Millions of dollars — to the tune of almost $50 million — are paid each year to injured individuals in workers’ compensation claims. That may have you thinking that getting workers’ compensation benefits is an easy feat. Unfortunately, this is not the case. There are many obstacles that an injured worker must undergo in order to obtain the benefits to which they are entitled. One of the many tasks an injured worker may need to undergo before receiving workers’ compensation benefits is submitting to a Functional Capacity Evaluation (“FCE”). Below is a brief explanation about what an FCE is and how it can affect a workers’ compensation claim.
An FCE is composed of a series of physical examinations that measure an injured worker’s functionality and ability to perform particular tasks. Insurance companies that offer workers’ compensation often require an injured claimant to submit to an FCE when trying to obtain benefits. When this examination is requested in relation to a workers compensation claim, the evaluator performing the FCE measures the worker’s ability to perform particular tasks required to do that occupation. The tests in the FCE are tailored to the physical demands of the worker’s occupation.
The FCEs are typically performed by physical therapists, certified physicians, and other medical practitioners. The examination happens in a medical facility setting appropriate for taking these performance measurements. The main purpose of an FCE is to figure out whether or not the injured worker can perform their job functions. The second purpose of the FCE is to help transition a worker back to the occupation — this may include providing recommendations for accommodations by the employer. Beyond physical capabilities, an FCE can also measure an injured worker’s mental fitness. Referred to as a mental FCE (“MFCE”), this evaluation measures a worker’s social, memory, and problem-solving skills needed to perform their job and determines whether they have the emotional and cognitive abilities to return to the workforce.
Issues with FCEs
While an FCE is an objective test of mental and/or physical capabilities, it is different from an independent medical examination (“IME”). The former requires the full participation and effort of the participant while the latter involves a doctor giving a medical opinion about the worker’s medical condition(s). Issues that can occur to an injured worker when sent to an FCE by the insurance company include evaluators:
- Alleging the injured workers did not make a full, good-faith effort to perform each activity during the FCE; or
- Unfairly administering the test in a manner that is improper or unrealistic, giving unrealistic results;
- Misreporting the test findings
An injured worker who experiences an improperly administered or skewed FCE should contact an experienced attorney to help fight for the benefits they deserve. An attorney can:
- Confirm why the workers’ compensation insurance company is requesting the FCE and seek an alternative way to establish the client’s functionality;
- Negotiate the place, time, and scope of the evaluation including the specifics of your occupation;
- Push back against the request for an FCE, should your treating providers recommend against submitting to the evaluation; or
- Challenge or appeal the findings of the FCE if it is inaccurate or flawed in any way.
We Can Help
For more information about your rights when injured, contact the skilled and experienced attorneys at H&P Law today.