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The Employer Handbook Blog
Can an Employer Reject a Doctor’s Return-to-Work Clearance?
His doctors cleared him to return to work. The railroad kept him away from moving trains for five years.
TL;DR: A federal appeals court upheld summary judgment for an employer that barred a railroad conductor from returning after a stroke because of the risk of a future seizure. Although the employee’s doctors cleared him, the employer conducted multiple individualized medical reviews and reached an objectively reasonable conclusion based on his condition, job duties, and medical guidance.
A stroke, a strong recovery, and a safety-sensitive job
A railroad conductor suffered a stroke while off duty. Within weeks, his neurologist and cardiologist cleared him to return to work. His recovery was described as “excellent,” and another physician later concluded that he was neurologically capable of commercial driving.
The railroad reached a different conclusion. Its medical department reviewed his records and initially restricted him from operating equipment, working near moving trains, and performing other safety-sensitive duties for one year.
A later review extended those restrictions to five years. The railroad’s physician concluded that the stroke and related brain bleeding created an unacceptable risk of a future seizure. He relied partly on FMCSA guidance recommending that commercial drivers with those conditions remain off the road for at least five years. FMCSA later withdrew that guidance because some of its information was obsolete or too prescriptive, but the court found no evidence that the railroad ignored better medical information.
The employee sued under the ADA. A federal appeals court affirmed summary judgment for the employer based on the ADA’s direct-threat defense.
The railroad’s medical judgment did not have to be correct
To establish that defense, the employer had to show that its decision resulted from an individualized assessment, was objectively reasonable, and relied on current medical knowledge or the best available objective evidence.
The railroad satisfied that standard through multiple fitness-for-duty reviews, examinations of the employee’s medical records, opinions from several physicians, and consideration of his particular duties. Applying general safety guidance did not make the review generic because the railroad first evaluated whether the guidance applied to this employee’s medical condition.
The employee emphasized that his doctors had cleared him and that he had obtained a commercial driver’s license after another medical examination. The court found that disagreement insufficient. The question was whether the railroad’s conclusion was objectively reasonable, not whether it was medically correct.
Employers evaluating a possible direct threat should preserve the reasoning that connects the employee’s individual medical information to the actual risks presented by the job. A conclusion supported only by a diagnosis or generalized safety concern may not receive the same treatment.
Four lessons from a five-year safety restriction
General medical guidance can inform, but cannot replace, individualized review
An employer may consult industry or government guidance, but it still needs a reasonable medical judgment connecting that guidance to the employee’s condition and actual job duties. Here, the railroad conducted multiple reviews of the employee’s medical records, and its physician explained why the five-year seizure-risk guidance applied to his condition and safety-sensitive duties.
A treating physician’s clearance is evidence, not the final decision
Competing medical opinions do not automatically make an employer’s assessment unreasonable. HR should examine the basis for each opinion, including whether the provider evaluated the specific consequences of sudden incapacity in the employee’s position.
The severity of the possible harm changes the analysis
The conductor worked around moving trains and heavy equipment. Even a relatively low probability of sudden incapacity may carry greater weight when the potential consequences are extreme.
Subjective disagreement is not a reasonable medical judgment
When an employer rejects a treating provider’s clearance, the direct-threat defense requires more than its subjective disagreement. The employer should obtain appropriate medical input connecting the employee’s condition to the risks of the job. An employer that acts as if it stayed at a Holiday Inn Express the night before may find itself explaining that diagnosis in court later.
The employee produced evidence that the railroad may have been overcautious or even wrong. He lost because he did not produce evidence that its conclusion was objectively unreasonable.