Four hospital cases addressed the limits on employer requests for employee medical information in the sick leave, disability management and return-to-work context. Read together, the awards confirm that employers must use a conservative, least-intrusive approach and generally cannot demand diagnosis, medication details, or unnecessary functional forms at first instance. They also show that employees still must provide objectively sufficient medical certification where the collective agreement or benefit plan requires it, and that a request for additional information may be upheld where the initial documentation is inadequate, the request is properly limited, and the employee remains in the communications loop.
1. Medical Note Not Enough — Hospital Entitled to APS for Mental Health Absence
Windsor Regional Hospital v. ONA, 2026 CanLII 55628 (ON LA)
George T. Surdykowski, Arbitrator — June 9, 2026
ONA challenged Windsor Regional Hospital’s request for an Attending Physician/Practitioner’s Statement after a nurse provided a specialist’s note supporting a short mental health leave. The arbitrator dismissed the grievance, finding that the note was insufficient for 1992 HOODIP purposes and that the Hospital was entitled to request the APS in the circumstances.
Background
The grievance formed part of a broader series of medical information grievances between the Hospital and ONA. The remaining grievance alleged that the Hospital requested excessive personal health information, rejected sufficient medical information, communicated directly with the grievor’s specialist, and improperly required information from the specialist rather than another provider.
The grievor was a full-time Registered Nurse in the Emergency Department and was covered by the 1992 HOODIP. The grievor called the Hospital’s Health Office to report a two-week mental health absence and provided a specialist’s note indicating that the grievor was not feeling well and should take sick leave.
The Hospital required an APS for the absence. Because of a cyberattack affecting email systems, the Health Office faxed a blank APS directly to the specialist’s office. The Union argued that the original note and the grievor’s statements were sufficient, and that the Hospital failed to keep the grievor properly in the communications loop.
Decision
Arbitrator Surdykowski dismissed the grievance. He found that the specialist’s note was insufficient because it did not provide medical certification adequate to justify the two-week absence or establish sick leave benefit entitlement.
The arbitrator held that the Hospital was not required to piece together the note with the grievor’s own statements, because employee statements are not medical certification. He also found that the APS was specifically required by the collective agreement for absences of more than three consecutive shifts.
The arbitrator was satisfied that the grievor consented to the Hospital faxing the blank APS to the specialist and to the specialist completing and returning it. He also found that the grievor was not kept out of the communications loop in the circumstances.
2. Return-to-Work Too Soon — Windsor Regional Hospital’s Approach Found Overly Aggressive
Windsor Regional Hospital v. ONA, 2026 CanLII 55618 (ON LA)
George T. Surdykowski, Arbitrator — June 6, 2026
Windsor Regional Hospital was found to have taken an overly aggressive approach to a nurse’s return to work after a fractured rib injury. The arbitrator issued multiple declarations, including that the Hospital wrongly rejected medical information and returned the grievor to work in a foreseeably unsafe modified role.
Background
The grievance was anonymized because it concerned confidential personal health information. The grievor was a full-time Registered Nurse on the Renal Chemotherapy/Dialysis Unit and was subject to the 1980 HOODIP sick leave requirements.
The grievor left work on September 27, 2023, and missed the first full shift on September 28. On October 2, the grievor’s physician completed an APS indicating a return-to-work date of November 10 and restrictions that included no lifting patients or pushing 50 pounds or more for six weeks.
ONA argued that the October 2 APS satisfied the first-instance medical documentation requirements and that the Hospital improperly pressured the grievor to return before the physician’s recommended date. The Hospital argued that it properly engaged in a return-to-work dialogue and offered modified work consistent with the available medical evidence.
Decision
The arbitrator found that the October 2 APS satisfied the 1980 HOODIP first-instance requirements. He reiterated that, at first instance, an employer is not entitled to more than certification from a qualified medical professional that the employee is unable to work due to illness or injury for a specified period, the general nature of the condition, confirmation of treatment, and an anticipated return-to-work date.
The arbitrator found that the Hospital’s return-to-work approach was overly aggressive. He concluded that the Hospital failed to properly consider the nature of the injury and the medical assessments, discounted the grievor’s concerns, and returned the grievor to modified work that was foreseeably unsafe.
ONA sought declaratory relief, and the arbitrator remained seized for any remedial issues. He noted that further non-declaratory relief appeared unnecessary unless additional evidence or argument justified it.
