Doctors’ certificates: Real or fake?

Doctors’ certificates—forms, notes, or letters prepared by a physician describing a patient’s health status—are routinely required to support an individual’s eligibility to receive sick leave or disability benefits, or workplace or learning accommodations and exemptions. Unfortunately, some certificates may not be what they appear: they could be fake or otherwise falsified and used for fraudulent purposes.

It’s not uncommon for employers, insurance companies, educators, or other parties to contact the physician named in a doctor’s certificate to verify its authenticity or to confirm the facts. When you receive such a query, your approach to responding will depend on a number of factors, including who is the requesting party and the purpose of the request.

If in doubt about whether and how to respond, contact the CMPA for individual advice.

You can start by reviewing the document and, if necessary, checking the contents against the patient’s medical record.

If the document is legitimate:

• Confirm to the requester that the document is authentic.
• Limit your response to confirming the document’s legitimacy (i.e. avoid offering further information which may inadvertently lead to breaching patient confidentiality).
• If you are asked for more information than is included in the certificate, reply to the requester that you cannot provide further information without the patient’s consent or other legal authority.

If the individual named in the document is your patient but you did not produce the document, or you did produce the document and its content has been altered without your authorization:

• You are generally not obligated to provide information to a requesting party in the absence of the patient’s consent or other legal authority. Important exceptions to this general principle may apply.¹ In all circumstances, consider your duty of confidentiality to the patient.
• In some cases, it may be appropriate to simply redirect the requester to the patient (to resolve the issue among themselves), or to ask that the requester obtain consent from the patient to speak with you about the certificate.
• You may choose to deny the request to confirm the authenticity of a document if there is no requirement to do so. In making this determination, consider the identity of the requester, purpose of the request, and the nature of any alteration to the document.
• If you choose to respond to the requester, limit your response to confirming or denying the authenticity of the certificate, and do not volunteer other personal health information about the patient that is outside the scope of the query.
• Regardless of whether you respond to the request, consider following up with the patient. The nature of the follow-up will depend on the circumstances and the existing doctor-patient relationship.
• If the forged or altered certificate appears to point to an unresolved health issue (e.g. mobility difficulty arising from an injury), discuss with the patient their motivation for falsifying the document and consider offering them additional treatment options, or preparing a legitimate certificate, or both.
• If you have reasonable grounds or just cause (such as the document forgery or other inappropriate behaviour), you may choose to end the therapeutic relationship, as described in the CMPA article “Ending the doctor-patient relationship.”

If the individual named in the document is not your patient and you did not produce the document:

• Reply to the requester that this is not your patient and that you did not produce the document.

Additional reading

• Who has custody of medical records, and who can they be shared with?
• Treating physician reports, IME reports, and expert opinions: The way forward
• Fitness to participate: Reduce your risk when patients ask for a certificate of fitness

Note

1. 1. 
   In certain provinces (e.g. Prince Edward Island, Newfoundland and Labrador), as an information custodian you must disclose information if it is requested by an entity, such as a law enforcement agency, conducting an investigation into possible unlawful activity.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.