Section 2
Functional assessment — emerging emphasis


  • Medical standards for drivers often cannot be applied without considering the functional impact of the medical condition on the individual.
  • All Canadian jurisdictions have policies in place that allow individuals the opportunity to demonstrate that they are capable of driving safely despite the limitations implied by a diagnosis. Criteria may vary across jurisdictions.

2.1 Overview

Historically, determining medical fitness to drive was based solely on a medical office examination and a diagnosis. However, various court decisions, including the Grismer decision (British Columbia [Superintendent of Motor Vehicles] v. British Columbia [Council of Human Rights]) , have recognized that a driver’s ability to accommodate and function with a given medical condition varies with the individual.

These court decisions have also established the right of drivers to be assessed individually for their ability to drive safely. A functional assessment, which is a structured assessment of the person’s ability to perform the actions and exercise the judgment necessary for safe driving, often including a road test, takes this individual variation into account. Functional assessments are usually administered by occupational therapists, although some jurisdictions may have driving rehabilitation specialists who can perform on-road assessments. In addition, some jurisdictions perform their own on-road assessments of driving fitness, but these tests are less comprehensive than those performed by occupational therapists. In particular, only occupational therapists can assess the requirements for modifications to vehicles that are needed to accommodate drivers with a physical disability.

A driver with a medical condition that could compromise cognitive or motor skills may require a functional assessment to determine fitness to drive. Any compromise of the ability to perform daily activities or of the driver’s autonomy should trigger some sort of functional driving assessment.

Functional assessments may be available only in urban centres and may be difficult to arrange for patients in rural areas.

2.2 Standards

Canadian jurisdictions are working to develop and apply standards that permit individual assessment of the functional capabilities of drivers with medical conditions that may affect driving.

Medical standards for drivers (e.g., Canadian Council of Motor Transport Administrators, 2021) must address three types of conditions:

  • Functional or permanent limitations — Certain medical conditions, or combinations of medical conditions, can lead to limitations of functional capabilities (e.g., amputation of a foot will affect the person’s ability to drive a vehicle with manual transmission).
  • Associated risk or episodic limitations — The risk of a catastrophic event due to a medical condition may be judged as unacceptable. Certain heart conditions are examples of medical conditions where the risk that an incapacitating event will occur while driving has led to the definition of criteria designed to diminish the risk.
  • Use of substances judged incompatible with driving — Illicit drugs, alcohol, and medications may interfere with fitness to drive.

2.3 Assessment

2.3.1 Office assessment

Various authors have described and explained the role of physicians in determining fitness to drive (e.g., Dow, 2006). Physicians in a medical office setting can assess their patients’ fitness to drive when the patients are clearly either capable or incapable of driving. This guide provides information to assist with those decisions. In less clear-cut situations, it may be necessary for the physician to employ other means of testing to perform a functional assessment. This usually involves on-road testing.

It should be emphasized that, with the exception of temporary restrictions for short-term medical situations, the physician is not required to determine whether a licence will be granted or suspended. The physician’s responsibility is to describe the situation, and the licensing authority will make a decision based on the physician’s observations, other available information (such as police reports), and its own interpretation of the regulations.

2.3.2 Functional assessment

A functional assessment is appropriate when the medical condition in question is present at all times. A functional assessment is not appropriate when the driver has a medical condition that is episodic (e.g., seizures) and known to be associated with increased risk.

Licensing authorities make their own decisions about the evidence and opinions on which to base their decisions to grant or suspend a licence. There is a role for specialized road testing and computerized screening, as well as some self-administered tests (provided the patient has insight). Physicians may choose to refer a patient for additional assessment when such resources are available.

The decision to refer for assessment can be deferred to the licensing authority. Assessments are usually available through private companies and are paid for by the driver. Some public health care facilities offer driving assessments free of charge, but access is limited and waiting lists tend to be long.

Some jurisdictions use off-road evaluations, based on tools such as driving simulators or batteries of tests, to predict on-road behaviour. Computerized testing may provide useful, objective information about functions believed to be important for safe driving. However, there is insufficient evidence to support licensing decisions based solely on the results of this type of testing.

Most Canadian jurisdictions have some form of formal road testing in place, often conducted by occupational therapists who specialize in the functional testing of drivers. In some jurisdictions, certified technicians do the testing. Assessments are typically limited to drivers of non-commercial cars. Drivers of commercial vehicles and motorcycles usually cannot be evaluated in private centres, although some specialized centres have developed testing protocols for drivers of these vehicles.

Currently, there is insufficient evidence to recommend for or against any specific testing method, although authoritative research in this field has demonstrated clearly that the novice driver’s road test is inappropriate for experienced drivers. Any road test for experienced drivers must include driving in unfamiliar surroundings, to test how the driver reacts to situations that differ from their daily routine. Although use of the driver’s own vehicle may reduce the level of stress, difficulty driving an unfamiliar vehicle may indicate cognitive inflexibility that could have a negative effect upon fitness to drive.

Geographic limitations (i.e., restricting drivers to their local area) are not recommended for drivers with cognitive problems, especially those with dementia. In fact, recent guidelines on dementia (e.g., Rapoport et al., 2018) recommend that any driver with dementia who requires the imposition of licence restrictions to ensure driving safety should be suspended from driving completely (see Section 8, Dementia).

2.4 Finding an occupational therapist

The Canadian Association of Occupational Therapists offers a service on its website called “Find an occupational therapist” ( However, not all occupational therapists perform functional assessments for drivers. Some provincial occupational therapist associations do provide a similar service to the public that will identify those who perform such assessments.


British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights), [1999] 3 S.C.R. 868. Available: (accessed 2022 July 28).

Canadian Council of Motor Transport Administrators. National Safety Code. Standard 6. Determining driver fitness in Canada. Part I: A model for the administration of driver fitness programs. Part 2: CCMTA medical standards for drivers. Ottawa (ON): The Council; 2021. Available:…(accessed 2022 July 4).

Dow J. Maladie et permis de conduire : comment s'y retrouver? Méd Québec. 2006;41(3):61-4.

Rapoport MJ, Chee JN, Carr DB, Molnar F, Naglie G, Dow J, et al. An international approach to enhancing a national guideline on driving and dementia. Curr Psychiatry Rep. 2018;20(3):16.