If you have suffered from a disabling condition and have long term disability insurance coverage, your insurance company may ask for you to undergo a functional capacity evaluation. An FCE is used to test your ability to perform simulated work-related tasks. It is important that you understand what this evaluation is and what the examiner will be looking for because insurance companies frequently try to use FCEs as reasons to deny long term disability claims. You may also want to get help from a long term disability attorney, like the team at Osterhout Berger Disability Law, with your claim before you go to a functional capacity evaluation appointment.
A functional capacity evaluation is used to analyze a person’s ability to perform job-related activities that are related to the ability to work. During the evaluation, your structures, bodily functions and health status will be compared to the demands placed on them by your working environment and your job.
The primary purpose of an FCE is to determine your ability to do your job, but it is also used to determine whether or not there are indicators that you might be malingering. In a thorough FCE, you should expect to undergo a battery of standardized tests that consist of measurements of performance providing predictions for your ability to return to work. In addition to measurements of your ability to physically perform your job tasks, some FCEs are also used to measure your cognitive ability to perform work as well. It is important that care is taken by your evaluator when he or she is performing your FCE to add accuracy and predictive value to it while also protecting your safety during the assessments.
Your FCE may be scheduled to last anywhere from a few hours to a few days. An FCE is substantially different than a medical examination and may require you to go through prolonged periods of intense physical activities. You may be asked to repeatedly lift, bend, climb, reach, pull or push. In many cases, FCEs are not administered by doctors and are instead completed by other professionals such as occupational or physical therapists. It is common for people to experience aggravations of their symptoms after these evaluations are completed. In addition to the physical demands that may be placed on you during your FCE, you should also expect to undergo a battery of psychometric tests.
During your FCE, you may also be asked to submit to a battery of assessments that are meant to test your perception of pain and your disability. If the evaluator finds that your results on these tests are inconsistent, they may then determine that your issues are caused by behavioral choices rather than by your physical condition. These tests may include a number of assessments. You may be asked to complete a pain drawing in which you identify the bodily areas in which you feel pain as well as its intensity. This drawing will then be scored using the Ransford scale for the evaluation of pain and functionality of 45 different body areas. Your evaluator may also ask you to assign a numeric rating to your pain and ask you to complete some questionnaires about it. You should also expect to undergo a Waddell’s test, which involves an evaluation of five categories of signs during a physical examination, including:
People who show three or more signs on the Waddell’s test are considered to be magnifying their symptoms and thus malingering. The evaluator will try to elicit descriptions from you, and he or she will be evaluating whether or not the descriptions that you provide are inappropriate for your particular condition. For example, if you claim that you have no periods during which your pain subsides, the evaluator is likely to believe that you are exaggerating. Other inappropriate descriptions include complaints of whole-leg pain or numbness, tailbone pain or your leg completely giving out. While you should cooperate with your functional capacity evaluation, it may be a good idea to refuse the portion containing the psychometric battery of assessments.
As previously mentioned, the FCE differs from a medical evaluation. For disability purposes, the insurance company may ask you to undergo an independent medical examination instead of or in addition to an FCE. The doctor who performs the exam is supposed to be neutral. In many cases, however, insurance companies send disability claimants to doctors who are likelier to be biased in their favor. Medical examinations may be relatively short in comparison to FCEs. The doctor will perform an examination, ask you questions and evaluate your symptoms and medical conditions. The aim of the independent medical examination is to determine whether or not you need further medical treatment, whether or not work restrictions are needed, whether your condition was caused by an accident and whether or not you are disabled. Following the examination, an IME doctor will then give his or her opinion in a prepared report that will list your diagnosis, recommended treatment, any work restrictions and whether or not an accident caused your condition or injury.
There are several concerns about functional capacity evaluations. The results may not be reliable, and the evaluation procedures that are used may not be safe for people. For example, your condition may be worsened by the rigorous physical nature of some of the required tasks. If you are injured as a result of your FCE, it may be difficult to hold either the insurance company or the evaluator liable. Chronic pain conditions such as fibromyalgia may not be accurately portrayed by an FCE as the symptoms come and go in waves. This may leave you with an evaluation that offers results that are unreliable and not probative of your actual functional limitations.
Other concerns exist about both FCEs and IMEs because of the potential bias of the evaluators or examiners performing the tests. Since they are hired by the insurance companies, some may avoid making proper recommendations and findings so that they can continue performing the tests and getting paid for them. Some long term disability lawyers recommend that their clients try to take witnesses to their evaluations or examinations. It may also be smart to videotape the evaluation or examination if possible. We may may also want you to schedule an appointment with your treating physician for the day following your FCE or IME to perform a separate exam.
An experienced long term disability attorney like the dedicated members of our team will focus on getting you the benefits that you deserve. Insurance companies often request FCEs or IMEs in order to bolster their denials of claims. Many insurance policies do not provide for functional capacity evaluations. If your policy does not state anything about an FCE, we may challenge the request.
Schedule a free confidential consultation about appealing your denial by calling us toll free at 1-866-438-8773. If you prefer, you can fill out our intake form, and an experienced lawyer will contact you to schedule an appointment.