This guide is maintained as a current resource for July 2026 and covers only the laws of England and Wales. Information is for general guidance, not legal advice. Consult a qualified solicitor for advice specific to your situation.
Occupational health referral process explained under UK law. Covers employer duties, medical assessments, employee rights, reasonable adjustments, data protection, and employment tribunal risks in England and Wales.
The occupational health referral process is a workplace procedure used by employers to obtain medical advice about an employee's health in relation to their work. It is commonly used where there are concerns about sickness absence, fitness to work, workplace adjustments, or the impact of a medical condition on job performance.
In the UK, there is no single statute that governs occupational health referrals in isolation. Instead, the process operates within a wider legal framework, including the Health and Safety at Work etc. Act 1974, the Equality Act 2010, and common law duties relating to employee wellbeing and reasonable care.
Occupational health assessments are not treatment services. They are independent medical evaluations designed to support decisions about workplace capability, adjustments, and safe working arrangements.
What Is an Occupational Health Referral?
An occupational health (OH) referral is when an employer asks a qualified occupational health professional or service to assess an employee's health in relation to their job.
The referral may address questions such as:
- Whether an employee is fit to work
- What adjustments may be needed to support the employee
- Whether absence is likely to continue or recur
- Whether a condition may be considered a disability under the Equality Act 2010
- Whether workplace duties may be affecting health
The outcome is typically a written report provided to the employer, often with the employee's consent.
Legal Basis for Occupational Health Referrals
Occupational health referrals are supported by several legal duties:
Health and Safety at Work etc. Act 1974
Employers must ensure, so far as reasonably practicable, the health, safety, and welfare of employees.
Management of Health and Safety at Work Regulations 1999
Requires employers to assess workplace risks, including those relating to employee health and capability.
Equality Act 2010
Requires employers to make reasonable adjustments for disabled employees and avoid discrimination arising from disability.
Common law duty of care
Employers must take reasonable steps to protect employees from foreseeable harm, including health-related risks.
When Employers Use Occupational Health Referrals
Employers typically initiate referrals in situations such as:
- Long-term sickness absence
- Repeated short-term absences
- Concerns about fitness to perform job duties
- Workplace stress or mental health concerns
- Suspected work-related illness or injury
- Need to assess reasonable adjustments
- Return-to-work planning after illness or injury
The referral is intended to support evidence-based employment decisions.
Step-by-Step Occupational Health Referral Process
1. Employer identifies a health or capability concern
This may arise from sickness absence records, performance issues, or employee disclosure of a medical condition.
2. Referral is prepared
The employer prepares a referral form, usually including:
- Job description and duties
- Attendance records
- Specific questions for the occupational health adviser
- Relevant background information
The questions must be relevant, fair, and not intrusive beyond what is necessary.
3. Employee consent and participation
While consent is generally sought, employers may proceed under contractual sick pay policies or capability procedures requiring cooperation.
Employees are typically asked to:
- Attend an occupational health appointment
- Provide medical information
- Discuss symptoms and workplace impact
4. Occupational health assessment
The occupational health professional may:
- Review medical history
- Conduct a clinical interview
- Assess functional ability in relation to work
- Consider workplace risks and adjustments
They do not usually provide treatment.
5. Occupational health report issued
The report is sent to the employer and may include:
- Fitness for work status (fit, unfit, or fit with adjustments)
- Prognosis and expected recovery time
- Recommendations for workplace adjustments
- Assessment of disability under the Equality Act (where relevant)
- Advice on return-to-work planning
Medical details are usually limited to what is necessary for workplace decisions.
6. Employer decision-making
The employer uses the report to determine:
- Sickness absence management actions
- Reasonable adjustments
- Return-to-work plans
- Capability procedures
- Redeployment or dismissal considerations (where appropriate)
The occupational health report is advisory, not binding.
Employee Rights During the Process
Employees have several important rights, including:
- Right to be informed about the purpose of the referral
- Right to see the questions being asked
- Right to access the occupational health report (subject to consent and data protection rules)
- Right to challenge inaccuracies in medical information
- Protection from discrimination under the Equality Act 2010
- Right to reasonable adjustments if disabled
Employers must also comply with UK GDPR when handling health data, which is classified as “special category data”.
Confidentiality and Data Protection
Occupational health information is highly sensitive and protected under data protection law.
Key principles include:
- Only necessary medical information should be shared with the employer
- Full medical records are not normally disclosed
- Reports should be limited to workplace relevance
- Employees usually have the right to see reports before or after disclosure
Improper handling of health data can result in legal and regulatory consequences.
Reasonable Adjustments and Occupational Health Advice
Where an employee is considered disabled under the Equality Act 2010, employers must consider reasonable adjustments. Occupational health advice often informs this process.
Examples include:
- Modified duties
- Reduced hours or phased return
- Ergonomic equipment
- Remote working arrangements
- Additional breaks or workload adjustments
Failure to implement reasonable adjustments may lead to discrimination claims.
Return-to-Work Process
Occupational health referrals are commonly used to support return-to-work planning.
This may involve:
- Phased return schedules
- Temporary adjustments to duties
- Monitoring and follow-up reviews
- Ongoing workplace support measures
The aim is to facilitate safe and sustainable return to work.
Capability and Ill Health Dismissal Considerations
Where long-term absence continues, occupational health reports may be used in capability procedures.
Employers must consider:
- Whether the employee is likely to return
- Whether adjustments are reasonable
- Whether alternative roles exist
- Whether dismissal is a proportionate last resort
Failure to follow a fair process may lead to unfair dismissal claims.
Common Issues and Disputes
Frequent disputes arise where:
- Employees believe referrals are premature or unnecessary
- Occupational health reports are unclear or inconsistent
- Employers rely too heavily on medical opinion without independent judgment
- Reasonable adjustments are not implemented
- Confidential medical information is mishandled
These issues often feature in employment tribunal claims.
Employee Refusal to Attend Occupational Health
If an employee refuses to attend a referral appointment, employers may:
- Continue absence management procedures
- Make decisions based on available evidence
- Consider disciplinary action in serious cases (depending on policy)
However, employers must still act reasonably and fairly.
Legal Risks for Employers
Improper handling of occupational health referrals can lead to:
- Unfair dismissal claims
- Disability discrimination claims
- Breach of contract disputes
- Data protection complaints
- Increased compensation liability
Tribunals often assess whether employers acted reasonably and relied appropriately on medical evidence.
Key Takeaways
The occupational health referral process is a structured system used by UK employers to assess employee fitness for work, manage sickness absence, and determine reasonable adjustments. It operates within employment, health and safety, and equality law frameworks. The process involves referral, assessment, reporting, and employer decision-making. Proper handling is essential to ensure legal compliance, protect employee rights, and reduce the risk of employment disputes.
