separate forms and stored in confidential medical files that are securely locked and separate from other records, only accessible under limited circumstances. Additionally, this information should not be included in an employee’s general personnel file.
Tests for illegal drug use are not considered medical examinations under the ADA and are not subject to the same restrictions as such examinations.