How Functional Capacity Exam (FCE) Can Affect Your Long-term Disability Claim

Key Takeaways:

• A functional capacity evaluation (FCE) tests your physical ability to preform specific abilities.
• There may be significant safety issues for some people undergoing an FCE test.
• Therapeutic intervention can reduce the validity of an FCE.
• FCEs are not uniform or standardized.
• Always discuss undergoing an FCE with your primary physician.
• Contact a disability attorney prior to undergoing an FCE, as its results could impact your case.

Insurance companies often request that a claimant undergo a functional capacity evaluation (FCE) for long-term disability claims. However, attending an FCE may be harmful to your claim. Also, many policies do not have any contractual language obligating claimants to undergo a functional capacity evaluation. You may be able to object to an FCE, even if you have a policy that requires one.

When you understand your rights and prepare adequately for the FCE, including using the advice of your treating physician and the guidance of a knowledgeable disability attorney, you can navigate the process with confidence and the knowledge that your evaluation will more accurately reflect your capabilities.

Contact the Law Office of Justin C. Frankel for a free consultation and to learn more about your rights before submitting to a functional capacity evaluation.

What is a Functional Capacity Evaluation (FCE)?

An FCE test for disability is a series of tests that measure several physical abilities, including:

• Strength
• Flexibility
• Endurance
• Pain
• Cardiovascular fitness
• Lifting ability
• Coordination
• Static posturing
• Repetitive movement
• Other physical abilities

However, these types of activities are potentially extremely dangerous to claimants’ health and could aggravate their conditions.

What to Expect at a Functional Capacity Evaluation

If you and your attorney agree that you should attend an FCE required by your disability insurance company, you can expect:

• Pre-Evaluation: The doctor performing the FCE may ask you to provide your medical history, your current symptoms, and information about your job duties. You may also discuss your functional limitations, impairments, and pain levels.
• Physical Examination: The doctor will most likely take your vital signs, including blood pressure and heart rate. He or she may also evaluate your muscle strength, posture, flexibility, reflexes, coordination, motor function, and the range of motion of your joints.

The functional testing portion of the FCE covers several tests, including:

• Strength Testing: Upper and lower body strength for pulling, lifting, carrying, and pushing
• Endurance Testing: Ability to sustain physical effort over time, such as doing repetitive tasks, walking, and climbing stairs
• Mobility Testing: Ability to bend, reach, crawl, and squat
• Manual Dexterity and Hand Function: Evaluation of eye-hand coordination, including gripping, manipulating small objects, and pinching
• Postural Tolerance Testing: Ability to tolerate sitting, standing, and kneeling for extended periods

In addition, the FCE will evaluate your ability to perform specific tasks that are the same as your job duties, such as handling tools, operating machinery, or assembly tasks. The assessor monitors and documents pain and fatigue and how they affect your performance.

Are Functional Capacity Evaluations (FCEs) Safe for Patients?

In a study published in Physical Therapy, a medical journal, the authors concluded that there are significant safety issues regarding FCEs. Because a patient is asked to perform physical tasks to demonstrate maximal effort, it could exacerbate the injury or cause additional injury without a physical therapist available to note exterior visible signs of unsafe performance. The authors also concluded that the assessors should have available criteria to determine when maximal effort has been put forth and when to intervene. Currently, no such criteria exist.

What Are the Deficiencies in FCEs?

Also, according to Physical Therapy, FCEs have many deficiencies, including:

• Lack of research
• Lack of protocol
• Lack of standardization
• Lack of ability to project what a patient can perform during an 8-hour workday
• Significant safety deficiencies
• Very few peer-reviewed journal articles regarding reliability

Additionally, the assessor could conclude that the patient is not putting forth maximal effort, even though he or she is, as there is no reliable and valid method of determining lack of participation.

What Should You Do if Required to Undergo an FCE?

If you are asked to undergo an FCE, consult with a knowledgeable disability insurance attorney to determine if you are contractually required to undergo an FCE. Even if required, you should discuss the potential for harm with your treating provider, who should be required to authorize a claimant’s participation in such testing.

If your insurer says you must attend an FCE for your long-term disability insurance claim, please do not hesitate to contact our nationwide office to see how we can assist you.

How is an FCE Used to Determine Eligibility for Disability Benefits?

An FCE can play a role in determining eligibility for long-term disability benefits, though its role may not always be beneficial for your long-term disability claim. Disability insurance companies use FCE results in the following manner:

• Comprehensive Assessment: The FCE provides detailed data on your functional abilities and specific limitations and how the limitations affect your ability to perform work-related tasks.
• Medical and Vocational: The disability insurance company can compare your FCE against your medical records to support or deny your claim for disability benefits. Medical experts can also use the FCE results in testimony for or against you in your initial disability case or a disability appeal.
• Correlation with Job Requirements: The FCE report compares the physical demands of your job to help determine whether you can perform your current job or a modified version of your job.
• Determining Restrictions and Recommending Accommodations: The FCE results can help identify work restrictions or recommend reasonable accommodations that would help you do your job safely and effectively.
• Baseline Functional Ability: The FCE results can establish a baseline of your current physical condition. If you are undergoing rehabilitation, your disability insurance company can ask for it to be repeated so it can track changes in your functional abilities.
• Rehabilitation: The FCE can also guide rehabilitation professionals in creating a tailored therapy plan or a structured return-to-work plan.

How Do I Prepare for a Functional Capacity Evaluation (FCE) for Disability?

Preparing for an FCE involves several steps.

First, consult with your attorney to determine whether you must take an FCE. If your attorney advises you to undergo the FCE, speak with your doctor and physical therapist regarding the safety of undergoing an FCE.

Additionally, understand your job duties and print out a detailed job description to take with you. You may be asked to bring medical records and other relevant documents related to your disability claim. Wear comfortable clothing and take medications as prescribed.

How Long Does an FCE Take?

The length of time for an FCE depends on the exercises you will need to do. However, an FCE generally lasts one to two hours.

What If I Fail My FCE Test?

If you fail the FCE test, that typically means that the examiner determined that you cannot perform tasks essential to the work you did before your injury. If the insurance company scheduled the FCE then it is likely that they will not provide the claimant with a copy of the report unless they use it to deny or terminate the claim. If it is scheduled by the claimants doctor the claimant will get a copy of the report. Give a copy of the results to your doctor and your attorney if possible, especially if you must meet a court deadline.

Why Clients Trust The Law Office of Justin Frankel With FCE Requests

The Law Office of Justin C. Frankel has experience handling disability claims that require FCEs. We take a compassionate approach where we listen to your claims and unique circumstances to create a personalized approach to your case. We also offer comprehensive support throughout the FCE process and coordinate with medical professionals where necessary. Most importantly, we help you understand the FCE process, your rights and the potential outcome.

Testimonials

“Justin and his team instantly made me feel valued and heard.” — Anthony O.

“I have been working with Mr. Justin Frankel, ESQ., for nearly 20 years, and I have been extremely happy with his services.” — Noa B.

Need Help With An FCE Decision? Consult Our Experienced Attorneys Today

At the Law Office of Justin C. Frankel, we are dedicated to helping our clients navigate the disability claim system, which is why our firm focuses entirely on disability insurance claims and appeals. We have won over $250 million in compensation for our clients and have been awarded the Super Lawyers recognition every year since 2013. We also have a 4.9 average star rating on Google.

When you choose the Law Office of Justin C. Frankel, you are working directly with a top partner — not an associate. Let us use our 20-plus years of experience with disability insurance claims to your advantage. Contact the Law Office of Justin C. Frankel at 888-583-4959 or through our convenient online contact form for a free consultation.