Pre-Employment Medical Exam Laws in Texas

The Americans with Disabilities Act (ADA), 42 U.S.C. § 12112(d), strictly regulates when employers can require medical examinations and make disability-related inquiries. Federal law prohibits medical exams or disability questions during the application and interview process, before a conditional job offer is made. Only after extending a conditional written offer can an employer require a medical exam, provided all applicants for the same job position receive identical exams. The exam must be job-related and consistent with business necessity. Medical records must be kept in confidential medical files separate from personnel records and disclosed only to designated persons on a need-to-know basis.

The EEOC, which enforces the ADA nationally, provides detailed guidance distinguishing prohibited inquiries from permitted ones. Employers cannot ask about an applicant's medical history, current medications, prior treatment, disabilities, or family medical history before a conditional offer. Post-offer, if all applicants for the same position take the same exam, an employer may refuse to hire based on results if the refusal is job-related and consistent with business necessity, or if the person cannot perform essential job functions even with reasonable accommodation. Federal law covers employers with 15 or more employees.

Texas does not have a separate state law that strengthens the ADA's restrictions on pre-employment medical exams; the state follows federal ADA standards. The ADA applies to all Texas employers with 15 or more employees, and Texas courts have not imposed additional requirements beyond federal law. However, Texas employers must comply fully with the ADA as applied to the state's workforce.

Under the ADA, which governs in Texas, the timing of medical exams is strictly regulated: exams are prohibited before a conditional job offer and strongly restricted during interviews. After a conditional offer is extended in writing, employers may require medical exams, but only if they require identical exams for all applicants for the same job category. The exam cannot be used to screen out applicants with disabilities unless the employer can show the exam results are job-related and consistent with business necessity, or that the applicant cannot perform essential job functions even with accommodation.

Texas employers must treat medical information as confidential, storing it separately from general personnel records and limiting access to those with legitimate business need. Violations can result in ADA lawsuits in federal court, with remedies including back pay, front pay, compensatory damages for emotional distress, and punitive damages if the violation was intentional. The EEOC can investigate charges filed by employees, issue right-to-sue letters, and bring enforcement actions on behalf of the employee.

Medical exams are permissible in limited circumstances: (1) after a conditional job offer has been extended in writing to the applicant; (2) when all applicants for the same job category receive identical exams; (3) when the exam is job-related and consistent with business necessity; and (4) when the employer follows-up on medical information that was voluntarily disclosed by the applicant during or after the application process. Employers may also require exams if required by law, such as Department of Transportation medical certificates for drivers or health screenings required by state licensing boards.

An employer may withdraw a job offer based on medical exam results if the applicant cannot perform essential job functions even with reasonable accommodation, or if the refusal is job-related and consistent with business necessity. Employers are not required to hire someone who is a direct threat to workplace safety, though this exception is narrowly defined and must be based on objective medical or safety evidence, not stereotype or assumption.

Medical exams triggered by a specific workplace incident or exposure—such as after an employee is exposed to hazardous materials or after a workplace injury—may be required of all employees in the affected area, not just applicants. However, the employer must still treat the information confidentially and may use results only for legitimate business purposes. Applicants with disabilities may refuse an exam or fail one, and if so, the employer may withdraw the offer, but only if the withdrawal is truly based on the medical findings and not as pretext for discrimination.

Step 1 — Document everything: Keep a detailed record of when the employer asked disability-related questions or required an exam before extending a written job offer. Save all communications—emails, text messages, phone notes, job postings, and interview materials. Document the exact date and content of any medical inquiries, when you disclosed any disability, and whether the employer made a conditional written offer before requiring the exam. Write down names of witnesses, including interviewers, HR staff, and other applicants present.

Step 2 — Understand internal complaint options: Before filing an external charge, consider whether the employer has an internal complaint procedure. Request a copy of the employee handbook or internal complaint policy. File a formal written complaint with HR or the designated complaint officer, stating the facts, dates, and how the pre-employment medical requirement violated the ADA. Keep a copy of your complaint and any response. An internal complaint does not waive your right to file with the EEOC and may help establish a paper trail of the employer's knowledge and response.

Step 3 — File with the EEOC: Contact the U.S. Equal Employment Opportunity Commission's Houston District Office, the nearest EEOC office, or file online at www.eeoc.gov/charges. You must file within 180 days of the violation (the date the employer required the exam or asked the disability question). Include your name, address, phone, employer's name and address, the date of the violation, a detailed description of what happened, and how you were harmed. State that the violation was based on disability or perceived disability. You do not need an attorney to file; the EEOC does not charge a fee.

Step 4 — EEOC investigation and process: The EEOC will send a notice to the employer and begin an investigation, typically within 30–60 days. The employer will respond to your charge. The EEOC may request documents, conduct interviews, and may attempt mediation. The investigation usually takes 180–365 days. You will receive updates on progress. If the EEOC finds reasonable cause that discrimination occurred, it will attempt conciliation. If conciliation fails, the EEOC may file a lawsuit on your behalf or issue a right-to-sue letter, which allows you to file a private lawsuit in federal court within 90 days.

Step 5 — Consult an employment attorney: Contact a disability rights attorney or an employment law attorney licensed in Texas who has ADA experience as soon as possible, ideally before filing with the EEOC or within 30 days of the violation. An attorney can evaluate whether you have a strong case, advise on remedies, and represent you before the EEOC and in court. Many employment attorneys work on contingency—you pay only if you win or settle. Remedies can include back pay, compensatory damages for emotional distress, punitive damages, and attorney's fees.