When you file a long-term disability claim for an injury or illness, your insurance company could require that you complete a Functional Capacity Evaluation (FCE).
Insurance companies require claimants to jump through hoops when filing disability claims. These will ultimately determine whether their claims will be approved or denied. An FCE is just another one of these “hoops” that could have a life-changing impact, for better or worse.
If your insurance company asks you to undergo an FCE, you should contact a long-term disability lawyer immediately. The stakes are much too high to take chances, and an experienced legal team can help you to know what to expect and how to prepare.
This article outlines some important information about what to expect at a Functional Capacity Evaluation, but we encourage you to contact us for a free consultation before you agree to participate in the test.
Table of Contents:
- What is a Functional Capacity Evaluation?
- What to expect at a Functional Capacity Evaluation
- How long does a Functional Capacity Evaluation take?
- What happens if you fail a Functional Capacity Evaluation?
- How to have a successful Functional Capacity Evaluation
- How Roy Law Group can help
What is a Functional Capacity Evaluation?
A Functional Capacity Evaluation (FCE) is an in-depth evaluation process to measure an individual’s ability to perform work-related tasks. An FCE is typically performed by a physical or occupational therapist and can be used to help determine a person’s capacity for work.
What to expect at a Functional Capacity Evaluation
During a Functional Capacity Evaluation, a physical or occupational therapist will assess factors such as strength, range of motion, endurance, coordination, and balance. They will review your medical records, ask questions about your medical history, and may monitor heart rate and oxygen levels during certain activities.
The tests and activities used during the FCE can vary depending on your condition, medical history, and specific functional limitations. FCE tests are sometimes tailored to simulate your specific job duties so that the therapist can observe your tolerances and levels of effort.
An FCE will test various physical and psychological abilities, such as:
- Lifting ability
- Range of motion
- Physical strength
- Attention span
- Stress tolerance
- Emotional stability
Work restriction vs. work limitation
The therapist will also often run through a validity testing protocol to determine if the test results are reliable. These tests are all designed to assess your functional ability and identify work restrictions and limitations that might exist when taking your exam.
- A work restriction is an activity your doctor has advised you against because it risks aggravating your symptoms.
- A work limitation is an activity you cannot safely perform due to a lack of physical or psychological capacity.
A work restriction or limitation can be temporary or permanent.
How long does a Functional Capacity Evaluation take?
A Functional Capacity Evaluation typically takes between two and four hours to complete. The overall duration will vary depending on the complexity of the assessment and your physical capabilities.
Some evaluations stretch over two consecutive days, depending on how difficult it is to assess your functional ability. Often when pain or fatigue is the primary disabling symptom, a two-day FCE is needed to measure the impact the first day of testing has on the second.
How to have a successful Functional Capacity Evaluation
Wear comfortable clothing that does not restrict your movement.
It’s natural to feel nervous during an FCE, however, too much stress could affect the results. Get plenty of rest beforehand and keep a positive outlook and relaxed attitude throughout your evaluation.
Communicate with your evaluator
It’s crucial to alert your evaluating therapist if your symptoms worsen during the testing. They should note which activities are causing your symptoms to worsen and stop that activity for safety.
It’s important that you are honest and try your best during your FCE. If your therapist suspects you are not being truthful, they could make note of this in their reports, which could harm your disability claim.
Contact a long-term disability lawyer
Be sure to contact a long-term disability lawyer before your FCE. An experienced lawyer will help you to be better prepared.
What happens if you fail a Functional Capacity Evaluation?
If you fail your FCE, don’t think of it as the end of the fight. You may still have options, and you are not alone.
You still have the right to appeal the evaluation results, which means you must retake the test. You should consult your disability insurance attorney for help if you haven’t done so.
How Roy Law Group can help
Our team at Roy Law Group knows all too well the tactics some insurers use to deny claims. One of those tactics is misstating or misinterpreting a therapist’s medical opinion in an FCE. A negative result of an FCE can have a devastating impact on your claim.
Read about Roy Law Group’s fight against Mutual of Omaha after an incorrectly stated outcome of an FCE: Noone v Mutual of Omaha.
With Roy Law Group by your side, we will:
- Review and assess your FCE report as your advocate
- Refute inaccurate results
- Recommend additional testing if needed to support your claim
We aim to help you get through the process, obtain your disability benefits, and hang onto them as seamlessly as possible. It might seem daunting, but a Functional Capacity Evaluation is not always bad. In many cases, it can strengthen your claim and support your entitlement to benefits.
Our disability insurance experts have reviewed hundreds of FCEs, and our experience can be invaluable when your insurance company sends you for FCE testing. As in all cases, we always work tirelessly to help you secure your benefits and stand up for your rights.
Contact Roy Law Group today for help with your disability claim or appeal.