Occupational Physician — When an Employer May Require an Employee to Undergo an Examination and What the Implications Are

Introduction

Occupational medicine is a unique professional field concerned with the relationship between an employee's health and their workplace. In recent years, with growing recognition of the importance of occupational health and employee wellbeing, the role of the occupational physician has become increasingly central in the Israeli workplace.

Nevertheless, many questions arise surrounding the authority of employers to require employees to undergo examinations by an occupational physician: when may an employer demand such an examination? Can an employee refuse? What are the implications of an occupational examination for continued employment? And what are the employee's rights in this context?

This article will provide a comprehensive analysis of all aspects related to occupational physicians in Israel, review the rights and obligations of employees and employers, and present the practical and legal implications of occupational examinations.

The Role and Authority of the Occupational Physician

Professional Definition

An occupational physician is a licensed physician who has undergone advanced training in occupational medicine and holds the relevant accreditation. The occupational physician specialises in identifying and evaluating connections between working conditions and health states, and in recommending preventive measures, accommodations, and interventions to improve employee health.

Core Functions

The occupational physician fulfils several key roles:

Assessment of fitness for work: the physician examines whether an employee is medically fit to perform their role, or whether accommodations are required. The assessment takes into account the demands of the position (physical, psychological, cognitive) and the employee's health status.

Identification and management of occupational risks: the physician identifies workplace risk factors that could harm employee health and advises the employer on how to reduce or prevent those risks. This may include recommendations on protective equipment, changes to work processes, or safety training.

Monitoring of exposed employees: employees exposed to risk factors (such as chemicals, noise, radiation, or high-voltage work) receive ongoing medical monitoring by the occupational physician. Monitoring includes periodic examinations for early detection of health impairments.

Recommendation of accommodations: if the physician identifies a medical limitation in an employee, they recommend reasonable accommodations to allow the employee to continue working safely. Accommodations may include changes to working hours, a change of role, installation of specialised equipment, or restrictions on certain types of work.

Advising employers and employees: the physician advises the employer on occupational health and safety matters, and provides employees with information about their rights, workplace risks, and ways to protect their health.

Opinions and recommendations: the physician provides the employer with a written opinion regarding the employee's fitness for work. The opinion should be concise and focused on whether the employee is fit for work and what accommodations are required if any — without disclosing unnecessary medical details.

Professional Independence

It is important to emphasise that the occupational physician operates with professional independence. Although the employer pays for their services, the physician must act in accordance with the rules of medical ethics and maintain the employee's trust. The physician may not disclose specific medical information to the employer without the employee's consent, and must act in the interests of the employee's health and wellbeing while also taking into account the employer's legitimate interests.

When May an Employer Require an Employee to Undergo an Examination by an Occupational Physician?

An employer may require an examination in certain circumstances, subject to the principles of reasonableness, proportionality, and legitimate need:

Return from extended sick leave: when an employee has been absent for a prolonged period due to illness or injury, the employer may require an occupational examination before the return to work. The examination is intended to verify that the employee has recovered sufficiently and is capable of performing their duties safely.

Genuine concern for health or safety: if there is reasonable concern that an employee's health condition affects or may affect their ability to perform their work safely, the employer may require an examination. Such concern must be based on concrete facts rather than gut feeling or bias. For example: an employee who has shown signs of significant decline in capacity, an employee who has reported medical symptoms relevant to their role, or an employee who experienced a medical episode during work.

Change in role or working conditions: when an employee transfers to a new role with significantly different physical or psychological demands, the employer may require an occupational examination to verify that the employee is suited to the new role. The same applies when significant changes to working conditions are planned that may affect health.

Doubt regarding a sick note: when the validity of a sick leave certificate is in question, an employer may require an employee to be examined by the occupational physician.

Limits of the Employer's Authority

It is important to emphasise that the employer's authority to require occupational examinations is not unlimited. An employer may not demand an arbitrary, discriminatory, or work-irrelevant medical examination. The examination must be:

Relevant: the examination must be directly connected to the requirements of the role or to health and safety in the workplace. An employer may not demand examinations unrelated to fitness for work.

Proportionate: the scope of the examination must be proportionate and appropriate to the purpose. Employees must not be subjected to invasive or extensive examinations beyond what is necessary to assess their fitness for work.

Non-discriminatory: examinations must not be demanded on discriminatory grounds — such as only from employees of a certain age, only from women, or only from employees of a certain background. Examinations must be based solely on objective and relevant criteria.

In good faith: the requirement for an examination must be made in good faith and not from hidden motives such as a desire to dismiss the employee or to harass them.

