What to Do When COVID-19 Long-Haulers Seek Exemptions from Vaccine Mandates

​COVID-19 long-haulers—those experiencing long-term effects of COVID-19—who seek disability-related exemptions from mandatory vaccination policies are straining employers' accommodation processes.

The Occupational Safety and Health Administration's (OSHA's) anticipated emergency temporary standard—which will mandate employees of businesses with at least 100 workers get vaccinated or submit to weekly testing—will result in more employers requiring vaccines. OSHA's rule will almost certainly affirm that employers must accommodate employees who refuse to be vaccinated based on a medical exemption or sincerely held religious belief, said Paula Ketcham, an attorney with Schiff Hardin in Chicago. With the rise of the delta variant, more small employers also are starting to mandate vaccinations.

What if an employer believes that a COVID-19 long-hauler is requesting an exemption simply because the person is opposed to vaccinations rather than having a medical condition that would put that person at risk if he or she was vaccinated?

"Employers should always balance empathy for its staff with the safety of its overall workforce," said David Epstein, SHRM-SCP, director of domestic human resources at Doctors Without Borders in New York City.

"Those who ask for an exemption from the vaccine should be afforded a pathway to apply for an exemption for medical reasons, and the required interactive dialogue should take place as is required" by the Americans with Disabilities Act (ADA), Epstein noted. "After that dialogue takes place, there are two options: a reasonable accommodation, which could include working remotely, or termination of employment if your company requires the vaccine and working remotely causes an undue hardship under the ADA."

Collect Information

The interactive process allows employers to collect information to make an intelligent and informed decision on an accommodation request, said Peter Petesch, an attorney with Littler in Washington, D.C.

If long-term effects of COVID-19, also known as "long COVID," are not already known or obvious, the employer may request medical documentation to determine if the condition is an ADA disability and, if so, if there is a reasonable accommodation, said Christine Walters, J.D., SHRM-SCP, an independent consultant with FiveL Co. in Westminster, Md. Long COVID-19 can rise to the level of an ADA disability.

"No two situations are necessarily identical," Petesch said. "Everything will depend on the medical information that an employee furnishes through their health care provider in connection with a request."

Employers should not play doctor, cautioned Jonathan Mook, an attorney with DiMuroGinsberg in Alexandria, Va. "Although some studies indicate that vaccination may actually assist in mitigating the symptoms of long COVID-19, rather than causing any harm, the assessment of a long-hauler's request to be exempted from vaccination should be done by a medical professional—not the employer," he said.

"Ask the employee to provide medical documentation from his or her physician that the employee would be put at risk by being vaccinated," Mook continued. "If an employee does this and an employer still has a question as to the legitimacy of the request, I usually recommend that the employer retain a physician knowledgeable in the field to act as a consultant to assess the documentation of the employee's doctor."

If, as a result of that assessment, the medical expert indicates that additional information is needed, the employer has a basis to request further medical information from the employee. "This entire process should be documented, as the initial stage in the ADA interactive process," he said.

If the employee can't provide any information as to why the medical condition prevents him or her from receiving the vaccine and instead can articulate only a generalized fear of the vaccine, that is not sufficient to trigger an employer's obligation to provide an accommodation under the ADA, said Amanda Van Hoose Garofalo, an attorney with BakerHostetler in New York City.

Employers may have difficulty determining what is reasonable medical care for an underlying condition, she noted. "Further, it is certainly possible that individuals with the same condition will receive different advice from their health care providers," Garofalo said.

Long COVID-19 manifests in a variety of ways, so some people may have it severe enough to qualify as a disability and some may have a less severe version, she added. "As a result of these variances, some individuals with long COVID may request exemptions, while others receive the vaccine," Garofalo said.

Accommodation Options

"If the medical documentation is sufficient, then an employer should engage with the employee about how the employee can perform his or her job without putting the employee or others at risk due to the unvaccinated status of the long-hauler," Mook said.

Options include:

• Wearing a mask at work with testing on a periodic basis.
• Working in an area where the employee will not come in close contact with other employees.
• Remote work.

"Changing or limiting an employee's location or interaction with others must be done with care," he said. "You do not want to single out or stigmatize an employee who is being accommodated."

Many employers are relying on regular testing as an option, noted Jesse Dill, an attorney with Ogletree Deakins in Milwaukee. But an employer may incur significant costs to provide regular testing, and monitoring can result in administrative headaches.

"With respect to a mandatory vaccination policy, it seems there would be little room for unpaid leave as an accommodation that the employer must provide," Dill added. Leave is an accommodation of last resort. "There is not a certain end date to the pandemic, which makes a request for leave as an accommodation to a mandatory vaccination policy as seeking indefinite or long-term leave," which the ADA doesn't require.

In addition, COVID-19 long-haulers who claim they should have an accommodation because they have natural immunity due to already being infected may be out of luck. A claim of natural immunity does not seem likely to meet the definition of an ADA disability, Dill said.