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Functional Capacity Evaluations For Disability
When you file a long term disability insurance claim or appeal a denial, your insurance company will expect strong evidence supporting the restrictions and limitations your medical condition imposes. More specifically, your insurance company will want to know how your condition prevents you from working the job you had. This is where a Functional Capacity Evaluation (also known as an “FCE”) can be instrumental to receiving your disability benefits.
Below we will answer common questions about undergoing a functional capacity evaluation for a disability claim.
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What is a Functional Capacity Evaluation?
A Functional Capacity Evaluation is a physical assessment done to gauge your physical ability. It involves a series of tests, practices, and observations that evaluate different aspects of your physical function. The final report can help demonstrate the aggregate impact of your symptoms on your ability to perform essential work duties.
Is a Functional Capacity Evaluation right for my claim?
The Functional Capacity Evaluation is best suited for individuals who suffer from physical conditions causing symptoms such as:
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- Abnormal/limited movements
- Muscle weakness
- Difficulty positioning
- Balance issues
- Numbness/tingling
- Pain
- Poor dexterity/gross movements, and/or
- Fatigue with physical activities
It irrelevant whether your disability is due to an injury or illness. If your physical abilities are impaired, the FCE results will provide evidence of your restrictions and limitations.
Keep in mind that most FCE evaluations are not designed to measure the impact of visual impairments, hearing problems, or mental/cognitive issues.
Who performs the Functional Capacity Evaluation?
A trained medical professional, such as an occupational therapist or a physician specializing in rehabilitative occupational medicine, will perform the functional capacity evaluation.
How long will the evaluation take?
The length of the Functional Capacity Evaluation may vary. Some evaluations are performed over the course of two days, while others are performed in just one day. For each day scheduled, you should be prepared for the evaluation to last the full day.
We generally recommend our clients undergo the two-day FCE. A two-day FCE helps measure whether your limitations increase when performing certain work functions on a more sustained basis. Comparing the results over two days can show how your functional ability decreases with activity, thus helping the insurer understand why you cannot sustain a normal work schedule (e.g., consecutive workdays).
What should I wear?
The FCE will involve physical tests, so you should wear comfortable clothing (e.g., sneakers, sweatshirt, casual pants, etc.). You should also dress in layers so that you can remain as comfortable as possible throughout the testing.
Do I need to bring anything with me?
Be sure to bring your medications and any assistive devices that you may need (e.g., eyeglasses, brace, cane, etc.). If you have an attorney, your attorney should provide your medical records and information about your occupational background, such as a job description, directly to the evaluator.
Will the evaluator know anything about me?
If you have an attorney, the evaluator should already be aware of your occupation, general work background, diagnosis, treatment, and date of disability. This information will help the evaluator prepare a more detailed and informed report.
Will the evaluator ask me questions about my disability?
Yes. The evaluator will likely ask questions to get a better sense of your diagnosis, symptoms, and complaints. The more information that the evaluator has, the more comprehensive the functional capacity evaluation report will be.
What tests will the evaluator perform?
The evaluator will perform testing to measure many of your physical functions, including but not limited to:
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- Physical strength
- Postural intolerances
- Balance
- Level of fatigue
- Range of motion
- Ability to lift/carry
- Ability to sit/stand/walk
- Ability to perform fine and gross manipulations
The evaluator will ask you to perform these tests by using various machines, tools, and maneuvers. The evaluator will perform many of the same tests on the second day to measure any comparative decrease in functioning.
What sort of observations will the evaluator make about me?
First, the evaluator will make observations throughout testing to ensure that you are consistently putting forth maximum effort. Second, the evaluator will observe your pain behavior and quality of movements. The evaluator will then use these observations to make conclusions about the reliability of your testing results. Lastly, the evaluator will record these observations to indicate the reliability of the testing results.
What if my symptoms worsen during testing?
Tell the evaluator immediately if you experience pain, dizziness, or other symptoms during the testing and await further instruction. This is very important for safety purposes and accurate testing. The evaluator will record which activities caused an increase in your symptoms. The evaluator will also stop testing or omit certain tests if they are unsafe for you to perform.
What happens if I become tired during testing?
The FCE testing requires you to exert yourself to your maximum capacity, so it is not uncommon to become tired. If you become very fatigued, simply tell the evaluator and await further instruction. Again, this is very important for safety purposes and accurate testing. The evaluator will record which activities caused an increase in your fatigue. The evaluator may stop testing or skip certain tests if they are unsafe to perform.
Can I take breaks?
The evaluator will allow you to take breaks to eat meals and use the restroom. If you require additional breaks, simply tell the instructor.
What if I can’t perform or finish a test?
Tell the evaluator immediately and await further instruction. You should never complete any tests that will jeopardize your health and/or safety. The evaluator will simply omit tests that you cannot perform. The report will note that you were physically unable to perform or finish the test. Your inability to complete a test will not damage the reliability of the report at all.
What if I’m exhausted or in a lot of pain after the first day of testing?
Tell the evaluator how you’re feeling when you return on the second day. The evaluator will record your reactions, including pain and exhaustion, following the first day of testing. If needed due to aggravated symptoms, certain tests can be omitted on the second day of evaluation.
Should I arrange for someone to drive me to and from the evaluation?
Consider arranging for a ride. Many people experience a temporary increase in symptoms following the evaluation. Therefore, it may be difficult for you to drive home.
Can I have an FCE if I’m recovering for surgery or currently undergoing rehabilitative therapy?
You should most likely not undergo an FCE if you are recovering from surgery or undergoing rehabilitative therapy. Communicate these circumstances to your FCE provider before scheduling your appointment(s).
How can a long term disability attorney help with an FCE?
There are 5 important ways that an experienced long term disability attorney can help.
First, your attorney can help identify whether an FCE may be helpful for your claim. Depending on your particular symptoms and the stage of your claim, your attorney can anticipate whether the insurance company will want to see FCE results and make the recommendation accordingly.
Second, your attorney will recommend which tests should be performed at your FCE. This will ensure that the results fully demonstrate your disability and limitations to the highest extent possible.
Third, your attorney’s office will provide the evaluator with all necessary background information and medical records before your scheduled evaluation. This will help ensure that the evaluator is familiar with your diagnosis and symptoms before testing begins.
Fourth, your long term disability attorney will be able to review the FCE report to identify any inconsistencies and inaccuracies that may require correction by an addendum.
Fifth, your attorney will interpret the report to assess whether it is supportive of your long term disability claim. If the report is supportive, your attorney may help highlight the most favorable portions for the insurance company’s review. If the report is unsupportive, your attorney may recommend additional testing and/or comments from your physicians.
A Functional Capacity Evaluation can be crucial for your long term disability claim. A long term disability attorney can help determine if undergoing an FCE is the right move for you, and recommend other helpful testing options.
The attorneys and staff and Riemer Hess are well-versed in Functional Capacity Evaluations. Contact an attorney at Riemer Hess today at (212) 297-0700 to discuss how a Functional Capacity Evaluation may help your long term disability claim.
