Reasonable Adjustments at Work for a Chronic Illness
How to ask your employer for reasonable adjustments in the UK or reasonable accommodation in the US after telling them about a chronic illness.
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A chronic illness can make parts of your job harder, and a small change can remove the biggest obstacle. In the UK that change is called a reasonable adjustment, and in the US a reasonable accommodation. To get one, tell your employer what is hard and which change would help. In the UK the duty starts when your employer knows, or could reasonably be expected to know, that you are disabled. In the US it generally starts when you ask. In the symptom diary in Sam you can log symptom days and sick days with a date. The record you bring then shows the disadvantage in numbers instead of a feeling.
This text is general information, not legal advice. Only a lawyer or adviser who knows your case can say what applies to you. In the UK that means ACAS, Citizens Advice, the Equality Advisory Support Service or an employment lawyer. In the US it means the Job Accommodation Network (JAN), the EEOC or an employment lawyer.
What are reasonable adjustments and accommodation?
In Great Britain, the Equality Act 2010 protects you against disability discrimination (Northern Ireland has separate law). Its section 20 sets a duty to make reasonable adjustments. Reasonable adjustments are changes that remove or reduce a disadvantage linked to your disability.
ACAS lists the examples. They include finding a different way to do something, changing the workplace, changing working arrangements, and providing equipment or support. An adjustment is specific to you and your job.
In the US, the ADA uses the term reasonable accommodation. It covers employers with 15 or more employees, and some state laws reach smaller ones. The EEOC describes it as any change or adjustment to a job or work environment that lets a qualified person with a disability do the job or enjoy equal benefits of work. Examples include job restructuring, modified schedules, equipment and reassignment to a vacant position.
When does the duty apply to your employer?
In both countries, the trigger is knowledge. ACAS says employers must make reasonable adjustments when they know, or could reasonably be expected to know, that you are disabled and that you are disadvantaged because of it.
In the US, the EEOC says employers provide accommodation for limitations of which they are aware, and it is usually the employee who tells them. You can request accommodation at any time, even if you did not disclose a disability when you were hired.
So the change usually starts with a conversation. If you are unsure whether or what to tell your employer, the guide on telling your employer is the natural next read.
How do you ask?
There is no required form. In the UK, Acas says you can ask in writing, in a meeting with your manager, or through a formal process if your employer has one. Citizens Advice suggests an informal letter first, explaining your condition, how long the effect lasts, what causes you a problem at work, and the changes you think would help.
In the US, the EEOC says you can use plain English and do not have to say "reasonable accommodation" or mention the ADA. You just need to make clear that you need a change at work related to a medical condition. A simple request like "I'm having trouble getting to work at my scheduled starting time because of medical treatments I'm undergoing" counts.
JAN offers a sample accommodation request letter if you want a written form.
Does your employer have to pay?
Usually yes. ACAS and Citizens Advice both say the employer is responsible for the cost of reasonable adjustments in the UK. Many are simple and affordable, such as a screen filter or a quiet corner.
In the US, the ADA requires the employer to provide the accommodation unless it would be an undue hardship. The employer cannot lower your pay to cover it. If only part of the cost would be an undue hardship, the employer may ask whether you will pay the difference.
What if the adjustment seems too costly?
Reasonableness is judged case by case. In the UK, what is reasonable depends on the situation, including how far the change removes the disadvantage and the size and resources of the employer. A small employer may not have to do as much as a large one, but it should still try a reasonable alternative.
In the US, the limit is undue hardship, meaning significant difficulty or expense for that specific employer. Cost alone does not end the matter. The employer should weigh the options and can often use outside funding.
Where should you start? A doctor visit checklist can help you gather what you need to explain the disadvantage clearly.
Who helps with funding in the UK?
Access to Work is a government scheme in England, Scotland and Wales (Northern Ireland has a separate one) that supports people with a disability or health condition to get or stay in work. GOV.UK says it can fund practical support such as specialist equipment, support workers and physical changes to your workplace, and your workplace can include your home.
Access to Work is not a substitute for reasonable adjustments, and your employer is still responsible for those. The two work together. GOV.UK notes you can apply for it alongside most benefits, and you do not need a diagnosis to apply.
What is the interactive process in the US?
