The recent admission of a large number of new health professions
to those recognized in the Ontario Regulated Health
Professions Act, which governs who can provide medical
services in Ontario, raises fresh questions for employers as to
what they should do with medical documentation from health care or
medical practitioners who are not traditional doctors. Must they be
given the same weight as doctor's notes or letters? Do they
need to be given any consideration at all?
The expansion of regulated health and medical
The Act lists 25 different professions, with another to be
introduced in the near future at a yet-to-be-determined date. These
professions run the gamut from traditional professions such as
doctors and nurses to newly minted professions such as traditional
Chinese medicine and homeopathy. They may involve the use of
non-traditional methods for diagnosis in treatments, resulting in
different conclusions from that of a doctor.
Do the opinions of these professionals carry much legal
This issue has not been the subject of much case law to guide
employers. Nonetheless, it is only a matter of time before this
issue is litigated with more frequency given the increasing
popularity of non-traditional medical and healing methods.
The traditional rule that an employee must provide reasonable
medical documentation to support a medical leave of absence or
accommodation request still stands. Although each case and note
must be assessed individually, some basic questions can help
determine whether a document from a medical practitioner who is not
a doctor is sufficient:
Does the document provide a prognosis
or outline functional restrictions?
Does the document indicate that the
worker has been under the health professional's care?
Does the opinion fall within the
expertise of that profession?
Is the information in the document
consistent with other information the employer has received?
In general, the weight to be given a medical note or letter,
regardless of the type of professional giving it, will depend on
the cogency of the information provided in the note, the rigour of
the examination and the specialization of the medical
The fact the note is from a doctor does not mean it cannot be
questioned or even rejected by an employer. By the same token, a
note from another medical or health practitioner should not be
dismissed just because it is not from a doctor.
The specialization of the individual providing the note will be
an important factor for employers to consider. This is particularly
so when a note is provided by a professional working in an area
with non-traditional diagnostic practices.
However, where the accommodation requested by an employee will
involve some difficulty for the employer, it will usually be a good
practice for the employer to seek an opinion from a doctor with a
specialization in the type of condition an employee is seeking
accommodation for to confirm the opinion of the alternative medical
Employment Standards Act leaves
Unlike requests for accommodation of duties or hours or for
general sick leaves, the Employment Standards Act
specifically sets out the type of medical professional who can
provide the documentation required to support the leave. They are
Type of leave
Family medical leave, organ donor
Family caregiver, critically ill
Type of medical practitioner
Legally qualified medical
Physician, registered nurse,
In these types of leaves, an employer is obligated to accept a
note from the type of medical practitioner indicated so long as
that note meets the requirements of the individual section.
Conversely, an employer is not required to accept a note or letter
from any other type of medical practitioner in relation to the
In some other cases, medical notes may be necessary as well. For
example, in order to receive personal emergency leave, an employee
may be required to furnish evidence reasonable in the
circumstances, which may involve a note from a medical professional
who is not a doctor. Since this is not an explicit requirement,
what is reasonable, and who may provide a note, will depend on the
circumstances of each case.
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