The 6th Circuit's ruling in Kroll v. White Lake Ambulance Authority had a different focus than many other Americans with Disabilities Act (ADA) cases, and the court itself noted in its opinion that there was little precedent on the issue. The closest example, in the court's estimation, was the 7th Circuit's 2006 ruling in Karraker v. Rent-A-Center. In that case, the court found that Rent-A-Center's requirement that candidates for managerial positions submit to psychological tests including the Minnesota Multiphasic Personality Inventory violated the ADA, as the test could inadvertently reveal mental disabilities. Although that case did require the 7th Circuit to define “medical examination,” the Kroll court noted that the substance of the counseling in its case was “unclear and somewhat in dispute by the parties.”

Bill Nolan, a managing partner at Barnes & Thornburg, says that other similar cases have often occurred in a pre-employment or promotion context. He suggests that the lack of case law on the issue may be due to the 2009 amendments to the ADA, which changed the focus of ADA cases. “Pre-2009, quite literally, a majority of ADA cases revolved around the issue of, 'Is the person disabled or not?'” he says. “So the issues have shifted a little bit, and oftentimes you may not have been getting to this issue previously.”