Occupational medicine is characterized by conflicts between the employee’s interests and those of the employer. These conflicts arise from the employer’s obligation to pay for workplace injuries and disabilities, and potential regulatory sanctions against employers who have disproportionate numbers of OSHA (Occupational Safety and Health Administration) reportable events. It is to the employer’s benefit to minimize injuries and to attribute them to off the job activities or personal illness. Conversely, in today’s marketplace, many employees have limited or no personal health benefits. This gives the employee an incentive to claim that personal medical problems are workplace related so that they must be paid for by the employer.

State and federal law recognizes that the physician–patient relationship is different in occupational medicine, and that there are situations where physicians make medical evaluations of patients without forming a legal physician–patient relationship. Conversely, the law expects occupational medicine practitioners of all types to be honest with their patients and to respect their autonomy and their right to consent to, and be informed about, their medical care.

This section discusses the basic state and federal laws governing occupational medical practice, special legal problems such as communicable disease control in the workplace, and occupational medical services in general medical care settings. Occupational medicine is a recognized medical specialty, and nonspecialist physicians who are not experts in occupational medicine can incur substantial legal risks. Unlike most other areas of medical practice, providers of occupational medical services must comply with very intrusive federal regulations on access to and retention of medical records, including the right of OSHA and others to enter the practitioner’s office and go through all the occupational medical records.