Concepts in medical ajudication - medical unfitness

Building on the concept of the inherent requirements of the job there are then two aspects to unfitness for the job.

If the positive aspect of the inherent requirements is not met, such as for example, a lack of capability to perform the work to the required standard would result in the worker being unfit.

If the negative aspect of the inherent requirements is present e.g. a medical condition that excludes the worker from the relevant occupation, this would also result in the worker being unfit.

Put another way, the term medically "unfit" refers to the failure to meet the specific inherent requirements of an occupation due to a lack in the capability (physical or mental) to perform the work, to the required standard, and/or the presence of a medical condition that is an exclusion for the relevant occupation.

Note that a person may be "unfit", but not "disabled"! An example of this is a small and lightly built person who applies for a job that entails heavy manual labour.

Absolute exclusions:

The degree to which a person is unsuitable to work in a particular occupation varies according to circumstances. For example, for a job applicant who fails to meet a minimum statutory requirement, or for whom the risks of the occupation are unavoidable and life-threatening, the degree of unsuitability would be regarded as a non-negotiable. The medical conditions that lead to the failure to meet these requirements would be regarded as absolute exclusions.

An example of an absolute exclusion would be the presence of uncorrectable visual impairment in a company driver of a vehicle carrying hazardous substances on the national roads.

Relative exclusions

It is logical to conclude that there are always many medical conditions that are only exclusions when they are present simultaneously with other factors. On their own, they may pose an acceptable degree of risk, with or without certain restrictions.

These restrictions could be on the working conditions (a working condition), or that the employee’s health (a health condition) remains satisfactory. These medical conditions are known as relative exclusions.

An example of a relative exclusion would be as follows. The occupation entails potential exposure to lung irritants, such as chlorine or ammonia. Lung protection is reliant upon adequate ventilation or by means of PPE (respirators, etc). Mild asthma could be regarded as a relative exclusion, with the proviso (restriction) that:

• lung function be monitored regularly,and that there be no significant decline of measured function (health condition)
• the employee is not exposed to levels of lung irritants that exceed the statutory limits (working condition).

Five possible job fitness adjudication outcomes:

There are therefore 5 possible medical adjudication outcomes in respect of job fitness:

• Can do the job - relative exclusion, no restrictions.
• Can do the job - relative exclusion, working condition.
• Can do the job - relative exclusion, health condition.
• Can do the job - relative exclusion, working and health conditions.
• Cannot do the job - absolute exclusion