# Residency accommodations approved but not provided: what to check Practical Guidance · Published 2026-07-21 · Resident Help **Short answer:** An approval letter is not an accommodation until something changes in practice. Check that the determination lists each accommodation, who is responsible, and when it starts, and that it reached your program. If any approved accommodation is not in place, send a short factual email the same day asking when each one will start, and keep a dated timeline of request, approval, first day in place, and any adverse action. You have an approval letter. Your schedule has not changed. If you have a disability, your sponsoring institution must have an accommodation policy, and as your employer it generally must work through an interactive process with you once you ask. Many residents do the hard part. They ask, they provide documentation, and they receive an approval letter. Then nothing on the schedule changes. Send us the letter and tell us what has happened since: [start a confidential intake](https://www.residenthelp.org/intake). ## Questions to ask about your own accommodations - Did you make the request in writing, and do you have the date? - Was there an interactive meeting, and did you receive a written determination? - Does the determination list each accommodation, who is responsible for it, and when it starts? - Was the determination sent to your program, and did anything in your schedule, evaluations, or remediation plan change because of it? - Were you given a chance to use the accommodations before you were evaluated, suspended, or dismissed? - If a request was denied, does the denial describe what you actually asked for? If not, see [accommodation denied for something you never asked for](https://www.residenthelp.org/blog/residency-accommodation-denied-not-what-you-asked). - Did anything adverse happen soon after you asked? ## If any answer is no Write it down the same day. Send a short, factual email to HR and your program contact asking when each approved accommodation will be in place. Keep copies outside your institutional account. Your accommodation file should be kept separate from your training file, so ask who has seen it. ## Keep a dated timeline Record the date of the request, the meeting, the determination, the first day each accommodation was actually in place, and any adverse action. The gap between approval and use is often the key fact. ## If you are suspended or removed from clinical work Approval letters can issue and then never be put into practice, especially when a resident is suspended or removed from clinical work soon after. Ask in writing when each approved accommodation starts. If you are on a remediation plan, ask that the plan account for them. See [suspended with no letter](https://www.residenthelp.org/blog/suspended-from-residency-without-written-notice). ## One honest limit Accommodations usually work going forward. They rarely erase concerns raised before you asked, which is why asking early matters. ## Deadlines Charges for disability discrimination or failure to accommodate carry the same 180- or 300-day federal limit as other discrimination charges. Whether you have a claim is a question for a lawyer who has reviewed your file. See [deadlines you cannot miss](https://www.residenthelp.org/blog/deadlines-after-residency-dismissal). ## If this is happening to you Approved but not provided? Send us your determination letter and tell us what has changed on your schedule since. We will review it confidentially and tell you the next step: [start a confidential intake](https://www.residenthelp.org/intake). Resident Help is not a law firm, and submitting an intake does not create an attorney-client relationship. If your situation needs a lawyer, we will tell you and help you find one. ## Common questions ### My residency approved my accommodations but nothing changed. What can I do? Write it down the same day. Send a short, factual email to HR and your program contact asking when each approved accommodation will be in place. Keep copies outside your institutional account, and keep a dated record of when each one actually starts. ### Should my accommodation file be in my training file? Generally no. Medical information supporting an accommodation is expected to be kept confidential and separate from personnel records. Ask who has seen your accommodation file. ### Is there a deadline if my accommodations were not provided? There is no fixed deadline to ask for an accommodation. But a charge for failure to accommodate carries the same 180- or 300-day federal limit as other discrimination charges. Whether you have a claim is a question for a lawyer who has reviewed your file. ## Sources - Accreditation Council for Graduate Medical Education, Institutional Requirements, 2025, https://www.acgme.org/globalassets/pfassets/programrequirements/2025-reformatted-requirements/institutionalrequirements_2025_reformatted.pdf - U.S. Equal Employment Opportunity Commission, Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA, https://www.eeoc.gov/laws/guidance/enforcement-guidance-reasonable-accommodation-and-undue-hardship-under-ada - U.S. Equal Employment Opportunity Commission, Time Limits for Filing a Charge, https://www.eeoc.gov/time-limits-filing-charge - Job Accommodation Network, https://askjan.org/ This post is general information and not legal advice. Institutional policies and board rules change, so confirm the version in force on your dates. ## Related guidance - [How to request an ADA accommodation in residency: a checklist](https://www.residenthelp.org/blog/how-to-request-accommodation-in-residency): The request you make in writing is the one that counts. This checklist covers how to ask, what the interactive process is, what a determination should contain, and how to check that an approval was put into practice. - [Residency accommodation denied for something you never asked for](https://www.residenthelp.org/blog/residency-accommodation-denied-not-what-you-asked): Sometimes an accommodation denial answers a different request than the one the resident made. Correcting the record in writing, promptly, and restating the request in terms that answer the stated objection is often the most useful next step. - [Deadlines you cannot miss after a residency dismissal or adverse action](https://www.residenthelp.org/blog/deadlines-after-residency-dismissal): An adverse action in residency starts several clocks at once. The internal ones are short and usually negotiable. The outside ones are long but unforgiving. This is the list, with what each clock runs from and which ones can be extended. ## Start here - [Questions residents ask, answered](https://www.residenthelp.org/faq): Short answers to every question our guides cover, from resignation offers and appeal deadlines to accommodations and visas. - [Know your rights as a resident](https://www.residenthelp.org/rights): What your program owes you under ACGME requirements, what federal law protects, and the first 72 hours. - [Court decisions on resident dismissal and probation](https://www.residenthelp.org/cases): Published opinions every resident should know before a probation, dismissal, or forced-leave decision. - [The free Residency Record](https://www.residenthelp.org/record): The documents every resident should keep, the dates that decide non-renewal, and a private place for both. --- Source: https://www.residenthelp.org/blog/residency-accommodations-approved-not-provided Publisher: Resident Help (https://www.residenthelp.org) This website provides general information and is not legal advice. Using this site or submitting a form does not create an attorney client relationship.