When It Comes to the ADA, Ignorance Is Not Bliss

Providing services helps you comply with public accommodations requirements.

Risk Management

When It Comes to the ADA, Ignorance Is Not Bliss

Confused about what the Americans with Disabilities Act (ADA) requires of you as an owner/operator of a business that provides “public accommodations?” You're not alone.


Understanding the ADA can be complicated. Even many legal experts will say the language of the ADA is subject to interpretation and its requirements are often misunderstood. Fortunately, making your practice more accessible and welcoming to people with disabilities is not as difficult as you may think—and it could help you avoid costly litigation.

Beyond Building Accessibility

Whoever coined the phrase “ignorance is bliss” certainly was not referring to the Americans with Disabilities Act (ADA) and its requirements for business owners, including D.C.s.

A common misconception about the ADA is that it is a building code and only involves making buildings accessible for people with disabilities. The ADA actually is a civil rights law, which was created to ensure individuals with disabilities are treated with dignity, respect and fairness under the law. It also involves making all goods and services available to people with disabilities. One simple way to do this and comply with the ADA requirements is by providing effective means of communication for your patients and their family members who have vision, hearing or speech disabilities.

How do you determine an effective communication method? First, you must decide what type of communication aids or service is most appropriate based on the complexity of the information being conveyed and the patient’s normal method of communicating. For example, you can write notes to “speak” with a patient who is deaf or hearing-impaired. A patient who is blind may need physical assistance to maneuver through your office space.

On the other hand, in situations where there is little call for interactive communication, such as providing insurance information or completing medical history inquiries, having simple written forms or information sheets available may suffice.

The good news: Your patients will usually let you know what type of communication assistance they require. Sometimes they will ask in advance which ones you provide. If not, be sure to ask what technique a patient normally uses to understand printed information (in the case of a vision disability) or spoken information (in the case of a hearing disability).

Help, I Need an Interpreter

There may be times when you will need to obtain the services of a qualified sign language interpreter, or an oral interpreter for a patient trained to speech-read (read lips).

In these cases, you are required to provide the services free of charge to the patient.

Here are some examples of situations where an interpreter may be required for effective communication:

  • Discussing a patient’s symptoms and clinical condition, medications, and health history
  • Providing a diagnosis, prognosis and recommendation for treatment
  • Explaining and describing clinical conditions, tests or X-rays, treatment options and other procedures
  • Providing instructions for post-treatment activities and follow-up treatments
  • Obtaining informed consent for treatment
  • Discussing complex billing or insurance matters

It is important to note the ADA places limits on how far you must go in “providing effective communication.” For example, the ADA does not require you to furnish any communication aids or services that would place an “undue burden” on your business. The ADA defines undue burden as “significant difficulty or expense.”

In the case of interpreters, it would be an undue financial burden for most D.C.s to have full-time interpreters on staff. However, when requested by a patient or family member in advance, the D.C. can arrange for an interpreter to be available at a specified time.

For this reason, it is a good idea to familiarize yourself with agencies in your area that provide these services. Check with your local disability organizations for names of qualified interpreters. The Department of Justice ADA Information Line (800-514-0301 voice or 800-514-0383 TTY) can also help you identify local service providers.

Who Pays for Services?

Two questions many D.C.s often ask about providing assistance to people with disabilities are:

  • Can I simply require patients to bring their own interpreters?
  • Can I charge extra to cover the costs of any aids or services needed to communicate effectively?

The answer to both questions is: “No.”

However, this is an area in which the ADA language is purposefully flexible. If a patient prefers to bring his or her own interpreter, the ADA allows you to accept this arrangement, if agreed upon in advance. In cases like this, you are responsible for paying the interpreter’s fees. But if a patient shows up with an interpreter unarranged, you are not obliged to use or pay for the interpreter’s services, unless you have agreed to do so.

Keep in mind you are required to provide qualified interpreters when needed. This is why it is not a good idea to ask family members and friends of patients with disabilities to act as interpreters, particularly in situations requiring explanations of clinical terminology and in situations of stress for the patients.

Relying on family members or friends to interpret also puts a D.C. at risk for breaching well-established rights of patients to privacy and confidentiality. Only after a hearing-impaired person has been fully informed of the availability of qualified interpreters and communication options (at no cost to the patient)—and refused them—should an unqualified interpreter such as a family member or friend be used.

The bottom line: More than 50 million Americans with disabilities—along with their family and friends—are potential consumers for your professional services. Familiarizing yourself with the ADA requirements and making chiropractic goods and services more accessible not only lets you avoid the risks of future litigation, but it also helps you and other D.C.s attract an untapped group of patients, which can translate into practice success.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.