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XIX. Occupational Medicine and Disability Law
HIGHLIGHTS
Introduction
Occupational medicine poses difficult conflicts of interest between practitioners
and employees.
The laws governing the physician–patient relationship are modified in
occupational medicine.
Occupational medicine practitioners must understand the applicable state and
federal laws.
Occupational medical records in private offices are subject to inspection by
OSHA and labor unions.
Communicable diseases pose special workplace risks.
Occupational medicine is characterized by conflicts between the employee’s interests
and those of the employer. These conflicts arise from the employer’s obligation to pay
for workplace injuries and disabilities, and potential regulatory sanctions against
employers who have disproportionate numbers of OSHA (Occupational Safety and
Health Administration) reportable events. It is to the employer’s benefit to minimize
injuries and to attribute them to off the job activities or personal illness. Conversely, in
today’s marketplace, many employees have limited or no personal health benefits. This
gives the employee an incentive to claim that personal medical problems are workplace
related so that they must be paid for by the employer.
State and federal law recognizes that the physician–patient relationship is different in
occupational medicine, and that there are situations where physicians make medical
evaluations of patients without forming a legal physician–patient relationship.
Conversely, the law expects occupational medicine practitioners of all types to be honest
with their patients and to respect their autonomy and their right to consent to, and be
informed about, their medical care.
This section discusses the basic state and federal laws governing occupational medical
practice, special legal problems such as communicable disease control in the workplace,
and occupational medical services in general medical care settings. Occupational
medicine is a recognized medical specialty, and nonspecialist physicians who are not
experts in occupational medicine can incur substantial legal risks. Unlike most other
areas of medical practice, providers of occupational medical services must comply with
very intrusive federal regulations on access to and retention of medical records,
including the right of OSHA and others to enter the practitioner’s office and go through
all the occupational medical records.
A. Legal And Ethical Problems in Occupational Medicine
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