Fitness for Duty Exams—A Powerful Tool to Offer Employers

Fitness for Duty Evaluations—A Powerful Tool to Offer Employers

The Fitness for Duty (FFD) evaluation is often an under-utilized service that many occupational health programs do not educate their clients enough on and the benefits of an evaluation of this caliber.

FFD evaluations are medical evaluations used to determine if an employee can perform the essential functions of a job, without risking injury to themselves or other co-workers.

When to do a Fitness for Duty Evaluation

FFD evaluations are also used as a “Return to Work Evaluation” after employees have been off work, due to a non-work or work-related condition or illness.

The court ruled that this position defies the spirit and letter of the FMCS Regulations. 49 C.F.R §391.45 that imposes a continued obligation upon commercial motor vehicle drivers to seek medical evaluation and certification:

“The following persons must be medically examined and certified… as physically qualified to operate a commercial motor vehicle:

 

(a) Any person who has not been medically examined and certified as physically qualified to operate a commercial motor vehicle;

 

(b)(1) Any driver who has not been medically examined and certified as qualified to operate a commercial motor vehicle during the preceding 24 months.

 

(c) Any driver whose ability to perform his/her normal duties has been impaired by a physical or mental injury or disease; AND

 

(d) Beginning June 22, 2018, any person found by a medical examination not to be physically qualified to operate a commercial motor vehicle… 49 C.F.R §391.45

 

The use of the word ‘and’ makes it clear the twenty-four-month period in which a medical evaluation’s certificate is typically valid does not defeat or limit a drivers’ continuing obligation to be physically qualified to operate a commercial motor vehicle and the on-going responsibility of the trucking company to only place medically qualified drivers on the road.

In this case, the trucking company failed to send this driver for a FFD evaluation when he had missed work and did not investigate the reasons behind his absence. If the trucking company had conducted a 391.45c FFD evaluation they would have uncovered an eye problem that rendered the driver unfit-to-drive.

Summary

In summary, FFD evaluations are an important, complex service line for OHS programs that provide tremendous value for employers. In addition to a physical evaluation, a FFD evaluation requires a detailed review of medical records. Depending on the situation conferring with a treating physician, functional capacity testing, cardiovascular stress testing, drug and alcohol testing, job site analysis and other specialized testing can be utilized to make an accurate assessment. The pricing for the services varies on the complexity of the issue the evaluating provider is asked to access and it may require several visits or additional testing to complete. Since most FFD evaluations are for non-work-related issues the evaluation must pay attention to HIPAA-protected health information and obtain a written release from the patient before releasing any confidential medical information to the company.

  • When an employee is off work more than five days.
  • During a job transfer to determine whether they can meet the essential job functions of the new position.
  • If an employee has a physical or mental medical condition, which could affect job performance.
  • Reasonable cause situations with indicators of impaired job performance.

 

Often after an illness or injury, a personal physician will release their patient back to work because the patient requests to return to work, even when their illness or injury has not completely resolved and poses risk in the workplace. The ill or injured employee will want to return to work for economic reasons. The premature release to work may be inappropriate because the treating physician will have no knowledge of the physical demands of the job and the workplace environment and suddenly a non-work-related issue is turned into a work-related problem. A FFD evaluation protects the employer from such risk.

The FFD Evaluation Process

The occupational health professional that conducts a FFD evaluation must have a thorough knowledge of the job to properly determine an employee’s ability to meet the physical demands of the job.

The FFD evaluation process has many steps:

  1. Outline the ground rules to the patient on confidentiality of information shared to the employer.
  2. Review pertinent medical records.
  3. Conduct a thorough physical evaluation.
  4. Evaluate the diagnosis to determine if it is a correct assessment of the employee’s physical or mental condition.
  5. Collect information regarding on the job requirements and compare to individual’s physical ability to protect them from worsening their condition.
  6. Access the State’s Prescription Monitoring Program (PMP)system (if applicable) to determine if any employee is taking a controlled substance.
  7. Consider drug and alcohol screening, if appropriate.
  8. Conduct additional testing, such as functional capacity evaluation (FCE) or neuropsychological (NP) testing if the situation dictates.

