Verifying Disability Policy
Model Letter
[EMPLOYER LETTERHEAD]
[insert doctor’s name & address]
[insert date]
Dear [insert doctor’s name];
We are in receipt of your letter of [insert date] respecting [insert employee’s name], which states:
[insert relevant parts, e.g., “Please allow above patient to work only a maximum of 3 days per week due to medical reasons.”]
In order to effectively manage our organization and determine our ability to accommodate [insert employee’s name], we require further information. As such, please provide us with the following information: (please add additional pages if necessary):
- The nature of [insert employee’s name]’s illness:
- A prognosis for [insert employee’s name]’s return to full-time work:
- a) Is this condition permanent or temporary? _____________________________
- b) Is the condition likely to stay the same, improve or worsen over time? _______
__________________________________________________________________
- c) If it is likely to improve, what is the estimated time frame for improvement to occur?
- More specific information with respect to [insert employee’s name]’s limitations:
- a) Is he/she able to work [insert details, e.g. 3 regularly scheduled consecutive or non-consecutive days or are the days based upon her own judgment of her ability to work?]
- b) Can he/ she work up to more than [insert details, e.g., 3 days per week over a certain period of time?]
- c) Are there any other limitations of which we should be aware? (if so, please explain)
- Were diagnostic or other objective tests performed or was most information self-reported?
- Details about medical examinations:
- a) When did you first see [insert employee’s name] for this condition? _________
- b) When did you most recently see him/her for this condition? _______________
- Is there a continuing course of treatment planned? _____________________________
- Is [insert employee’s name] taking any medication that might impact any
accommodation or her ability to perform her job?
We would appreciate receiving this information by [insert date]. Please fax this form to my attention at [insert fax #]. We will pay the reasonable costs associated with you providing this additional information. Thank you in advance for your assistance. Please contact me at [insert phone #] if you have any questions.
[insert your signature block]
Insider Source
Vicki L. Giles, Partner, McLennan Ross LLP, 600 West Chambers, 12220 Stony Plain Road, Edmonton, AB T5N 3Y4; (phone) 780.482.9123; (fax) 780.482.9101; vgiles@mross.com