Key Takeaways
Employees can refuse to participate in a Fitness for Duty Evaluation (FFDE), but this refusal can lead to significant employment consequences. FFDEs are assessments conducted by qualified psychologists to determine if an employee can safely perform their job, particularly in safety-sensitive roles. While participation is voluntary under U.S. employment law, employers may require an FFDE if there are objective concerns about the employee's ability to perform essential job duties or if they pose a direct threat.
If an employee refuses an FFDE, employers might place them on administrative leave, restrict their duties, or even terminate their employment to ensure workplace safety. Employees may decline due to fear of stigma, misunderstanding the evaluation's purpose, confidentiality concerns, distrust, or legal advice. For employers, a defensible FFDE request should be well-documented, job-related, and consistently applied.
In summary, while refusal is an option, it often leads to consequences as employers must prioritize safety in the workplace. Clear communication and a transparent process can help mitigate misunderstandings and support fair decision-making.
When an employee’s behavior, emotional stability, or cognitive functioning raises legitimate concerns in the workplace, employers and attorneys often turn to a psychological or neuropsychological Fitness for Duty Evaluation (FFDE) to determine whether the individual can safely and effectively perform essential job duties. These evaluations are especially critical in safety-sensitive roles like healthcare, law enforcement, transportation, public safety, and high-risk corporate environments, where impaired functioning can have serious consequences.
But one question arises in nearly every consultation with employers and legal counsel:
Can an employee refuse to participate in a Fitness for Duty Evaluation?
The short answer is yes. Employees can refuse. However, refusal often carries significant employment consequences. Understanding the legal, procedural, and practical implications of refusal is essential. Not only for employers, but also for HR leaders and attorneys navigating these complex situations.
This article breaks down what refusal means, how employers can respond, and what makes an FFDE request legally defensible.
What Is a Fitness for Duty Evaluation?
A Fitness for Duty Evaluation is a formal, job-related assessment conducted by a qualified psychologist or neuropsychologist. It can determine whether an employee can perform essential job functions safely and effectively.
Depending on the referral question, an FFDE may evaluate:
Psychological stability, including mood, behavior, and emotional regulation
Cognitive functioning, such as memory, attention, processing speed, and executive functioning
Behavioral risk, including judgment, impulse control, and workplace conduct
The impact of medical, neurological, or psychiatric conditions on job performance
FFDEs are not punitive. They are risk-management tools designed to protect the employee, coworkers, and the public.
Is an Employee Legally Required to Participate?
Under U.S. employment law, including the ADA, FEHA, and EEOC guidance, employees are not forced to undergo a medical or psychological evaluation. Participation is voluntary.
However, employers are permitted to require an FFDE as a condition of continued employment when:
There is objective evidence that the employee may be unable to perform essential job duties, or
There is reasonable concern that the employee poses a direct threat to themselves or others
In these cases, refusal may justify administrative action on the part of the employer.
What Happens If an Employee Refuses?
While employees can decline an FFDE, refusal often triggers employment consequences because the employer still has a duty to maintain a safe workplace.
Common employer responses to refusal include:
Administrative leave, either paid or unpaid
Removal from safety-sensitive duties
Revocation of workplace privileges
Fitness-based separation or termination
Inability to return to work until the evaluation is completed
In other words, refusal does not prevent the employer from making decisions based on the information available. If the employer cannot verify that the employee is safe and fit for duty, they may restrict or end employment to mitigate risk.
Why Employees Refuse and What It Means
Employees may decline an FFDE for several reasons:
Fear of stigma or judgment
Mental health evaluations can feel intimidating, especially in high-stress industries.
Misunderstanding the purpose
Employees may believe the evaluation is punitive or disciplinary.
Concerns about confidentiality
Many employees worry their personal health information will be shared broadly.
Distrust of the process
If the referral is not clearly explained, employees may feel targeted or unfairly singled out.
Advice from legal counsel
Attorneys may recommend refusal if the referral appears retaliatory or unsupported.
Refusal does not automatically indicate impairment. However, it does prevent the employer from verifying fitness, which is often the core issue.
What Makes an FFDE Request Legally Defensible?
For employers, HR, risk managers, and attorneys, the key to managing refusal is ensuring the FFDE request is job-related, necessary, and well-documented.
A defensible FFDE referral includes:
Objective, observable behaviors
Vague concerns (“seems off,” “acting strange”) are not enough. Concrete examples are essential.
Clear connection to essential job duties
The employer must articulate how the concerning behavior impacts safety or performance.
Consistent application of policy
FFDEs should be used uniformly and fairly, not selectively or punitively.
Written notice to the employee
The referral should explain why the evaluation is being requested, what it will involve, what information will be shared, and what happens if the employee declines.
Use of a qualified evaluator
Psychologists conducting FFDEs must have expertise in occupational functioning, psychological and neuropsychological assessment, risk evaluation, and legal and ethical standards.
A well-structured referral reduces the likelihood of refusal. It also strengthens the employer’s position if a refusal occurs.
