Functional Capacity Evaluations in Disability Claims

Functional Capacity Evaluations (“FCEs”) are a type of test used to determine the severity of someone’s physical impairments. FCEs are common in disability insurance claims, workers compensation claims, and other contexts where the level of a claimant’s injury or sickness needs to be evaluated.

FCEs are usually administered by a physical therapist or physician who specializes in occupational medicine. Common measurements during an FCE include how much the claimant can lift, how much they can push and pull, how long they can walk and stand, how long they can sit, the ability to reach in all directions, the ability to grasp and manipulate with each hand, the degree to which a claimant can move all joints, the ability to squat and bend, and the ability to stoop and balance. FCEs can vary in duration: some FCEs are very brief – only a couple of hours – and some FCEs are actually performed over the course of two days.

In long term disability insurance cases, many insurance policies allow the insurance company to request that a claimant undergo an FCE at a facility of their choosing. A claimant’s refusal to undergo such testing may give the insurance company grounds to deny disability benefits. Therefore, it is likely that the claimant will have to comply with the insurance company’s request for an FCE. However, a claimant may want to consider the following tips before attending an FCE:

First, a claimant should check with their treating physicians to see if they are medically cleared to undergo an FCE. Because an FCE requires the claimant to physically exert themselves, it may be a health risk for some claimants to attend an FCE.

Second, it may be wise for the claimant to bring relevant medical records to their evaluation. For example, if an MRI or x-ray clearly shows a severe physical impairment, these test reports may be helpful for the FCE examiner to review before testing begins. If the FCE examiner does not know anything about the claimant’s physical condition, they may not be able to make an informed decision about the severity of the claimant’s impairments.

Third, the claimant should be aware that the evaluation starts as soon as they are in sight of the facility. Many FCE examiners observe claimants in the facility’s parking lot before and after the FCE. If the claimant’s observed activity outside of the examination room is inconsistent with how they act in the examination room, then the FCE examiner may be suspicious that the claimant is exaggerating their disability. Also, some insurance companies may hire a private investigator to conduct video surveillance of the claimant on the day(s) of the FCE.

Fourth, the claimant should give maximal effort while also acknowledging when an activity causes pain. FCE examiners will be looking for consistency over the entire course of the examination. If the examiner believes that the claimant is not giving maximal effort, then they may report to the insurance company that the claimant failed to perform the test as instructed and “self limited” their performance. Failing to provide maximal effort may be grounds for an insurance company’s denial. At the same time, a claimant should not hide their pain. If an activity is causing pain, the claimant should report this to the FCE examiner, so that it is documented in the FCE report.

Fifth, the claimant should create a detailed account of their FCE as soon as their evaluation ends. The claimant will want to include important details in their account, such as how long the evaluation lasted, which physical activities they were asked to perform, which questions the examiner asked, how the claimant felt immediately after the evaluation, and how the claimant felt one day after the examination.

Although FCEs can be a valuable tool to consider the impact of a disabling condition, they can also be misused. Because the FCE examiner will likely only see the claimant for a brief period of time and only on one occasion, the FCE is a snapshot of a person’s disability. If the person follows the above tips, they can help make sure that the FCE report will properly document their disability.

If your disability insurance claim has been denied, contact O’Ryan Law Firm for a free consultation today.