Despite adequate medical treatment and occupational rehabilitation, some patients reach the point of maximal medical improvement but appear unable to return to their full duties.  When this occurs, the patient’s ability to perform the “essential tasks” of his or her particular job must be determined.

The Americans with Disabilities Act defines essential tasks as those that make up a significant part of the work or are required for safety or contingency.  Also important is the question of whether the removal of these tasks would substantially alter the job.


If it is perceived by the employer that a patient is unable to perform all of the job’s essential tasks and the employer is unable to reasonably accommodate the patient in the performance of those tasks, the patient may be declared “unfit” for that particular job.

The employer would then initiate an administrative procedure to determine the patient’s “fitness for duty.”  In this process, the employer may request the physician to, with the patient’s consent, provide medical information regarding diagnosis, treatment, and prognosis.  The patients treating physician may find it helpful to employ tools such as a functional capacity evaluation or an occupational medicine consultation.

Many physicians have good understanding of the return-to-work process and should be able to assist most injured or ill patients in returning to the workplace.