After filing a disability insurance claim, your insurance company may ask you to undergo a Functional Capacity Evaluation, or FCE. The insurer tells you where and when to show up, but you likely have little idea what to expect when you arrive. What is an FCE, what is its purpose, and how will it affect your claim?
What Is an FCE?
FCEs are formal examinations performed by occupational therapists (OTs) or physical therapists (PTs), not physicians. The purpose of the FCE, according to your insurer, is to evaluate your ability to perform the substantial and material duties of your occupation.
What Can You Expect at the FCE?
FCEs usually last between four to six hours, but depending on the tests your insurer has requested, they could be longer, taking place over two consecutive days.
Prior to the FCE, the therapist conducting the testing should review your medical records to get a general picture of your medical condition(s). Often, the insurance company will provide the FCE examiner with copies of your claim forms, correspondence, and surveillance tapes as well. If the insurance company has ordered an Independent Medical Examination by a physician, the FCE examiner will often touch base with that physician as well.
Once you arrive at the FCE, you will likely be asked to complete some intake paperwork outlining your medical history and current symptoms. Whether or not you realize it at the time, the examiner or one of his/her staff will monitor you to see how long it takes you to fill out the forms, and whether you can sit comfortably for the entire time it takes you to complete them. Once you’re done, the examiner may go over the forms with you and perform a brief interview.
Next, the FCE examiner will lead you through a series of musculoskeletal and functional testing. The examiner will normally measure things like your capacity to lift, push, pull, and carry objects; your ability to stand, sit and walk; whether and how far you can reach, stoop, kneel, crouch and crawl; and your ability to handle and manipulate small objects. The examiner is supposed to use these tests to evaluate your dexterity, coordination, endurance, and other job-specific functions, as well as your pain levels relative to these activities. FCE examiners should ideally follow up with you on the telephone a couple of days after the examination to see if the testing exacerbated your condition; however, this follow-up rarely occurs.
After the FCE, the examiner will prepare a report for your disability insurer. You should request a copy of the report so that you can review it and discuss it with your attorney.
How Will the FCE Affect Your Claim?
In some instances, FCEs can help support your claim for disability insurance benefits. For certain purely physiological conditions, the FCE testing will provide objective evidence of your inability to perform your prior job functions. Performed properly, an FCE can also document your pain clearly, as well as verify additional physical reactions that support your complaints of pain (i.e., trembling, shaking, muscle weakness, etc.). However, FCEs can lend themselves easily to interpretation, so disability insurers frequently use them as proof that your claim should be denied. In our next post, we’ll discuss some of the limitations of FCEs and what you can do to minimize the risk a FCE can pose to your claim.