Pre-Employment Medical Exam Laws in Missouri

The Americans with Disabilities Act (ADA), 42 U.S.C. § 12101 et seq., prohibits covered employers from requiring medical exams or disability-related inquiries before making a conditional job offer. This applies to all employers with 15 or more employees. Section 12112(d) specifically states that employers cannot conduct medical exams or make disability-related inquiries of applicants, even if the role is safety-sensitive or physically demanding.

Once a conditional job offer is extended, employers may require medical exams if they are required of all applicants for that job category. The EEOC enforces the ADA through 29 C.F.R. § 1630.14, which clarifies that "medical examination" includes any examination or inquiry designed to reveal physical or mental impairments or health status.

Federal law requires employers to keep medical information confidential and stored separately from personnel files. Employers can make employment decisions based on the results, but only if the decision is job-related and consistent with business necessity. Refusing a pre-offer exam cannot alone be the reason for non-selection. The federal remedies include damages for lost wages, emotional distress, punitive damages, and attorney fees under 42 U.S.C. § 1981a.

Missouri has not enacted a separate pre-employment medical exam law. The state relies entirely on federal ADA standards as enforced through Missouri's Human Rights Act, Missouri Revised Statutes § 213.010, which incorporates federal employment discrimination protections. Missouri employers are bound by the same federal prohibition: no medical exams or disability-related inquiries before a conditional job offer is made.

Under Missouri law, employers with one or more employees are covered (broader than the federal ADA's 15-employee threshold). However, the substantive protections for pre-employment exams are identical to federal law—the state has not strengthened or weakened the federal baseline. Missouri courts consistently apply ADA standards to pre-employment situations and do not recognize any state-specific exception allowing pre-offer medical screening.

Missouri's Human Rights Act § 213.010 prohibits employers from "inquiring about" or "requiring" a medical examination as a condition of hire. This language parallels the ADA but applies to a larger class of employers. Medical information obtained in violation of this rule must be kept confidential. Employers cannot retaliate against applicants who refuse pre-offer exams.

Remedies under Missouri law include compensatory damages, exemplary (punitive) damages up to $5,000 for each violation if willful, and attorney fees. The Missouri Commission on Human Rights (MOCHR) investigates complaints. Missouri has not created any state-specific carve-out for safety-sensitive positions, medical conditions, or job classifications—federal standards control.

Pre-employment medical exams are permitted post-offer if applied uniformly to all applicants for the same job category. The ADA recognizes a narrow exception: after a conditional offer, employers may condition the offer on the results of a medical exam, provided all similarly situated applicants are subjected to the same exam, and the results are kept confidential.

Employers in certain industries (federal contractors, transportation, law enforcement under specific federal statutes) may have different rules under specialized statutes such as the Department of Transportation regulations or the Federal Motor Carrier Safety Administration rules, but these do not override the ADA's pre-offer prohibition in Missouri.

Another exception exists for safety-sensitive positions under 29 C.F.R. § 1630.14(c): an employer may conduct medical exams of applicants in safety-sensitive positions following a conditional offer if the exams are required of all applicants for that position, are job-related and consistent with business necessity, and results are kept confidential. However, this does not permit pre-offer exams; it only clarifies the post-offer scope.

The ADA also does not protect applicants who cannot perform the essential functions of the job even with reasonable accommodation. However, this determination cannot be based on a pre-offer medical exam; it must be made post-offer based on an actual exam and evaluation. Additionally, if an applicant voluntarily discloses a disability before an offer (e.g., in a cover letter), the employer's failure to make an offer cannot be solely attributed to that disclosure—any non-selection must be job-related and consistently applied. Good-faith business judgment in hiring decisions is not an exception; the prohibition is absolute for pre-offer exams.

**Step 1: Document the Violation.** Write down the date, time, location, and exact language used when the employer asked you to undergo a medical exam or made disability-related inquiries (e.g., "Do you have any health conditions?" or "You must pass a medical examination to be hired"). Keep copies of all written communications: emails, letters, job postings, application forms, or handwritten notes. Screenshot web-based application systems that ask medical questions before an offer. Record the names and titles of individuals who made the request. Note whether this exam was required before or after a job offer in writing was given. Save the date you were not hired or offered employment.

**Step 2: Internal Complaint (Optional but Recommended).** Contact the employer's Human Resources department in writing (email or certified letter, keeping a copy). State: "I was asked to undergo a medical examination [date] before receiving a written job offer. This violates the ADA. I am requesting that this practice cease and that I be reconsidered for the position." Do not threaten legal action yet. Request a written response within 5 business days. This creates a record and may prompt internal review. However, if HR is the source of the violation, consult an attorney before proceeding internally.

**Step 3: File a Charge of Discrimination.** You have 180 days from the date of the violation to file. Contact the EEOC (federal) or the Missouri Commission on Human Rights (state). Missouri is a "work-sharing" state, meaning the EEOC and MOCHR jointly handle filings. You may file with either; they coordinate. **For the EEOC:** Go to www.eeoc.gov/employees, select "File a Charge," or contact the St. Louis District Office at (314) 539-7800. **For MOCHR:** Go to https://www.labor.mo.gov/DER/Discrimination or call (573) 751-3325. You will need: employer name and address, date of violation, description of what happened, the names of witnesses if any, and your contact information. There is no filing fee. You do not need an attorney to file.

**Step 4: Investigation Process.** The EEOC or MOCHR will notify the employer of your complaint within 10 days. The agency assigns an investigator who will request documents from the employer: hiring records, job descriptions, personnel files, any medical exam policies, and communications with you. The investigator will interview you (in person or by phone, typically within 30–60 days) and may interview the employer and witnesses. The investigator will determine whether probable cause exists that a violation occurred. This phase typically takes 60–120 days. You will receive a written investigative report. If probable cause is found, the agency issues a "Right to Sue" letter, allowing you to file a private lawsuit in federal court. If no probable cause is found, you can still request a Right to Sue letter and pursue litigation.

**Step 5: Consult an Attorney.** Consult an employment law attorney after filing a charge or immediately if the employer retaliates (e.g., withdraws an offer, refuses to consider you for other roles, or blacklists you). Most employment attorneys work on contingency (no upfront cost; they take a percentage of any settlement or judgment). Request a free consultation. Ask the attorney whether your case qualifies for a demand letter before litigation (often faster). If the EEOC/MOCHR investigation concludes with no probable cause, an attorney can advise whether pursuing a private lawsuit is viable (the burden is higher, but damages may be larger).