Questions and Answers About Diabetes in the Workplace and the Americans with Disabilities Act (ADA)

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Questions and Answers About Diabetes in the Workplace and the Americans with Disabilities Act (ADA)

Introduction
The Americans with Disabilities Act (ADA) is a federal law that prohibits discrimination against individuals with disabilities. Title I of the ADA covers employment by private employers with 15 or more employees as well as state and local government employers. The Rehabilitation Act provides similar protections related to federal employment. In addition, most states have their own laws prohibiting employment discrimination on the basis of disability. Some of these state laws may apply to smaller employers and provide protections in addition to those available under the ADA.

The U.S. Equal Employment Opportunity Commission (EEOC) enforces the employment provisions of the ADA. This guide explains how the ADA might apply to job applicants and employees with diabetes. In particular, this guide explains:
* when diabetes is a disability under the ADA;
* when an employer may ask an applicant or employee questions about her diabetes;
* what types of reasonable accommodations employees with diabetes may need; and,
* how an employer should handle safety concerns about applicants and employees with diabetes.

General Information About Diabetes
Diabetes is becoming more common in the United States, with approximately one million new cases diagnosed each year.(1) Today, nearly 17 million Americans age 20 years or older have diabetes, including individuals of nearly every race and ethnicity.(2) Diabetes occurs when the pancreas does not produce any insulin or produces very little insulin, or when the body does not respond appropriately to insulin. Insulin is a hormone that is needed to convert sugar, starches, and other food into energy. The process of turning food into energy is crucial because the body depends on this energy for every action, from pumping blood and thinking to running and jumping. Although diabetes cannot be cured, it can be managed. Some people control their diabetes by eating a balanced diet, maintaining a healthy body weight, and exercising regularly. Many individuals, however, must take oral medication and/or insulin to manage their diabetes.(3)

Individuals with diabetes successfully perform all types of jobs from heading major corporations to protecting public safety. Yet, many employers still automatically exclude them from certain positions based on myths, fears, or stereotypes. For example, some employers wrongly assume that anyone with diabetes will be unable to perform a particular job (e.g., one that requires driving) or will need to use a lot of sick leave. The reality is that, because many individuals with diabetes work with few or no restrictions, their employers do not know that they have diabetes. Some employees, however, tell their employers that they have diabetes because they need a "reasonable accommodation" a change or adjustment in the workplace to better manage and control their condition. Most of the accommodations requested by employees with diabetes such as regular work schedules, meal breaks, a place to test their blood sugar levels, or a rest area do not cost employers anything to provide.

1. When is diabetes a disability under the ADA?
Diabetes is a disability when it substantially limits one or more of a person's major life activities. Major life activities are basic activities that an average person can perform with little or no difficulty, such as eating or caring for oneself. Diabetes also is a disability when it causes side effects or complications that substantially limit a major life activity. Even if diabetes is not currently substantially limiting because it is controlled by diet, exercise, oral medication, and/or insulin, and there are no serious side effects, the condition may be a disability because it was substantially limiting in the past (i.e., before it was diagnosed and adequately treated). Finally, diabetes is a disability when it does not significantly affect a person's everyday activities, but the employer treats the individual as if it does. For example, an employer may assume that a person is totally unable to work because he has diabetes. Under the ADA, the determination of whether an individual has a disability is made on a case-by-case basis.

Obtaining and Using Medical Information
Applicants
The ADA limits the medical information that an employer can seek from a job applicant. During the application stage, an employer may not ask questions about an applicant's medical condition or require an applicant to take a medical examination before it makes a conditional job offer. This means that an employer cannot ask:
* questions about whether an applicant has diabetes, or
* questions about an applicant's use of insulin or other prescription drugs.

After making a job offer, an employer may ask questions about an applicant's health (including asking whether the applicant has diabetes) and may require a medical examination as long as it treats all applicants the same.

2. May an employer ask any follow-up questions if an applicant reveals that she has diabetes?
If an applicant voluntarily tells an employer that she has diabetes, an employer only may ask two questions: whether she needs a reasonable accommodation and what type of accommodation.

Example: An individual applying at a grocery store for a cashier's position voluntarily discloses that she has diabetes and will need periodic breaks to take medication. The employer may ask the applicant questions about the reasonable accommodation, such as how often she will need breaks and how long the breaks need to be. Of course, the employer may not ask any questions about the condition itself, such as how long the applicant has had diabetes, whether she takes any medication, or whether anyone else in her family has diabetes.

3. What should an employer do when it learns that an applicant has diabetes after he has been offered a job?

The fact that an applicant has diabetes may not be used to withdraw a job offer if the applicant is able to perform the fundamental duties ("essential functions") of a job, with or without reasonable accommodation, without posing a direct threat to safety. ("Reasonable accommodation" is discussed at Questions 8 through 11. "Direct threat" is discussed at Questions 12 through 14.) The employer, therefore, should evaluate the applicant's present ability to perform the job effectively and safely. After an offer has been made, an employer also may ask the applicant additional questions about his condition. For example, following an offer, an employer could ask the applicant how long he has had diabetes, whether he takes any medication, and whether the condition is under control. The employer also could send the applicant for a follow-up medical examination. An employer may withdraw an offer from an applicant with diabetes only if it becomes clear that he cannot do the essential functions of the job or would pose a direct threat (i.e., a significant risk of substantial harm) to the health or safety of himself or others.

Example: A qualified candidate for a police officer's position is required to have a medical exam after he has been extended a job offer. During the exam, he reveals that he has had diabetes for five years. He also tells the doctor that since he started using an insulin pump two years ago, his blood sugar levels have been under control. The candidate also mentions that in his six years as a police officer for another department, he never had an incident related to his diabetes. Because there appears to be no reason why the candidate could not safely perform the duties of a police officer, it would be unlawful for the employer to withdraw the job offer.

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Contact:
1-800-669-4000
TTY number is 1-800-669-6820
info@eeoc.gov

U.S. Equal Employment Opportunity Commission
131 M Street, NE
Washington, DC 20507
Phone: (202) 663-4900
TTY: (202) 663-4494