Unless the employee signs a written release that authorizes release of the comprehensive FFD report, the only written communication an occupational health provider can release is whether the employee is fit for duty, conditionally fit for duty, or not fit for duty.

The following is a general guideline of what services are included in each evaluation level and costs are built into the services required to provide a medical opinion.

Basic Evaluation                                                      

  • Patient has been off work for 5 or more days for a work or non-work-related injury
  • Has paperwork for SafeWorks Illinois provider
  • Has been released from another provider/specialist
  • Comes in to SafeWorks Illinois with all information necessary to give the appropriate return to work decision

 

Extended Evaluation                                               

  • Patient has been off work for 5 or more days for a work or non-work-related injury
  • Supervisor accompanies patient to visit
  • More complex return to work decision
  • SafeWorks Illinois provider deals with multiple specialists to obtain necessary information to make a proper return to work assessment
  • Examples for this would be previous cardiac or neurological issues, etc.

 

Comprehensive Evaluation                        

  • Patient has been off work for 5 more days for work or non-work-related injury
  • Supervisor accompanies patient to visit
  • More complex return to work decision
  • Dealing with multiple medical issues (illnesses, medications)
  • Multiple physicians to deal with to make a proper return to work assessment
  • Examples for this would be psychiatric issues, etc.

 

FFD Evaluations for Trucking Companies

FFD evaluations for trucking companies are a service line that OHS programs should aggressively market.

Most trucking companies are not educated about the requirements of 49 C.F.R §391.45c that mandates fitness-for-duty evaluations on drivers who develop medical issues in between their periodic medical certification evaluations.

A recent court case in Kentucky that resulted in a fatality illustrates this widespread ignorance about continuously monitoring commercial drivers’ health.

The defendant trucking company argued that their driver was medically qualified on the day of the fatal accident despite the driver’s deteriorating vision, because he was in possession of a current medical certificate. The Defendant trucking company maintained that 49 C.F.R §391.41 establishes a driver need only be ‘physically qualified to operate a commercial motor vehicle’ at the time of a medical evaluation. Thereafter, it was the apparent position of the Defendant trucking company that the driver’s physical well-being is not material until the expiration date displayed on the medical certificate.

The court ruled that this position defies the spirit and letter of the FMCS Regulations. 49 C.F.R §391.45 that imposes a continued obligation upon commercial motor vehicle drivers to seek medical evaluation and certification:

“The following persons must be medically examined and certified… as physically qualified to operate a commercial motor vehicle:

(a) Any person who has not been medically examined and certified as physically qualified to operate a commercial motor vehicle;

(b)(1) Any driver who has not been medically examined and certified as qualified to operate a commercial motor vehicle during the preceding 24 months.

(c) Any driver whose ability to perform his/her normal duties has been impaired by a physical or mental injury or disease; AND

(d) Beginning June 22, 2018, any person found by a medical evaluation not to be physically qualified to operate a commercial motor vehicle… 49 C.F.R §391.45

The use of the word ‘and’ makes it clear the twenty-four-month period in which a medical evaluation’s certificate is typically valid does not defeat or limit a drivers’ continuing obligation to be physically qualified to operate a commercial motor vehicle and the on-going responsibility of the trucking company to only place medically qualified drivers on the road.

In this case, the trucking company failed to send this driver for a FFD evaluation when he had missed work and did not investigate the reasons behind his absence. If the trucking company had conducted a 391.45c FFD evaluation they would have uncovered an eye problem that rendered the driver unfit-to-drive.

 

Summary

In summary, FFD evaluations are an important, complex service line for OHS programs that provide tremendous value for employers. In addition to a physical evaluation, a FFD evaluation requires a detailed review of medical records. Depending on the situation conferring with a treating physician, functional capacity testing, cardiovascular stress testing, drug and alcohol testing, job site analysis and other specialized testing can be utilized to make an accurate assessment. The pricing for the services varies on the complexity of the issue the evaluating provider is asked to access and it may require several visits or additional testing to complete. Since most FFD evaluations are for non-work-related issues the evaluation must pay attention to HIPAA-protected health information and obtain a written release from the patient before releasing any confidential medical information to the company.

 

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