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What Are the Requirements for a Vaccine Medical Exemption?

By Richard Dahl | Last updated on

As COVID-19 vaccine mandates proliferate around the country, so is the pushback against them by those who do not want to get the jab.

While many employees are seeking exemptions on religious grounds, others contend that they have medical reasons to sidestep the mandates.

Federal law requires employers to accommodate employees with qualifying medical conditions that would interfere with vaccinations. But what, exactly, are those qualifying medical conditions when it comes to COVID-19?

According to the Centers for Disease Control and Prevention, the only people who should clearly qualify for an exemption from vaccination are those who have a severe allergic reaction after a first vaccine dose or have a known allergy to a component of the vaccine.

Beyond that, medical experts say there are no known medical conditions that make COVID-19 vaccination unsafe.

That much is clear. But as the pushback against vaccinations continues, so is pressure — much of it politically driven — for expanding employees' ability to claim a medical exemption. This is where things get complicated.

The Republican governors of two states, Alabama and Iowa, recently signed laws giving workers the right to claim medical exemptions simply by filling out a form. An even broader bill passed the Utah Legislature on Nov. 11 and awaits Gov. Spencer Cox's signature. In addition to providing employees the right to get exemptions by simple request for medical and religious reasons, the Utah legislation adds "personal beliefs" as an acceptable reason.

Exactly how these measures square with federal law, however, might be a matter for courts to decide. The Alabama and Iowa laws, at least, appear to provide medical exemptions that are greater than those required by the federal Americans With Disabilities Act.

Under the ADA, employers can require an employee to provide a note from a medical provider detailing the employee's disability or medical condition that prevents them from doing their jobs unless they receive "reasonable accommodations." It also means that the employee needs to show that providing such a reasonable accommodation can occur without creating an "undue hardship" on the business operation.

With COVID-19 vaccinations, this means the employee needs to provide medical evidence for needing an exemption. The Alabama and Iowa laws, however, remove the requirement for medical evidence, placing them directly at odds with the ADA and federal law.

States Seek to Halt Vaccination Mandates

Meanwhile, some states seek to resolve the matter of exemptions by making them a moot point. Texas Gov. Greg Abbott issued an executive order that prohibits all employers in that state from requiring COVID-19 vaccinations, and Tennessee's legislature just passed a measure that seeks to achieve the same result by prohibiting employers from asking employees whether they have been vaccinated. Gov. Bill Lee said he intends to sign it.

Other states with Republican governors or GOP-led legislatures are seeking to settle the matter in a broader way by simply forbidding vaccine mandates everywhere.

The Biden Administration released the Path Out of the Pandemic COVID-19 Action Plan in September, setting a Jan. 4 deadline for employers with 100 or more employees to mandate vaccinations or weekly tests. But a group of plaintiffs, including several Republican governors, filed suit against that measure, and on Nov. 6, the 5th U.S. Circuit Court of Appeals temporarily blocked the Biden plan, creating widespread confusion among employers about what to do now.

Meanwhile, for employees who want medical exemptions to COVID-19 vaccinations, federal law is clear: Their chances of success are remote. But it's also clear that the legal landscape is shifting.

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