Decreasing Work Comp with Physical and Medical Pre-Employment Screening

One of the easiest ways to reduce your workers' compensation cost is to not hire the prospective employee who has a higher than average propensity of having a workers' comp claim — a pre-existing condition.   We previously posted a blog on the importance of pre-employment drug screening. Drug screening is a major step in eliminating unnecessary workers’ comp claims, but it is only half of the pre-employment screening. The other half of the pre-employment screening is the physical and medical screening.
An effective way to identify the employee applicants who are a workers’ comp claim waiting to happen is to have a medical history questionnaire, relevant to the essential job functions, as an attachment to the job application. This allows your company to judge pertinent factors about the applicant's ability to perform the work required of the job/position. The medical history questionnaire will be of greater value in screening for  blue-collar jobs then for most white-collar jobs.
The usual example used to illustrate the need for a medical history questionnaire is the job applicant who has had previous back surgery. If you do not ask, the job applicant will probably not volunteer the information about the prior back surgery, even though the position the job applicant is applying for involves heavy lifting. Without the medical history questionnaire, your company will be lucky if the new employee is employed six months before he is off work with another back injury.
The medical history questionnaire should address and identify such factors as:
1.     Past repetitive motion injuries
2.     Past prolonged musculoskeletal injuries
3.     Past surgical interventions
4.     Past chronic pain issues
5.     Past neurological problems
6.     Past psychosocial attitudes and behavioral problems
The answers to the questionnaire assists you in identifying the job applicants who are predisposed to work related injury or illness. If your company does not have anyone on staff to evaluate the medical history questionnaire, a physician who specializes in occupational medicine can review the questionnaire for your company and provide recommendations to hire or not to hire.
Note: Prior to using any medical history questionnaire, have it reviewed by a knowledgeable employment attorney to be sure you do not violate any Americans with Disabilities Act (ADA) requirements or any state statutes on job applicants' disabilities rights. The laws regarding pre-employment medical information are complex and confidentiality is an absolute must.
The medical history questionnaire must state clearly and boldly that the failure to disclose any medical information pertinent to the applicant’s ability to perform the job is grounds for immediate termination. This will encourage job applicants not to withhold information about pre-existing conditions.
If there is nothing in the medical history that would preclude the job applicant from being hired, any offer of employment should be made conditionally on the job applicant passing a physical examination. The physical examination must be required of all persons offered employment for the same type job and the examination should test only physical abilities related to the job. 
Before offering a job and before requesting the physical examination, your company should formulate a description of the job that reflects the physical requirements of the job. If the employee will routinely have to lift 50 pounds, it should be so stated in the job description.  
The physical examination should include more than the basics of the job applicants blood pressure, weight, height, etc. Depending on the job position, the physical exam can include a functional capacity evaluation and/or a work simulation test.  The functional capacity evaluation is basically a strength test to determine the job applicant's physical abilities, capabilities, and restrictions needed. Work simulation testing is designed to measure the job applicant's ability to perform specific work functions
Some of the physical capabilities of the employee that can be tested include:
1.     Exertion
2.     Lifting capabilities
3.     Sight (including color blindness where appropriate)
4.     Hearing
5.     Balance – especially for workers who would use ladders or other equipment to be elevated
Both functional capacity evaluations and work simulation testing have limitations on their effectiveness. They both measure the employee's ability at the given moment, they do not measure the job applicant's endurance over a longer period of time. Nevertheless, your company needs to know if the job applicant has the physical ability to do the work in a short time frame. If not, the job applicant should not be considered for employment. (WCxKit)

As an employer,
you need to protect your company from higher than normal workers' compensation cost brought on by the aggravation of pre-existing conditions. Pre-employment screening of job applicants is the most effective way of preventing workers’ comp claims arising out of the aggravation of a pre-existing condition. By not hiring people who may be more susceptible to injury, you can significantly reduce your exposure to injury claim involving the aggravation of a pre-existing condition. The cost of medical history questionnaires and physical exams is minor compared to what a new employee with the pre-existing condition can do to your Experience Modification Factor.

Author Rebecca Shafer,
President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare,  printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact:   or 860-553-6604.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact 


  1. In the past, I was never asked to undergo a pre-employment medical when starting a new job, but some of the companies I’ve applied to recently have mentioned that this is part of their hiring process. It looks like it’s becoming more of a routine thing, and your article is helpful to me in understanding why employers might be doing this – to decrease their workers’ compensation costs. Thanks for the comprehensive article.

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