Pre-Employment Medical Exam Laws in Massachusetts

The Americans with Disabilities Act (ADA), 42 U.S.C. § 12111, establishes the federal framework governing pre-employment medical examinations. Under the ADA, covered employers with 15 or more employees cannot require medical exams or make disability-related inquiries before making a conditional job offer to a job applicant. This applies to any test or procedure that seeks information about an individual's physical or mental impairments or health status.

Once a conditional offer is made, employers may require medical exams, but only if: (1) all entering employees in the same job category are required to undergo the same examination; (2) the information is kept confidential and stored separately from personnel files; and (3) the exam is job-related and consistent with business necessity. The employer cannot withdraw the offer based on medical findings unless the applicant cannot perform the essential functions of the job, even with reasonable accommodation.

The EEOC enforces the ADA pre-employment examination rules. Violations can result in damages for lost wages, emotional distress, and attorney's fees. The exam must be truly conditional—meaning the applicant has already received a contingent offer of employment based on non-medical criteria.

Massachusetts law provides stronger protections than federal law in several respects. M.G.L. c. 149, § 24L is the Massachusetts employee medical record privacy law that applies to all medical information, including pre-employment examinations. Unlike the ADA, which applies only to employers with 15 or more employees, Massachusetts law applies to employers of all sizes with one or more employee.

Massachusetts law requires that any medical examination conducted by an employer—whether pre-employment or otherwise—must be kept in a separate, confidential file, apart from the employee's personnel record. Access is strictly limited to occupational health professionals and managers who have a legitimate need to know. Employers cannot disclose medical information without written consent, except in narrow circumstances such as workers' compensation claims or legal proceedings.

M.G.L. c. 149, § 24M further prohibits employers from requiring or requesting any genetic information, genetic testing, or family medical history. This includes genetic tests, carrier status for genetic conditions, and predictive genetic information. Violations carry statutory damages.

While Massachusetts follows the ADA framework of prohibiting pre-offer exams, state courts and the Massachusetts Commission Against Discrimination (MCAD) enforce stricter standards for job-relatedness and business necessity. Massachusetts also requires that if an exam reveals a medical condition, the employer must engage in the interactive process to consider reasonable accommodations before making any adverse employment decision. Remedies under state law include damages for emotional distress, liquidated damages for violations of the genetic testing statute, and attorney's fees.

Massachusetts law contains limited exceptions to pre-employment medical exam restrictions. An employer may require medical exams or health-related inquiries if the exam is required by law—for example, Department of Transportation physicals for commercial drivers, or certain fitness-for-duty exams mandated by federal statute. Occupational safety-related inquiries (e.g., asking if a candidate can lift 50 pounds when the job requires it) are permissible before offer if job-related; these are not considered "medical examinations."

The genetic information prohibition (M.G.L. c. 149, § 24M) has narrow statutory exceptions: family medical history obtained incidentally during a medical exam is permissible if not solicited, and genetic information obtained in connection with monitoring or testing for workplace hazards (e.g., lead exposure) is allowed if required by law.

Under the ADA, an employer may ask about ability to perform specific job functions before an offer is made (e.g., "Can you stand for 8 hours?"), but cannot ask whether the applicant has a disability or medical condition. The distinction between permissible functional questions and impermissible medical inquiries is critical and fact-dependent.

Small employers (under 15 employees) are not covered by the ADA but remain subject to Massachusetts state law requirements. Union collective bargaining agreements may contain provisions regarding medical exams, though these must still comply with state and federal anti-discrimination law. Medical exams required as part of background checks or security clearance processes (e.g., for government contracts) may have additional regulatory exceptions, though Massachusetts law still applies.

Step 1: Document the violation thoroughly. Keep copies of any medical questionnaires, exam forms, or requests for medical information provided before your conditional job offer. Record dates, times, and names of individuals who requested medical information. Retain any communications (email, letters, phone notes) from the employer mentioning medical exams, health questions, or disability-related inquiries prior to offer. Take screenshots of online application portals if they contained prohibited medical questions. Note whether other applicants for the same position were treated differently.

Step 2: Determine if an internal complaint process exists. Review the employer's employee handbook or hiring materials for a complaint procedure; however, for pre-employment violations, there may be no internal mechanism since you are not yet hired. You may contact the hiring manager or HR in writing (email preferred for documentation) to formally object to the medical exam requirement and request clarification of the business necessity for the exam. Send this via email to create a written record. Do not delay formal agency filing while pursuing internal resolution.

Step 3: File a charge with the appropriate agency. If the employer has 15 or more employees, file a charge with the Equal Employment Opportunity Commission (EEOC) at www.eeoc.gov or visit the Boston Area EEOC office (JFK Federal Building, 15 New Sudbury Street, Boston, MA 02203; phone: 1-617-565-3200). You have 300 days from the violation to file (Massachusetts is a deferral state). Alternatively, or in addition, file a complaint with the Massachusetts Commission Against Discrimination (MCAD) at www.mass.gov/mcad; phone: 1-617-994-6000. MCAD accepts complaints from applicants and can investigate violations of state medical privacy law (M.G.L. c. 149, § 24L and § 24M) regardless of employer size. Provide specific dates, the text of medical questions asked, names of individuals involved, and confirmation of whether you were made a conditional offer prior to the exam requirement.

Step 4: Understand the investigation process. The EEOC will issue a "receipt of charge" and conduct an investigation, typically taking 2-6 months. EEOC will contact the employer for a response and may interview you and witnesses. The agency will determine whether probable cause exists to believe discrimination occurred. If probable cause is found, EEOC will attempt conciliation. If conciliation fails, you may receive a "right to sue" letter, which permits you to file a federal lawsuit in U.S. District Court. MCAD investigations typically take 4-8 months and follow similar procedures; MCAD can issue a determination and, if violations are found, seek remedies on your behalf.

Step 5: Consult an employment law attorney. Contact an employment discrimination attorney licensed in Massachusetts before filing if possible; if not possible, file the charge and consult an attorney immediately after. An attorney can review the facts, assess whether a viable ADA or state law claim exists, advise on negotiation or settlement, and represent you in investigation proceedings or litigation if necessary. Many employment lawyers work on contingency for discrimination cases. Legal aid organizations in Massachusetts can provide referrals if cost is a barrier.