Under the ADA, a request for accommodation starts an informal exchange. The EEOC says you and your employer should talk through what you need and identify what would work.
Your employer may ask for reasonable documentation when the disability is not obvious. It cannot demand your whole medical record, only what is needed to confirm a disability and the need for accommodation. Your employer cannot force an accommodation on you, but refusing one you need to do the essential parts of the job can affect whether you remain qualified for it.
If you need leave or a modified schedule because of migraine or epilepsy, the explainer on FMLA intermittent leave covers the documentation that requests often need.
How do you prepare the request?
Before you ask, be clear on the disadvantage and on what would help. Your employer needs to understand the link between your condition and the difficulty, and then the change you propose.
Part of that is your own record. In Sam you can log sick days and symptoms in the symptom diary, so you can point to the dates that show the pattern instead of describing it from memory.
Bring a dated record to the adjustments request
A record with dates makes the request concrete, and it helps your doctor and your employer see the same picture.
- Instead of memory: in the symptom diary every symptom day and sick day carries a date, so you can show the last twelve months and not "quite often".
- Instead of loose notes: if a diary program runs for your condition in Sam, the doctor report as a PDF sums up the period you choose, which makes a useful support for a note from your doctor.
- Instead of screenshots: for migraine and epilepsy, new entries made today bring in last night's sleep and heart rate variability from Apple Health when a value exists.
Sam decides nothing about your request. What you show, and to whom, remains your choice.
Try Sam HealthSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
General information, not legal advice. Laws, deadlines and agency practice change, and your case may differ. Before applications, deadlines and conversations with employers, insurers or agencies, get advice from an adviser or lawyer.
Related reading
- Must you tell your employer about a chronic illness?
- Doctor visit checklist for a chronic condition
- FMLA intermittent leave and documentation for migraine and epilepsy
- Exam Accommodations for a Chronic Illness: UK and US
- Vocational Rehabilitation for a Chronic Illness: UK and US
Sources
Updated: October 2026
- ACAS: Reasonable adjustments at work (last updated 30 January 2025)
- GOV.UK: Reasonable adjustments for workers with disabilities or health conditions
- GOV.UK: Access to Work: get support if you have a disability or health condition
- Citizens Advice: Asking your employer for changes to help you if you're disabled
- EEOC: Enforcement guidance on reasonable accommodation and undue hardship under the ADA
- JAN: Disability disclosure and the ADA
- GOV.UK: Access to Work eligibility
- ACAS: Asking for reasonable adjustments (last updated 30 January 2025)
- EEOC: Disability discrimination and employment decisions
More on recording and taking it along
Frequently Asked Questions
What are reasonable adjustments?+
In Great Britain, under section 20 of the Equality Act 2010, they are changes that remove or reduce a disadvantage linked to your disability. This can mean changing how a task is done, changing the workplace, changing working arrangements, or providing equipment or support. In the US, the ADA calls the same idea reasonable accommodation.
When must my employer make them?+
In the UK, only when your employer knows, or could reasonably be expected to know, that you are disabled and disadvantaged because of it. That is why disclosure matters. In the US, the duty to accommodate generally starts when you ask and your employer becomes aware. If your employer never knows, it has nothing to act on.
Does my employer have to pay for adjustments?+
Usually yes. ACAS and Citizens Advice both say the employer is responsible for the cost of reasonable adjustments in the UK, and in the US the ADA requires the employer to provide the accommodation unless it would be an undue hardship. Many adjustments are simple and affordable.
What if my employer says the cost is too high?+
Reasonableness depends on the situation, including the effect of the change and the size of the employer. In the UK, an employer can refuse a change that is genuinely unreasonable, but it should still look for another way to help. In the US, the standard is undue hardship, which means significant difficulty or expense for that employer.
What is the interactive process in the US?+
Under the ADA, once you request accommodation, you and your employer talk through what you need and what would work. Your employer may ask for reasonable documentation if the disability is not obvious, but you do not have to hand over your whole medical record. The employer must consider effective options, not simply deny the request.
Can I get help to pay for support?+
In England, Scotland and Wales, Access to Work is a government scheme that can fund practical support to help you get or stay in work. It does not replace the employer's legal duty to make reasonable adjustments. In the US, state vocational rehabilitation programs and the Job Accommodation Network (JAN) can advise on options.