Employee Rights Within an Occupational Examination

Right to Full Information

An employee is entitled to receive detailed information about the examination before it takes place. The information must include: the purpose of the examination and why it is required, the scope of the examination and which specific tests will be conducted, who will perform the examination and their qualifications, what will be done with the medical information collected, and what the possible implications of the examination may be. This information is essential so that the employee can give informed consent to the examination.

Right to Medical Privacy

An employee is entitled to full medical privacy. The occupational physician may not disclose to the employer all of the medical details discovered, but only information relevant to fitness for work. The opinion provided to the employer must be concise and answer the questions: is the employee fit for work? Are accommodations required? What are the limitations, if any?

All additional private medical information remains confidential and is retained by the physician. The employer is not entitled to demand access to the employee's full medical file or to demand detailed explanations of diagnoses and conditions.

Right to Refuse an Examination

In certain circumstances, an employee may refuse to undergo an occupational examination:

When there is no legal or reasonable basis for the requirement: if the examination is not required by law and has no reasonable and objective basis, the employee may refuse. Such a justified refusal cannot serve as grounds for dismissal or disciplinary action.

When the examination is discriminatory or offensive: if the employee believes the examination is based on discrimination or is offensive and disproportionate, they may refuse and seek legal recourse.

When insufficient information has been provided: if the employer has not supplied full information about the examination, the employee may demand information before agreeing to undergo the examination.

However, it is important to understand that refusing an examination required by law or one that has a reasonable basis may be problematic and lead to negative consequences. In such cases, it is advisable to consult a lawyer before refusing.

Right to Receive Results

An employee is entitled to receive a copy of the medical opinion and examination results. The information belongs to the employee, and they are entitled to know what the physicians found and what they recommended. Receiving this information allows the employee to understand their situation, obtain a second opinion if desired, and consult with other physicians or a lawyer.

Right to Appeal Findings

If an employee disagrees with the findings of the occupational physician, they are entitled to obtain a second medical opinion. The employee may approach another specialist at their own expense, or request that the employer fund a second opinion. If there is a dispute between opinions, a third and decisive opinion may be required, or the matter may be brought before the Labour Court.

Right to Reasonable Accommodations

If the occupational physician recommends accommodations to enable the employee to continue working, the employer must seriously consider implementing them. The Equal Rights for Persons with Disabilities Law, 5758–1998, requires employers to make reasonable accommodations. Only if the accommodations are unreasonable (meaning they involve disproportionate cost or effort) may the employer be exempt from carrying them out.

Employer Obligations and Rights

The Duty to Ensure Health and Safety

The employer bears general responsibility for the health and safety of their employees. As part of this duty, the employer is required to conduct risk assessments, implement safety measures, and carry out occupational examinations as required.

Failure to fulfil this duty may result in serious consequences: fines, closure of the workplace, criminal liability in certain cases, and civil liability towards employees who have been harmed.

The Right to Receive Relevant Information

The employer is entitled to receive from the occupational physician information relevant to the employee's fitness for work. This includes: whether the employee is fit to perform their role, whether there are limitations or restrictions on certain types of work, what accommodations are required to allow the employee to work safely, and whether further medical monitoring is required and when.

The employer is not entitled to medical details beyond this. They do not need to know the precise diagnosis, what medications the employee is taking, or other personal medical details not directly relevant to fitness for work.

The Duty to Fund Examinations

The employer must bear all costs associated with occupational examinations they require. This includes the physician's fee, additional laboratory or imaging tests, travel expenses, and work hours lost due to the examination. The employee should not pay anything. If the employer attempts to impose the costs on the employee, this constitutes a breach of their obligations.

The Right to Act on the Physician's Recommendations

If the occupational physician has determined that an employee is unfit to perform a certain role or poses a safety risk, the employer is entitled to act on that recommendation. This may include transferring the employee to a different role, imposing restrictions on certain types of work, or in extreme cases — even dismissal. However, the employer must act fairly, give the employee the right to be heard, and exhaust alternatives before taking drastic steps.

Implications of the Occupational Examination

Possible Outcomes of the Examination

Following an occupational examination, the physician may reach several conclusions:

Fit without restrictions: the employee is in good health and is fit to perform all aspects of their role without any limitation or accommodation. This is the most favourable outcome, and the employee continues working as normal.

Fit subject to accommodations or restrictions: the employee is fit to work, but subject to certain accommodations or restrictions. For example: a restriction on lifting heavy loads, a need for more frequent breaks, a prohibition on working at heights, a need for special protective equipment, or a change in working hours. The employer must implement the recommended accommodations, subject to their reasonableness.

