When an employee refuses occupational health assessment, the employer may lack important information about their fitness for work, likely return date and support needs.
An employee cannot normally be forced to attend an assessment or authorise the release of a medical report. However, the employer does not have to leave the matter unresolved indefinitely.
Employers should explain why the assessment is necessary, address the employee’s concerns and warn that decisions may eventually have to rely on the available evidence.
Why might an employer request occupational health advice?
Occupational health advice focuses on how an employee’s health affects their work. It can help an employer manage long-term absence, repeated short absences, performance concerns or a proposed return.
A report may provide information about:
- whether the employee is currently fit for work;
- their likely return date or recovery period;
- temporary or permanent workplace restrictions;
- possible reasonable adjustments;
- whether the condition may amount to a disability; and
- whether redeployment could support continued employment.
The occupational health adviser provides recommendations rather than making the employment decision. The employer must still consult the employee and decide what action is reasonable.
Our employee sickness management page explains how medical evidence fits into the wider absence process.
Why might an employee refuse an assessment?
An employee may worry that the employer intends to use occupational health evidence to dismiss them. They may also have concerns about confidentiality or believe that the employer already has enough information.
Other employees may feel too unwell to attend, object to the proposed questions or distrust the selected provider.
The employer should not immediately treat refusal as misconduct. Instead, it should ask the employee to explain their concerns and consider whether it can resolve them.
For example, the employer could clarify that it will only receive work-related recommendations rather than the employee’s complete medical history. It could also provide the referral questions in advance or rearrange the assessment by telephone or video.
When an employee refuses occupational health assessment
When an employee refuses occupational health assessment, the employer should explain the purpose of the referral in writing.
The communication should identify the workplace decisions that require medical information. It should also explain who will carry out the assessment, what questions the employer proposes and who will receive the report.
The employer should reassure the employee that it will handle health information confidentially. Only managers or advisers who genuinely need the information should receive it.
It should also explain that participation could help identify adjustments, support a return to work or avoid decisions based on incomplete evidence.
Does the employee have to give consent?
The occupational health professional will normally need the employee’s permission before releasing a report to the employer.
An employee may also ask to see a medical report before the employer receives it. Separate statutory rights apply where the employer requests a report from a doctor responsible for the employee’s clinical care.
Health information is sensitive personal data. Employers should only request information that is relevant and necessary for a genuine employment purpose.
A contractual term may require an employee to cooperate with reasonable medical assessments. However, that does not remove confidentiality rights or allow the employer to obtain medical information without the required permission.
Can refusal lead to disciplinary action?
Employers should be cautious about treating refusal as a disciplinary offence.
Where the employment contract or sickness policy contains a clear requirement to attend reasonable medical assessments, an unexplained refusal could potentially become a conduct issue. Nevertheless, formal action should not be automatic.
The employer should first consider:
- whether the referral request was reasonable;
- whether the employee understood its purpose;
- whether illness affected their ability to cooperate;
- whether the proposed arrangements created genuine concerns;
- whether another source of medical evidence is available; and
- whether the employee received a reasonable opportunity to reconsider.
In many cases, it is safer to continue the sickness or capability process using the information available rather than begin disciplinary proceedings solely because of refusal.
Making decisions using the available evidence
An employer cannot allow uncertainty to continue forever. If the employee refuses to participate after receiving a clear explanation, the employer may have to decide using fit notes, attendance records and information supplied by the employee.
The employer should warn the employee about this possibility. It should also invite them to provide alternative medical evidence or written information about their health and likely return.
The absence of an occupational health report does not automatically justify dismissal. The employer must still consult properly and consider everything it reasonably knows.
Where communication has become difficult, our article on an employee not engaging when off sick explains the steps employers can take.
Employee refuses occupational health assessment during long-term absence
If an employee refuses occupational health assessment during long-term absence, the employer should consider whether it has enough evidence to assess the prognosis fairly.
It may ask the employee to authorise a focused report from their GP or specialist instead. The employer must obtain permission before approaching a doctor and should request only relevant information.
If the employee refuses every reasonable attempt to obtain current evidence, the employer may eventually proceed with a capability review.
Before considering dismissal, it should examine:
- the length and effect of the absence;
- the information already available;
- the possibility of a return within a reasonable period;
- whether adjustments could support employment;
- whether suitable alternative work exists; and
- the effect of continued absence on the business.
Our long-term sickness employment rights page covers the wider legal considerations.
Considering disability and reasonable adjustments
An employee’s refusal does not remove the employer’s duties under the Equality Act 2010.
If the employer knows, or should reasonably know, that the employee may be disabled, it should still consider reasonable adjustments based on the available information.
The lack of a formal diagnosis does not necessarily prevent disability protection. Employers should consider how the condition affects the employee rather than relying solely on its medical label.
However, an employee who withholds relevant information may make it harder for the employer to identify appropriate support. Clear written communication can help demonstrate the steps the employer took.
Common employer mistakes
Employers often increase their risk by threatening immediate dismissal, describing the assessment as compulsory or requesting excessive medical information.
Other mistakes include failing to explain the referral questions, ignoring confidentiality concerns and assuming that refusal proves the employee is fit for work.
The employer should keep records of the referral, the employee’s reasons, alternative arrangements offered and any warnings about decisions based on limited evidence.
Advice when an employee refuses occupational health assessment
When an employee refuses occupational health assessment, employers should try to understand the reason and resolve reasonable concerns.
If cooperation remains unavailable, the employer may make a decision using the evidence it holds. However, it must still consult fairly, consider disability and examine alternatives before dismissal.
Employers Law helps businesses manage medical referrals, capability procedures and difficult long-term sickness cases.