Responding to Requests for Medical Exemptions from COVID-19 Vaccination Policy

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Updated: October 27, 2021

Part of every COVID-19 vaccination requirement is a process to exempt or provide accommodations for people who cannot get vaccinated due to a disability or medical condition. Title I of the Americans With Disabilities Act (ADA) requires employers to provide reasonable accommodations. Exceptions to this requirement are limited. An employer who believes no reasonable accommodation can be made must meet a much higher burden of proof than exists for religious exemptions. Accordingly, employers should treat medical exemption requests with care and consistency, as a matter of law and respect for your employees.

The steps below will assist employers in handling these requests.

1. Assign a Human Resources Representative to review requests and set an appropriate deadline for workers to submit exemption requests.

To be consistent in your review and prevent any claim of bias, discrimination, or retaliation, all requests should be made using the standard form provided by the company, and they should all be assigned to one person, if possible. Ensure that this person reviews each request on a case-by-case basis. 

When setting deadlines for vaccination, employers should provide sufficient time to assess exemption requests, agree to reasonable accommodations, and allow workers time to get vaccinated (whether one shot or fully vaccinated) before the deadline. You want all workers to be vaccinated or working under approved accommodations by the deadline you’ve set.

2. Determine whether the employee has a disability under the ADA.

Employers are allowed to obtain supporting medical documentation about the employee’s disability. Your Representative should use only your company-approved Medical Exemption Request Form and should not make any further medical inquiries. All medical information must be kept confidential.

3. Identify reasonable accommodations that do not impose a significant difficulty or expense on your business.

If the employee’s healthcare provider certifies that the employee cannot receive a COVID-19 vaccination, the ADA requires that you offer reasonable accommodations, such as required mask-wearing, frequent testing, changing the employee’s shift, making changes to the work environment (e.g. improving ventilation systems or limiting contact with other people), remote work, or, as a last resort, reassignment to another position. Consider all options. 

There are limited exceptions to employers’ responsibility to provide reasonable accommodations. Employers must show that accommodations would cause an undue hardship or pose a “direct threat” to the health and safety of others. 

The ADA defines an “undue hardship” as imposing a “significant” difficulty or cost on the employer. This is a higher standard than the rules for religious exemptions, which define undue hardship as any cost that is more than minimal.

A “direct threat” is another high legal standard. To determine if an employee who is not vaccinated due to a medical condition would pose a “direct threat” in the workplace, the employer should assess four factors:

Additionally, an assessment of a “direct threat” should take into account the work environment, including whether the employee works alone or with others, inside or outside; the employee’s amount of direct interaction with others; the number of fully vaccinated people in the workplace; available ventilation; the space available for social distancing and more.

If any reasonable accommodation (like those described above) can be provided that will reduce or eliminate a direct threat, the employer is obligated to provide it.

4. Notify the employee of your company’s decision.

Inform the employee, in writing, of your company’s decision, including any accommodation you are granting and any additional required safety precautions that go with it.

You should not deny a request for medical accommodations without consulting your legal counsel.

And know that under the ADA, it is unlawful for an employer to disclose that an employee is receiving a reasonable accommodation or to retaliate against an employee for requesting an accommodation.

5. Review accommodations and adjust them as necessary.

Accommodations can be offered on a temporary basis. Employers may revisit accommodation requests and adjust them as necessary, especially if they begin to pose a direct threat to workplace health and safety or present an undue hardship on the employer.

DISCLAIMER: Public health guidance on COVID-19 is consistently evolving. Health Action Alliance is committed to regularly updating our materials once we've engaged public health, business and communications experts about the implications of new guidance from the public health community and effective business strategies that align with public health goals. 

Health Action Alliance is committed to the health and safety of employees and communities. You should speak with your doctor or healthcare provider about whether COVID-19 vaccines are right for you.  

The material in this sample policy is for general information purposes only. This sample policy is not intended to be, and should not be construed as, legal, business, medical, scientific or any other advice for any particular situation. The content included herein is provided for informational purposes only and may not reflect the most current developments as the subject matter is extremely fluid and may change daily.   

Readers of this sample policy should contact their attorney to obtain advice with respect to any particular legal matter. No reader, user, or browser of this material should act or refrain from acting on the basis of information in this sample policy without first seeking legal advice from counsel in the relevant jurisdiction. Only your individual attorney can provide assurances that the information contained herein – and your interpretation of it – is applicable or appropriate to your particular situation.