When a Tennessee employee’s behavior, performance, or condition raises a real question about whether they can safely do their job, a fitness for duty evaluation (FFDE) is often the right next step.
Done correctly, it protects the workplace, supports the employee, and gives the employer or licensing board a legally defensible basis for the decision that follows. This page is written for the people who actually initiate or advise on FFDEs in Tennessee: HR leaders, licensing-board staff and contracted peer assistance programs, and the attorneys advising either side.
Here’s how Athena Care handles these in Tennessee, when an FFDE is the right call under Sixth Circuit law, and what to gather before making the referral. Evaluations are tailored to the circumstances and based on the situational needs. Evaluations can be as intensive as a 3-day process or as simple as a couple of hours and are condition- and profession-specific. Many evaluations can also be done remotely through a telehealth platform.
Who we evaluate
Part of our Comprehensive Assessment Program for Professionals (CAPP), our forensic psychology team conducts FFDEs across Tennessee for the most common referral categories:
- Attorneys
- Judges
- Dentists
- Nurses referred through the Tennessee Board of Nursing, often in coordination with the Tennessee Professional Assistance Program (TnPAP), which serves nursing, EMS, occupational therapy, physical therapy, medical laboratory, and massage licensees [1]
- Physicians, physician assistants, and several allied health professions referred through the Tennessee Medical Foundation (TMF) Physician’s Health Program, which handles identification, evaluation coordination, and re-entry monitoring [2]
- Public safety personnel, including peace officers (in connection with POST Commission requirements under T.C.A. § 38-8-106), firefighters, and EMS personnel
- Commercial drivers with psychological concerns identified during DOT physicals under FMCSA’s medical fitness-for-duty framework
- Corporate and government employees following a serious workplace incident, post-leave return, or significant change in functioning
If your category isn’t listed here, we likely still evaluate for it. The referral starts with a conversation.
When an FFDE is appropriate in Tennessee
For employer-initiated FFDEs, the governing law is the federal Americans with Disabilities Act, and in Tennessee, the binding interpretation comes from the Sixth Circuit Court of Appeals. Under Sullivan v. River Valley School District and Kroll v. White Lake Ambulance Authority, an employer may compel a psychological exam only when there is “significant evidence that could cause a reasonable person to inquire as to whether an employee is still capable of performing his job” [3]. The standard is objective, not subjective: an employer’s honest belief, without supporting evidence, is not enough.
In practice, the Kroll framework recognizes business necessity when one of three conditions is met: the employee has requested an accommodation, the employee’s ability to perform essential functions is impaired, or the employee poses a direct threat to themselves or others [3].
One Tennessee-specific nuance worth flagging for HR and counsel: the Tennessee Disability Act (T.C.A. § 8-50-103) prohibits disability discrimination but, unlike the ADA, does not require reasonable accommodation. The Tennessee Court of Appeals confirmed this in Bennett v. Nissan North America in 2009. For accommodation duties, the ADA is the operative law.
For board-initiated referrals, the framework is different. Tennessee’s peer assistance programs (TnPAP, TMF, TPRN) operate under T.C.A. § 63-1-136 as alternatives to discipline, with statutorily privileged and confidential records [4]. We frequently work in coordination with these programs and follow their evaluator-of-record requirements.
What our FFDE includes
A defensible FFDE follows the structure outlined in the IACP Psychological Fitness-for-Duty Evaluation Guidelines and the broader forensic psychology standard. Ours includes:
- Clinical interview and mental status examination, typically several hours, often across one or two sessions
- Psychological testing with standardized, validated instruments selected based on the referral question, often including symptom validity measures
- Evaluation from a psychiatrist for medical perspectives, blood, genetic, and toxicology evaluations, all reviewed in a collaborative team prior to issuing a final report with recommendations specific to the individual’s job duties and licensing requirements.
- Collateral records review of the job description, performance documentation, incident reports, and relevant medical or treatment records
- Collateral interviews when appropriate, with proper informed consent
- A written report and recommendations narrowly tailored to the essential functions of the role
Turnaround, fees, and virtual options
Turnaround. We typically schedule within about a week of referral and deliver a written report within 7 to 14 business days of completing the assessment. Cases involving extensive records review or collateral interviews may take longer. Urgent matters can sometimes be expedited; ask when you call.
Fees. Tennessee FFDE fees vary substantially with complexity. Simpler screening-type evaluations may start in the range of $850. Forensic-grade FFDEs with extensive testing and collateral review commonly run $1,750 and higher. Hourly forensic rates of $250 to $500 are typical when complex case work is involved. The employer pays for an employer-required FFDE; insurance rarely covers FFDEs.
Virtual availability. Tennessee is a PSYPACT member state, which allows clinical interview components to be conducted via secure video. Standardized psychological testing is generally required in person to preserve test standardization and security. A hybrid model, virtual interview plus in-person testing, is the realistic norm for most cases.
