What dermatologists need to know about workplace disability accommodations under the ADA

By Jason Qu, JD, and Robert M. Portman, JD, MPP, January 1, 2025

Every month, DermWorld covers legal issues in “Legally Speaking.” This month’s authors are health care attorneys with Powers Pyles Sutter & Verville PC in Washington, D.C. Portman is also outside general counsel for the AAD and AADA.

Individuals with disabilities are protected by state and federal civil rights laws in realms such as access to housing, voting, education, public accommodations, and other areas of public life. Past editions of Legally Speaking have discussed how laws like the Americans with Disabilities Act (ADA) may impose accessibility requirements on providers of medical services and facilities, including dermatology practices and their websites.

In the employment context, laws including the ADA prohibit employment discrimination and mandate access to equal employment opportunities for people with disabilities, often by requiring the provision of workplace accommodations. Dermatologists may interact with disability accommodation questions as the employer of individuals with disabilities or as employed physicians who themselves may require workplace accommodations. Dermatologists may also be called upon to provide documentation supporting a patient’s request for workplace accommodations related to the patient’s disabling dermatologic condition.

The following is an overview of key legal concepts and rules dermatologists should be aware of when requesting, approving, or facilitating workplace accommodations under the ADA.

Background: The ADA and reasonable accommodations

Under Title I of the ADA, employers with 15 or more employees may not discriminate against qualified individuals with disabilities and must take steps to ensure that employees with disabilities have equal access to the benefits and privileges of employment. These obligations span all employment contexts including recruitment and hiring, job assignments, compensation, advancement, and in connection with layoffs and terminations.

Definition of disability

Under the ADA, a ‘disability’ is defined as any physical or mental impairment that substantially limits a major life activity. This definition includes forms of physical disability that may be obvious to an employer along with chronic conditions, mental impairments, and other less-obvious conditions that may nevertheless qualify for reasonable accommodations under the ADA.

• Major life activity: ADA regulations include a non-exhaustive list of ‘major life activities’ which could give rise to a disability if they are ‘substantially limited.’ The list includes key functional capabilities such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, lifting, speaking, breathing, learning, reading, concentrating, thinking, communicating, interacting with others, and working. Importantly, the operation of major bodily systems and of individual organs, including the skin, are also ‘major life activities’ under the ADA.

• Substantially limits: The Equal Employment Opportunity Commission (EEOC), which enforces the employment provisions of the ADA, has clarified that the term ‘substantially limits’ should be construed broadly in favor of expansive coverage for individuals with disabilities. An impairment can ‘substantially limit’ a major life activity without severely or significantly limiting that activity. Furthermore, an impairment may be ‘substantially limiting’ even if it is temporary or episodic in nature.

Reasonable accommodations under the ADA

To ensure that employees and job applicants with disabilities have equal access to the benefits and privileges of employment, the ADA requires covered employees to provide ‘reasonable accommodations’ to qualified employees unless doing so would cause an undue hardship for the employer.

• Accommodations: In general, an ‘accommodation’ under the ADA is defined as any change in the work environment or in the way work is customarily done that enables an individual with a disability to enjoy equal employment opportunities. Accommodation can include changes to a workplace’s physical environment, facilities, or to the equipment used for work, including the provision of assistive devices or services. Accommodation can also include changes to workplace rules and procedures including to the manner and place in which work is performed, work and break schedules, and the provision of non-standard leave. Finally, accommodation can also include the modification, elimination, or redistribution of non-essential functions within a particular role.

• Reasonable accommodations/undue hardship: Employers are only required to provide ‘reasonable’ accommodations under the ADA. For example, while employers are required to provide accommodations that enable an employee to perform the essential functions of their role, they are not required to eliminate or to modify the essential functions themselves. And while employers are required to provide ‘effective’ accommodations that enable an employee to perform their essential functions, they are not required to provide accommodations that are unrelated to these functions or that allow employees to perform beyond this standard. Finally, employers are not required to provide accommodations that are infeasible, implausible, or that give rise to an ‘undue hardship.’ For purposes of the ADA, an ‘undue hardship’ arises when an accommodation would cause significant difficulty or expense in light of the resources and circumstances of a particular employer. Undue hardship can include significant financial costs along with unduly extensive, substantial, and/or disruptive changes to the nature or operation of the employer’s business.

Interactive process

Under the ADA, reasonable accommodations are requested and granted through a highly individualized, fact-sensitive interactive process between the employer and employee. Employees are responsible for making an initial request for accommodation and can do so either orally or in writing. If necessary, employers can then ask for more information regarding the nature of the disability and the individual’s functional limitations in order to confirm that the requested accommodation would be reasonable and effective. If the employee’s disability is non-obvious, employers can also request necessary and relevant medical documentation from a physician to establish that the employee has a qualifying disability and that the disability necessitates a reasonable accommodation.

Based on the information gleaned throughout this process, the employer can ultimately choose to grant the employee’s requested reasonable accommodation or to grant an alternative effective accommodation. The employer may also deny the accommodation request if it determines that all potentially effective accommodation would cause an undue hardship and/or be incompatible with the essential job functions of the employee’s position.

Supporting workplace accommodations for dermatologic conditions

Along with finding themselves on either the employer or employee side of the interactive process, dermatologists may also be asked to provide third-party supporting documentation for a patient’s workplace accommodation request.

The Job Accommodations Network (JAN), a service of the Department of Labor, has noted that a range of skin conditions may constitute a disability and require workplace accommodations. Specific examples identified by JAN include skin irritation caused by workplace equipment and/or materials, ultraviolet sensitivity necessitating limitations to UV exposure, and pain related to skin conditions which may require modifications to an employee’s work schedule, work location, and/or the way work is performed.

In these contexts, the dermatologist’s role under the ADA is to provide employers with sufficient information to understand that a disability exists — including information regarding the nature, severity, and duration of the impairment giving rise to the disability — and the extent to which these impairments impact the patient’s life activities and functional capabilities, especially as they relate to the individual’s employment. The documentation should also substantiate why the requested accommodation is necessary to enable the patient’s performance of their job duties.

While employees will typically obtain this documentation directly from their physician, there are situations where employers may communicate directly with, or obtain medical information directly from, the physician. Under these circumstances, physicians must promptly obtain a HIPAA authorization from the patient or verify that the employer has obtained such authorization from the patient to release their medical information. Physicians should only disclose information relevant to assessing the individual’s accommodation request and should refrain from disclosing unrelated medical information or health records.

Other laws related to disability accommodations

In addition to reasonable accommodations under the ADA, dermatologists should be aware of other state and federal laws that protect the rights of workers with disabilities. For example, many states have enacted disability accommodation laws that surpass the protections established by the ADA or that widen the scope of covered employers. Furthermore, state and federal anti-discrimination laws prohibit workplace discrimination against individuals with disabilities and may be enforced against employers that are not directly covered by the ADA (e.g., because the employer has less than 15 employees). Notably, recent federal legislation also requires covered employers to provide ADA-like accommodations to employees impacted by pregnancy, childbirth, or related medical conditions, which may include temporarily modifying or suspending the essential job functions of these employees.

This article is provided for informational and educational purposes and is not intended to provide legal advice and should not be relied upon as such. Readers should consult with their personal attorneys for legal advice regarding the subject matter of this article.

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