Business of Well-being

Better Safe Than Sorry

Better Safe Than Sorry

The decision on whether to adopt pre-employment medicals should start with discussions on "why do we want to do pre-employment medicals"? And secondly, "to which roles should they apply"? Whilst this discussion might sound more philosophical than commercial, answering these questions will go a long way towards developing the rationale for a business case for adoption.

A decade ago, there was the common notion within an organization that if we don't know about the health of a worker, we cannot be held accountable for it. I think it's safe to say this has now proven not to be the case and that employers are expected to, at a minimum, have involvement in the protection of the health of a worker and ideally to be promoting better health.

As a consequence, with greater involvement comes greater responsibility and accountability. For any organization that is interested in improving the health and wellbeing of its workforce, understanding and managing the health risks that come into the business through the recruitment process is a key step and pre-employment medicals offer a way to achieve this.


Essentially, a pre-employment medical is used during the hiring process to increase the likelihood of hiring candidates who can meet the inherent job requirements at an acceptable level of health risk both to the worker and the organization. With respect to the medical, organizations need to understand and comply with anti-discrimination and privacy legislation, in that physical and indeed mental attributes must relate back to the intended occupation, rather than being simply a blanket approach to all occupations.

Essentially, every organization accepts a certain level of risk when engaging and retaining employees. This risk is counterbalanced by reward for the organization in measurable factors such as improved productivity, leading to financial gain.

By hiring the wrong worker in the wrong occupation, the organization imports significant risk directly into its operation and may stand to lose the productivity balance and expose itself to workers compensation claims, poor absenteeism and a high resource drain on existing personnel (such as those engaged in human resources, training and line management).

This can focus decision making away from productive avenues. On the subject of privacy, the National Privacy Principals (NPP) sets out 10 principles that organizations need to set as the minimum standard when dealing with personal information and, in relation to pre-employment medicals, this is particularly evident in NPP 1, Collecting Information, and NPP 10, Health Information.

As a part of an overall privacy policy, organizations need to implement and maintain an 'authority to release'"Organizations would be much better placed to target their reemployment medicals and their inherent requirements, against the physical attributes for each role within their organization"Process, to ensure that individuals are aware of what information will be collected and stored in relation to their health and their employment within an organization.

From my experience, the 'authority to release' is often overlooked by organizations and it has the ability to not just impact upon the collection and use of personal information in a practical sense (i.e., discussions with a worker around a health condition raised by a doctor), but also presents a significant legal exposure through contravention of the Privacy Act itself.

Pre-employment medicals must relate specifically to the attributes of the role and if they are not, then it is quite likely the Anti-Discrimination Act has been breached and the organization exposed to possible legal action. There are numerous factors that must also be considered, inclusive of age, sex, race and religion.

It is worthwhile quoting the NSW Anti-Discrimination Board: "It is vital that a pre-employment medical test relates exclusively and directly to the particular duties of the job and does not discriminate against people with disabilities."My view is that, for the individual, it should reinforce that the organization they are joining places a value upon their overall safety, ensuring they can carry out nominated duties without an increased risk to their health.

Pre-employment medicals can also raise health Issues, previously unknown or undetected that potentially, if left undiagnosed, can adversely impact upon the individual's health and have far reaching impacts other than simply their ability to work.

Likewise, from an employer's perspective, a reemployment medical can help address some of the cultural barriers around the mistrust of organizations using medical information, such as promotions. Establishing trust must be seen as a key priority and this can be demonstrated through a mature and sound pre-employment medical process.

The benefits

If organizations want to look at the benefits of reemployment medicals from purely a cost perspective in workers transitioning from normal employment into either poor health or compensation claims, the evidence stacks up and is supported statistically in academic (peer reviewed) journals (see box above).

As any rehabilitation provider will tell you, it is quite often the hidden component of a workers compensation claim that is much more difficult to manage. Often there is an underlying health or degenerative condition that gives rise to the compensation claim in the first place and makes both the claim and injury management very difficult.

From a claims management perspective, trying to disentangle the claim component from the health component in, say, a degenerative condition is extremely difficult and will quite often lead to a breakdown in the working relationship with the individual.

For example, telling a worker who was injured during the normal course of their employment that their claim for Compensation has now ceased because the residual loss of functioning and pain is as a result of their degenerative condition and not the work condition, is extremely difficult.

After all, the worker associates the pain, discomfort and, in some cases, the complete loss of being able to return to their job, as having everything to do with the work injury. In many instances, protecting the worker from themselves and not placing them in a position of exposure should have been seriously considered.

Potential downsides

Pre-employment medicals can backfire on an organization if all they are going to do is the screening and nothing else. This is because the results for that medical essentially become the benchmark for the worker and if there is any deterioration over time, which one would almost inevitably expect, there is an instant exposure to a claim for compensation if that deterioration has anything to do with the duties performed.

Using standardized or non-specific assessments paints too broad a picture and this type of approach has significant shortcomings in that it won't necessarily address all of the occupational risks or indeed the inherent requirement placed upon the individual.It is also worth considering the cost to reemployment and indeed what components within the assessments are actually going to be used by an organization.

I have seen a number of organizations that get all manner of radiology, including X-rays, CT scans and even MRIs of applicants and the cost for all of this does need to be considered in terms of what an organization is going to achieve by screening. The purpose of a pre-employment medical can be broken down into two main statements:

  • Identify risks to the individual that will place them in a position whereby a loss will be experienced (be that a workers compensation claim, illness or absenteeism or indeed force the worker to resign and seek employment elsewhere). It is worth remembering the initial cost of employing the individual, including their training and the loss of institutional knowledge.
  • Job matching the individual so that they are afforded the maximum ability and protection to stay at work, gainfully employed, for as long as possible. If we consider some of the key issues in the media at present skills shortage, ageing workforce, productivity and workers compensation claims the aim must be to get the right person in the right role for as long as possible.

Does a 'one size fits all' approach work?

The simple answer to this is no. Organizations need a more mature appreciation around targeting what risks are present and how they impact on each occupation within their organization. Carrying out detailed respiratory and radiography for what is essentially an administration position is largely overkill, both from an intrusive, personal perspective and from a cost Perspective.

Organizations would be much better placed to target their pre-employment medicals and their inherent requirements against the physical attributes for each role within their organization. For example, a highly physically demanding role would certainly require a higher level of physical ability than an administrative role and the medical testing carried out should reflect the aspects of the role that will impact on the individual(s).

The employee life cycle

In conclusion, having a discussion with an organization that is considering the deployment of pre-employment medicals and explaining the benefits to both parties is simple. Then, if employers are truly committed to the need and understand the benefit of pre-employment medicals then this same process can be extended to cover employees as they move between different roles in the same organization.

It is my belief that in adopting this approach, the benefits to the organization and the individual can continue throughout the lifetime of employment.

About the author

Mark Cassidy is the general manager, risk & innovation at 2cRisk. For further information email or visit

Learn about how you can become a Certified Corporate Wellness Specialist→