What to send when making a referral
A complete referral package speeds the process and produces a better report. Please provide:
- A written referral letter stating the specific referral question(s) you want answered
- The current job description with essential functions
- Recent performance documentation and reviews
- Specific incident reports and objective behavioral observations, with dates and witnesses
- Attendance records where relevant
- Any prior accommodation requests and the interactive-process record
- Prior medical leave or FMLA documentation when applicable
- Relevant employer policies the employee may have violated
- Written notice to the employee that they have been referred for an FFDE, with the appointment time and basis
- Signed authorizations and releases so we can speak with treating providers if needed
For board referrals or peer assistance program coordinations, please include the relevant board correspondence and any prior evaluation reports.
Frequently asked questions
What’s the controlling legal standard for an employer-required FFDE in Tennessee? For employers in the Sixth Circuit, including all of Tennessee, the controlling standard comes from Sullivan v. River Valley School District and Kroll v. White Lake Ambulance Authority: there must be significant, objective evidence that a reasonable person would question whether the employee can still perform essential job functions, and the exam must be job-related and consistent with business necessity under the ADA.
Does Tennessee state law add anything beyond the ADA? The Tennessee Disability Act (T.C.A. § 8-50-103) prohibits disability discrimination by employers with 8 or more employees, but it does not impose a separate reasonable-accommodation requirement (per Bennett v. Nissan, 2009). The ADA remains the operative federal standard for accommodation.
How does an FFDE differ from a peer assistance program intake? TnPAP, the TMF Physician’s Health Program, and TPRN are alternative-to-discipline programs that coordinate evaluation, treatment, and monitoring under T.C.A. § 63-1-136. An FFDE is a specific psychological evaluation that answers the question of whether someone can safely perform their job. The two often work together: a peer assistance program may refer to an FFDE, and an FFDE may recommend referral to a peer assistance program.
Is the FFDE virtual or in person? Hybrid is the norm. The clinical interview can typically be conducted via secure video under PSYPACT, while standardized psychological testing is generally done in person to preserve test security and validity.
Can the employer require the employee to attend? Generally yes, when the referral meets the ADA’s job-related-and-business-necessity standard and the Sixth Circuit’s significant-evidence requirement. Refusal may have employment consequences, which is why a clear written referral notice is part of the process.
What does the employer receive? A written report tying the findings to the essential functions of the job, with recommendations (fit for duty, fit with accommodations, temporarily unfit with a recommended path, or not fit for this specific role). Underlying clinical details and unrelated health information are not shared with the employer, consistent with confidentiality protections.
Can we set up an ongoing referral arrangement? Yes. For employers and licensing boards with regular volume, we can establish a direct referral pathway and standardized intake. Call to discuss arrangements.
How to refer
For employers and counsel, the fastest path is a call to CAPP coordinator at 615-502-0911 or email [email protected]. Our coordinator will connect you with our forensic team, walk you through the referral process, and help you assemble the right documentation. For ongoing referral arrangements (multi-employee or licensing-board volume), we can set up a direct referral pathway.
You can also learn more about our fitness for duty psychological evaluation services and the broader testing and assessment services we offer Tennessee employers and boards.
We handle FFDEs across Tennessee from our Nashville, Franklin, Murfreesboro, Hendersonville, Clarksville, Memphis, and Knoxville locations.
Contact us today
Dr. Ihrig, Ph.D., HSP
Psychologist and Professional Counselor
Dr. Ihrig is a generalist with experience working with persons of all ages. While still seeing a broad range of therapy clients, Dr. Ihrig spends the majority of his time doing diagnostic work, specializing in the assessment of conditions such as Asperger’s/Autism, ADHD, Pre-surgery Evals, Forensic Evals, and Neuro-Psychological Assessments. Dr. Ihrig is a former Adjunct Professor at TSU and Vanderbilt University. He is highly active in the community serving on the boards of the Nashville Area Psychological Association, the Tennessee Psychological Association, and the Sexual Assault Center. He works with people age 2 and up.
Meg Stein, CFP
Editor
Meg is a certified mindfulness instructor and works at Alive and Aware Practice in Durham, NC. She has over ten years of experience as a content creator and marketing consultant, working in mental healthcare and social justice.
Sources:
[1] U.S. Department of Justice, “Founder/CEO and Clinical President of Digital Health Company Convicted in $100M Adderall Distribution and Health Care Fraud Scheme” (Nov. 19, 2025). https://www.justice.gov/opa/pr/founderceo-and-clinical-president-digital-health-company-convicted-100m-adderall
[2] Kooij JJS, et al. “Updated European Consensus Statement on diagnosis and treatment of adult ADHD.” European Psychiatry, 2019. https://www.sciencedirect.com/science/article/pii/S0924933818301962
[3] Becker’s Payer Issues, “The largest commercial insurer in every state | 2024” (citing AMA market share data). https://www.beckerspayer.com/payer/the-largest-commercial-insurer-in-every-state-2024/
[4] Centers for Disease Control and Prevention, MMWR, “Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults,” Oct. 10, 2024 (Vol. 73 No. 40). https://www.cdc.gov/mmwr/volumes/73/wr/mm7340a1.htm