Once an employer determines that an accommodation is reasonable, it is required to provide it, unless the employer can demonstrate that the requested accommodation would impose an undue hardship on the operation of the business. If the requested accommodation would impose an undue hardship, the employer is not required to provide the accommodation. An undue hardship is an action that requires "significant difficulty or expense" in relation to the size of the employer, the resources available, and the nature of the operation. Determination as to whether a particular accommodation poses an undue hardship must be made on a case-by-case basis.

Customer or co-worker attitudes are not relevant factors in determining an undue hardship. The potential loss of customers or co-workers because an employee has a medical condition does not constitute an undue hardship.

An employer is not required to provide an employee's first choice of accommodation. The employer is, however, required to provide an effective accommodation, i.e., an accommodation that meets the individual's needs and will allow him or her to perform the essential functions of the job or enjoy the full benefits of employment.

An employer is only required to accommodate a "known" disability of a qualified applicant or employee. Thus, in most circumstances, it is the responsibility of the employee to request the reasonable accommodation. If the employee does not want to disclose that he or she has HIV or AIDS, it may be sufficient for the employee to say that he or she has an illness or disability covered by the ADA, that the illness or disability causes certain problems with work, and that the employee wants a reasonable accommodation. However, an employer can require medical documentation of the employee's disability and the limitations resulting from that disability so disclosure may be necessary at some point during the interactive reasonable accommodation process.

Family and Medical Leave Act FMLA

It is important to remember there is a Federal FMLA and depending on where you live there may also be a state version of FMLA.   In cases where there are both Federal and State, both may be used based on the laws of that state. Here we will discuss the federal law in greater detail.
The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:

• Twelve workweeks of leave in a 12-month period for:

  • the birth of a child and to care for the newborn child within one year of birth;
  • the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
  • to care for the employee's spouse, child, or parent who has a serious health condition;
  • a serious health condition that makes the employee unable to perform the essential functions of his or her job;
  • any qualifying exigency arising out of the fact that the employee's spouse, son, daughter, or parent is a covered military member on "covered active duty;"

or

• Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember's spouse, son, daughter, parent, or next of kin (military caregiver leave).

Patients with HCM could qualify under "a serious health condition", however it is wise to think of the ADA first and attempt reasonable accomidations if the work is becoming difficult.    There is no compensation for FMLA times by federal or state laws, therefore in some states short term disablity can be collected or application for long term social securtiy disablity can be applied for if it likely you will NOT return to work.  However the majority of those with HCM can work productively and many use FMLA for the purpose of having surgical myectomy, ICD implantation, to adjust to new medications  and in some case heart transplantion.

Alternate pathways

Employment often times turns into how we see or define ourselves.   It is not however "who we are" it is in fact "what we do".  For some with HCM it may be an oppurtunity to explore new options and career paths.  In some cases funding for retraining or education may be available and it is advised you contact your employer, state unemployment/disabilty office or the social security administations to learn about what programs are currently available.