3. Medical Information Requests Go Too Far — Windsor Regional Hospital Grievance Allowed in Part
Windsor Regional Hospital v. ONA, 2026 CanLII 55636 (ON LA)
George T. Surdykowski, Arbitrator — May 24, 2026
In a second Windsor Regional Hospital medical-information award, the arbitrator found that Acclaim Ability Management’s clarification questions to a cardiologist and request for medication names and dosages went too far. The grievance was allowed in part, even though the grievor’s absence was ultimately supported and benefits were paid.
Background
The anonymized grievance concerned a full-time Occupational Health Nurse in the Hospital’s Employee Health Office. The grievor’s position was sedentary and was often used for nurses with physical restrictions preventing direct patient care.
The grievor began a medical leave related to surgery on November 21, 2024. As the leave progressed, the medical reasons shifted toward cardiovascular and blood pressure issues, including elevated blood pressure, cardiac symptoms, medication changes, and specialist follow-up.
On January 23, 2025, the cardiologist completed an APS indicating that the grievor remained unable to work due to systemic cardiovascular reasons and anticipated a return to work in 90 days. Acclaim then sent clarification questions to the cardiologist on January 27, 2025, focusing on why the grievor could not return to a sedentary job and why 90 days was required.
ONA argued that the letter to the cardiologist and Acclaim’s subsequent medication request exceeded the Hospital’s entitlement to private medical information. The Hospital argued that the request was reasonable because the case was no longer at first instance and the grievor’s restrictions did not obviously relate to a sedentary position.
Decision
The arbitrator confirmed that the “least amount necessary for the legitimate purpose” test applies to medical information requests. He also confirmed that later-stage absences may justify more information than a first-instance absence, but the conservative, least-intrusive approach still governs.
The arbitrator found that Acclaim’s January 27 clarification request was inappropriate in the circumstances. Acclaim already had sufficient information to assess the relationship between the grievor’s cardiovascular symptoms and the duties of the sedentary position.
Several questions were found unnecessary, repetitive, or framed inappropriately. The arbitrator emphasized that “words matter” when asking treating specialists to clarify medical opinions.
The arbitrator also found that Acclaim’s request for the names and dosages of the grievor’s prescribed medications was inappropriate. Such a request is prohibited even at later stages of an absence unless it arises from return-to-work safety considerations or other reasonable cause.
4. Diagnosis Not Required, But Disability Still Must Be Proven — THP HOODIP Grievance Allowed Only in Part
Trillium Health Partners v. CUPE, Local 5180, 2026 CanLII 62311 (ON LA)
Elaine Newman, Arbitrator — June 24, 2026
A porter claimed HOODIP short-term disability benefits after a disrespectful workplace encounter caused stress and led him to remain off work. The arbitrator found that the Employer erred by requiring a diagnosis at first instance, but ultimately denied the benefit claim because the evidence did not establish total disability or active and continuous medical care.
Background
The grievor had 22 years of seniority and had worked as a porter for approximately five years. He described long-standing workplace unpleasantness and feeling unappreciated.
On January 26, 2026, he had a negative interaction with a nurse during a patient transfer. He filed a respectful workplace complaint, but as of the June 15, 2026 hearing he had not heard the outcome.
The grievor went off work from January 28 to February 26, 2026. His doctor described psychosocial stress from the workplace encounter and recommended a meeting with management and the employee involved.
The Union argued that the Employer improperly required a DSM-V diagnosis and failed to respect the privacy limits applicable to first-instance HOODIP claims. The Employer argued that the evidence did not disclose an illness or injury, a prescribed treatment plan, or functional limitations preventing the grievor from working.
Decision
The arbitrator held that the Employer erred by requiring a diagnosis at first instance. Employers are entitled to information about the general nature of the illness or injury, but not a detailed diagnosis such as adjustment disorder, anxiety disorder, or depression at the early stage of a HOODIP claim.
However, the arbitrator conducted a de novo review of the evidence and found the claim did not meet the HOODIP criteria. The evidence did not establish that the grievor suffered an illness or injury preventing him from performing his regular porter duties. The medical evidence did not identify restrictions or functional limitations affecting his work.
The arbitrator found that the grievor’s desire for a workplace meeting was related to resolution of a human resources conflict, not medical treatment. She also found that he was not under the active and continuous care of a physician for a disability, as required by HOODIP.
The grievance was allowed in part only to declare that the Employer erred in requiring a diagnosis. The claim for benefits and damages was otherwise denied.