Recognition of Medical Examinations as Disability Discrimination Under the ADA: Back Pay Remedies in Nawara v. Cook County

Introduction

John Nawara v. Cook County Municipality (7th Cir. April 1, 2025) clarifies for the first time that a requirement for fitness-for-duty medical examinations and related inquiries under 42 U.S.C. § 12112(d)(4)(A) of the Americans with Disabilities Act (ADA) constitutes “discrimination on the basis of disability” and thus entitles a successful plaintiff to back pay under the ADA’s incorporated Title VII remedial scheme. The case arose from correctional‐officer John Nawara’s refusal to submit medical-information releases during a mandatory fitness-for-duty screening after workplace altercations. Nawara prevailed at trial on his § 12112(d)(4) claim but was denied back pay by the district court. On appeal, the Seventh Circuit reversed, holding that any violation of § 12112(d)(4)—whether or not the employee is actually or perceived as disabled—qualifies as disability discrimination and supports an award of back pay.

Summary of the Judgment

The Seventh Circuit affirmed in part and reversed in part:

Affirmed: The district court’s order restoring Nawara’s seniority under the ADA’s equitable-relief provisions.
Reversed: The dismissal of Nawara’s request for back pay on the ground that § 2000e-5(g)(2)(A) bars back pay unless the adverse action is “on account of” disability. The court held that any § 12112(d)(4) violation is by definition discrimination “on the basis of disability” under § 12112(a), triggering eligibility for back pay under Title VII’s remedial framework (42 U.S.C. § 2000e-5(g)).
Remanded: For further proceedings to determine the proper measure of back pay and related relief.

Analysis

Precedents Cited

Kurtzhals v. County of Dunn, 969 F.3d 725 (7th Cir. 2020): Held that § 12112(d)(4)(A) claims are available to employees regardless of actual or perceived disability.
Franks v. Bowman Transportation Co., 424 U.S. 747 (1976): Approved restoration of employee benefits (seniority) as an equitable remedy under Title VII, and thus under the ADA.
Food Marketing Institute v. Argus Leader Media, 588 U.S. 427 (2019): Emphasized starting statutory interpretation from the plain text.
Bates v. Dura Automotive Systems, Inc., 767 F.3d 566 (6th Cir. 2014): Concluded that the ADA’s ban on “discrimination on the basis of disability” “encompasses medical examinations and disability inquiries involving employees.”

Legal Reasoning

The court’s reasoning proceeded in three main steps:

Statutory Framework: Section 12112(a) broadly prohibits discrimination “on the basis of disability” against qualified employees in all terms and conditions of employment. Section 12112(d)(4)(A) separately forbids non‐job‐related medical examinations or inquiries. Section 12117(a) incorporates Title VII’s enforcement provision (42 U.S.C. § 2000e-5) into the ADA, making Title VII’s remedies available for ADA violations.
Statutory Interpretation: The court held that § 12112(d)(1) (“The prohibition against discrimination ... shall include medical examinations and inquiries”) and § 12112(d)(4)(A) are not mere examples of discrimination but establish that the act of requiring medical examinations or inquiries is itself discrimination “on the basis of disability.” Reading these provisions together avoids surplusage and aligns with the ADA’s remedial purpose.
Remedial Impact: Once a violation of § 12112(d)(4)(A) constitutes disability discrimination under § 12112(a), the plaintiff may obtain back pay under Title VII’s general remedy provision (§ 2000e-5(g)(1)), notwithstanding the § 2000e-5(g)(2)(A) limitation on adverse actions “for any reason other than discrimination on account of” the protected characteristic. In an ADA context, “protected characteristic” is replaced by “disability.”

Impact

This decision has significant effects on ADA‐related litigation and employer practices:

Expanded Remedies: Employees who successfully prove unlawful fitness-for-duty examinations or medical inquiries may now recover back pay, even if they lack a disability or perceived disability.
Employer Compliance: Public and private employers must ensure that any fitness-for-duty or medical‐record inquiries are strictly job-related and consistent with business necessity, or else risk compensatory and equitable relief.
Uniform Application: Clarifies that Title VII’s remedial structure, including restoration of seniority and back pay, fully applies to ADA discrimination claims.
Future Litigation: Anticipate more ADA suits challenging medical inquiries, with plaintiffs seeking back pay in every successful § 12112(d)(4) case.

Complex Concepts Simplified

Fitness-for-Duty Examination: A medical evaluation required by an employer to confirm an employee’s ability to perform job duties safely.
§ 12112(d)(4)(A) Inquiry Prohibition: Employers may not demand medical exams or inquiries into an employee’s disability unless the exam is job-related and a business necessity.
Back Pay: Compensation for earnings lost between the date of the adverse employment action and the date of court relief.
Restoration of Seniority: Reinstatement of an employee’s pre-action rank, which affects promotions, shift assignments, and benefits.
Title VII Incorporation: The ADA borrows Title VII’s enforcement mechanisms, meaning ADA plaintiffs use the same filing procedures and may obtain the same remedies.

Conclusion

Nawara v. Cook County Municipality establishes a landmark precedent: any employer‐imposed medical examination or inquiry that violates ADA § 12112(d)(4)(A) is automatically discrimination “on the basis of disability” under § 12112(a), thus opening the door to back pay and equitable relief. This ruling strengthens the ADA’s protections, clarifies remedial rights, and underscores employers’ obligations to limit medical inquiries to those strictly required by business necessity.