Fit for a different role: the employee is not fit to continue in their current role, but can perform another role in the workplace. In this situation, the employer must examine whether a suitable alternative role exists and offer it to the employee. Only if no reasonable alternative role is available may dismissal be considered.

Temporarily unfit for work: the employee is not fit for work at this stage, but their condition may improve in the future. In this case, the employer should allow the employee reasonable time to recover and require a repeat examination at a later date.

Permanently unfit for work: in rare and serious cases, the physician may determine that the employee is entirely unfit to work in this role or at all, and that there is no reasonable prospect of improvement.

Implications for Social Rights

Sick days and sick pay: if the occupational examination was conducted following illness, the results do not affect the employee's entitlement to sick pay for the period they were ill. However, if the physician has determined that the employee is fit to return to work, the employer is not required to continue paying sick pay from that point.

Severance pay: if the employee is dismissed as a result of medical incapacity determined in an occupational examination, they are entitled to full severance pay. In addition, they may be entitled to benefits or a disability pension from the National Insurance Institute, depending on the circumstances.

Disability pension: if the employee's medical condition results from a work accident or occupational disease, they may be entitled to benefits and a disability pension from the National Insurance Institute. The occupational physician's opinion may serve as evidence within the claim to the Institute.

Insurance Implications

Executive insurance: many employees hold executive insurance or other insurance policies as part of their employment terms. An occupational medical opinion negating fitness for work may activate insurance coverage for loss of work capacity. It is important to consult with an insurance agent and a lawyer regarding the possibility of submitting an insurance claim.

National Insurance: the National Insurance Institute may require an occupational medical opinion as part of the review of claims for disability benefits, unemployment benefits, or work accident compensation. The occupational physician's opinion can serve as supporting evidence for the claim.

Special and Complex Issues

Drug and Alcohol Testing

In certain workplaces, especially those involving hazardous work or responsibility for others (such as driving, operating heavy machinery, or working in critical facilities), the employer may require drug and alcohol testing. These tests form part of the occupational examination, but raise privacy concerns.

Drug and alcohol testing is permitted only when relevant to safety and fitness for work, when conducted equally and without discrimination, and when carried out through a fair and transparent procedure. Random testing or testing directed against specific employees without justification may be considered unlawful.

Genetic Testing

Israel's Genetic Information Law, 5761–2000, prohibits employers from requiring employees to undergo genetic testing or to disclose genetic information.

Psychological and Psychiatric Examinations

For certain roles, particularly those involving high stress, significant responsibility, or work with vulnerable populations, the employer may require a psychological or psychiatric examination as part of the occupational examination. Such examinations must be conducted by qualified professionals, address only aspects relevant to fitness for work, and maintain maximum privacy.

Conflict Between Medical Opinions

Sometimes there is a gap or even a contradiction between the opinion of the occupational physician and the opinion of the employee's treating physician. In such situations, preference tends to be given to the treating physician's opinion, on the assumption that they are better acquainted with the employee's condition. However, if the occupational physician is a specialist in the relevant field and conducted a comprehensive examination, their opinion will be taken seriously.

In the event of a significant dispute, a third and decisive medical expert may be appointed, or the matter may be brought before the Labour Court, which will examine all the evidence and rule accordingly.

Foreign Workers

Foreign workers are entitled to the same health and occupational protections as Israeli workers. The employer must ensure that foreign workers undergo the required occupational examinations, and that these are conducted in a language the workers understand or with appropriate translation.

Practical Tips for Employees

Preparing for the Examination

If you are required to undergo an occupational examination, prepare in advance. Bring with you a list of medications you are taking, details of relevant previous illnesses, and medical documentation if available.

Protecting Your Rights

Be aware of your rights. Do not sign forms or consents without reading and understanding them. If something is unclear, ask questions. If you feel the examination is unfair or discriminatory, speak with the employer, and if the issue is not resolved — consult a lawyer.

Documentation

Keep copies of all documents related to the examination: the referral letter from the employer, the medical opinion, and examination results. Good documentation will assist you in the event of a future dispute.

Obtaining a Second Opinion

If you disagree with the occupational physician's findings, consider obtaining a second opinion from another specialist. A second opinion can strengthen your position or provide a different perspective that will help in decision-making.

Seeking Legal Advice

If you fear the employer is about to take action against you based on the occupational examination, or if you feel your rights are being violated, consult an employment lawyer as early as possible. Timely advice can prevent problems and protect your rights.

Practical Tips for Employers

Establishing a Clear Policy

Formulate a written and clear policy regarding occupational examinations: when they are required, who will conduct them, what will be done with the information, and what the employees' rights are. A transparent policy will prevent misunderstandings and disputes.