How a Psychologist Handles Refusal
As an evaluator, my role is to remain objective. Although I am retained by the employer, part of my ethical obligation is to provide an unbiased opinion based on evidence and data. These cases are often complex, as human psychology is complicated, but my goal is always to reach a conclusion based on the medical facts available, results of standardized testing, the nature of the work, the level of safety risk involved, and the probability of harm. When an employee refuses to participate in an FFDE through my California practice, I:
Document the refusal
Notify the referring party
Do not speculate about impairment
Do not make conclusions without data
The employer then determines next steps based on their organization’s policy, safety considerations, and legal guidance.
What Should Employers and Attorneys Do When Refusal Occurs?
Review the referral documentation
Ensure the request is clearly tied to job duties and supported by objective evidence.
Communicate consequences clearly
Employees should understand that refusal may impact their ability to return to work.
Offer clarification—not persuasion
Employers can explain the FFDE process, but should avoid pressuring the employee.
Maintain confidentiality
Only those with a legitimate need to know should be informed.
Consult legal counsel
Especially in unionized, public safety, or high-risk environments.
Final Thoughts From an FFDE Psychologist in Los Angeles, CA
Employees can refuse to participate in a Fitness for Duty Evaluation, but refusal does not prevent employers from taking necessary steps to ensure workplace safety. When an FFDE request is well-documented, job-related, and consistent with policy, employers are on solid ground to act appropriately even if the employee declines.
In my experience as an FFDE psychologist in Los Angeles, who does both psychological and neuropsychological FFDEs, refusal is relatively rare. Most employees understand that if there is a concern about risk that is supported by evidence, their employer has the responsibility to ensure their fitness for work. They are often anxious about the evaluation, and sometimes resentful or angry, but most employees do not refuse to participate.
For attorneys and employers, the key is understanding that FFDEs are not punitive; they are risk-management tools designed to protect everyone involved, including the employee. A clear, transparent process reduces confusion, minimizes conflict, and supports fair, defensible decision-making.
Ready to Pursue Fit For Duty Testing in Los Angeles? Dr. Reger Can Guide The Process
Understanding your rights and responsibilities as an employer, including how to handle an employee who resists or refuses a Fitness For Duty Evaluation, starts with having the right professional in your corner. Dr. Stacy Reger provides thorough, legally defensible FFDEs that give organizations the documentation and direction they need to move forward with confidence.
A licensed psychologist serving employers, attorneys, and safety-sensitive industries throughout California, Dr. Reger is based in Los Angeles and conducts evaluations statewide. Depending on the circumstances, telehealth may also be a viable option for certain fitness-for-duty evaluations. Starting the process is simple:
Schedule a consultation
Reach out to discuss your situation, the referral question, and whether an FFDE is the appropriate next step
Share supporting documentation
Relevant materials such as incident reports, job descriptions, and medical notes help ensure a comprehensive evaluation
Book your evaluation
Dr. Reger, an experienced FFDE psychologist in Los Angeles, will work with your organization to schedule an assessment at a time and location that fits your needs
Receive a clear, actionable report
Findings and recommendations are presented in a well-supported, defensible format that your organization can rely on
Other Services Dr. Stacy Reger Provides in Los Angeles, California
Navigating a fitness for duty situation requires a psychologist with the experience and credentials to support your organization every step of the way. Especially when an employee pushes back or refuses to participate. Dr. Stacy Reger brings a thorough, methodical approach to every evaluation, ensuring that employers walk away with a clear, well-documented report they can stand behind. Whether the process moves smoothly or presents legal and procedural complications, Dr. Reger is equipped to guide you toward a well-supported outcome.
While FFDEs are a significant focus of her practice, Dr. Reger offers a wide range of psychological and neuropsychological services to meet diverse clinical and legal needs. These include testing and neuropsychological assessments for cognitive decline and learning difficulties, capacity evaluations for financial and testamentary matters, and Independent Medical Evaluations. Her med-legal offerings extend to workers' compensation, psychological and neuropsychological evaluations in her capacity as both a Qualified Medical Evaluator and Agreed Medical Evaluator.
She also conducts adult neuropsychological evaluations for conditions including TBI, stroke, ADHD, and dementia, along with pre-surgical psychological evaluations for spinal cord stimulator implantation, bariatric surgery, and organ transplants. In addition, Dr. Reger serves as an expert witness, public speaker, and consultant, and provides individual psychotherapy and therapeutic services for older adults.
To explore the full scope of Dr. Reger's expertise, browse her blog. And when you're ready to move forward, don't hesitate to get in touch.
About the Author
With nearly two decades of experience in neuropsychological and psychological assessment, Dr. Stacy Reger, Ph.D., is uniquely qualified to help employers navigate the complexities of Fitness for Duty Evaluations, including cases where employee participation is contested or legally complicated. Dr. Reger built and directed a neuropsychological testing clinic at the Long Beach VA Healthcare System, where she collaborated across interdisciplinary teams in demanding medical, cognitive, and behavioral environments. Experience that directly informs her methodical, defensible approach to FFDEs. She completed advanced clinical training in geropsychology at the San Francisco VA Medical Center and holds a Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada, Las Vegas. Licensed in California (PSY #27639), Dr. Reger brings both clinical depth and practical insight to every evaluation, giving employers and organizations the well-supported findings they need to make sound workforce decisions.