Selecting a Qualified Occupational Physician

Ensure that the occupational physician you engage is qualified, experienced, and well-regarded. A professional physician will provide reliable opinions and act in accordance with ethical and legal standards.

Maintaining Confidentiality

Be diligent in maintaining the confidentiality of medical information. Ensure that only those who need to know the information receive it, and that the information is stored securely. Breach of confidentiality may result in legal claims.

Acting Fairly

Act fairly and in good faith towards employees found to have medical limitations. Seek ways to adapt the work, transfer to a different role, or find creative solutions. A humane and respectful approach is not only ethically correct, but also reduces legal risks.

Legal Consultation

Before taking significant steps based on an occupational examination (such as transferring to a different role or dismissal), consult an employment lawyer. A lawyer will help you assess the risks, verify that you are meeting your legal obligations, and act in a manner that minimises risk.

Conclusion — Balancing Health and Privacy

Occupational medicine is an important tool for safeguarding employee health and ensuring workplace safety. Occupational examinations enable early identification of health problems, prevention of injuries, and proper alignment between employees' capabilities and the demands of their roles. Nevertheless, these examinations also raise questions of privacy, bodily autonomy, and the balance between employee rights and employer interests.

Israeli law seeks to find a delicate balance between the legitimate need of employers to verify the fitness for work of their employees and to protect safety, and the right of employees to medical privacy, dignity, and autonomy. Employees must understand their rights and stand by them, while recognising that in certain situations an occupational examination is legitimate and even essential. Employers must act transparently, fairly, and in good faith, adhering to fair procedures and protecting privacy.

If you are dealing with questions or problems related to occupational examinations — whether as an employee or as an employer — it is advisable to seek the professional guidance of an employment lawyer who specialises in the field. Accurate information and legal guidance can make the difference between protecting your rights and unnecessary exposure to legal risk.

Questions and Answers

1. Am I required to undergo an examination by an occupational physician if my employer demands it?

This depends on the circumstances. If the examination is required by law (such as in hazardous roles or roles involving exposure to risk factors), or if there is a reasonable and objective basis for the requirement (such as a work accident or prolonged illness), you are required to undergo the examination. Refusal in such cases may lead to disciplinary consequences and even justified dismissal. However, if the examination is arbitrary, discriminatory, or irrelevant to the work, you may refuse. In cases of doubt, it is advisable to consult a lawyer before refusing.

2. Who pays for the occupational examination?

The employer must bear all costs associated with the occupational examination they require. This includes the physician's fee, additional tests (laboratory, imaging), travel expenses, and the time the employee devoted to the examination (which must be counted as regular working hours). The employee should not pay anything out of pocket. If the employer attempts to charge the employee for the examination, this constitutes a breach of their legal obligations.

3. Is the employer entitled to see my entire medical file?

No. The employer is entitled to receive from the occupational physician only information relevant to fitness for work: whether you are fit to work, whether there are limitations, and what accommodations are required. The physician may not disclose to the employer all medical details, diagnoses, medications, or other personal medical information not directly relevant to fitness for work.

4. What happens if the occupational physician determines that I am unfit to work?

This depends on what the physician has determined. If determined temporarily unfit, the employer must allow you reasonable time to recover and require a repeat examination at a later date. If determined unfit for your current role but fit for another role, the employer must examine whether a suitable alternative role exists and offer it to you. If determined entirely unfit for work, the employer may consider dismissal, but only after exhausting all alternatives. You are entitled to obtain a second opinion and to appeal the findings if you disagree with them.

5. Can I receive a copy of the occupational physician's opinion?

Yes, absolutely. You are entitled to receive a copy of the opinion and all examination results. This is a basic right under the Patient Rights Law. The medical information belongs to you, and you are entitled to know what was found and what was recommended. Receiving the information will allow you to understand your situation, obtain a second opinion if desired, and protect your rights in the event of a dispute.

6. Can an occupational examination include a drug test?

For certain roles, particularly those involving hazard (driving, operating heavy machinery, working at heights), the employer may require drug and alcohol testing as part of the occupational examination. However, such tests must be relevant to safety, conducted equally and without discrimination, and carried out through a fair and transparent procedure. Random testing or testing targeted at specific employees without justification may be considered unlawful.

7. Am I entitled to be absent from work during the occupational examination?

Yes. The time devoted to an occupational examination required by the employer must be counted as regular working hours. You are entitled to full pay for these hours, and the time must not be deducted from leave or sick days. If the employer attempts to deduct the time or not pay for it, this constitutes a breach of their obligations. Furthermore, if the examination takes place outside regular working hours, consider requesting payment for overtime or compensation for the inconvenience.

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