When filing a short or long term disability claim, you will need to provide your insurance company substantial evidence of your disabling symptoms. This can include office visit notes from your doctors, imaging, test results, and hospitalization records. In some cases, your medical records from your treating physicians may not relay the full scope of your symptoms and how they prevent you from working. You may consider undergoing a Functional Capacity Evaluation (“FCE”) to obtain more objective evidence in support of your short or long term disability claim. If you claim has already been denied, consider an FCE for your long term disability appeal.
In this article, we’ll explain what a Functional Capacity Evaluation is, what kind of disability claims a Functional Capacity Evaluation can support, how a Functional Capacity Evaluation can support your disability claim, what you should expect from a Functional Capacity Evaluation, and how the experienced team at The Maddox Firm can help prove your short or long term disability claim.
What Is a Functional Capacity Evaluation?
A Functional Capacity Evaluation (“FCE”) is a type of assessment used to evaluate your physical restrictions and limitations in relation to your ability to perform specific job tasks.
FCEs are typically conducted by occupational therapists or physical therapists and involve a series of tests and measures designed to evaluate your strength, endurance, flexibility, range of motion, and functional abilities related to work tasks. The tests are often tailored to the demands of your job and may include activities such as lifting, carrying, pushing, pulling, and repetitive motions.
The results of an FCE can be used to determine your ability to work following an injury or illness. The information gathered during the evaluation is typically documented in a detailed report, which can then be submitted to your insurance company as evidence in support of your disability claim.
What Kind of Disability Claims Can a Functional Capacity Evaluation Support?
FCEs can be used for a wide range of medical conditions that affect your physical abilities and your capacity to perform work-related tasks. Some medical conditions that may be suitable for FCEs include:
Orthopedic injuries: FCEs are often used to evaluate individuals who have suffered orthopedic injuries, such as fractures, sprains, strains, or tears of the muscles, tendons, or ligaments.
Neurological conditions: FCEs can also be used to assess individuals with neurological conditions, such as stroke, spinal cord injury, or traumatic brain injury, that affect physical functioning.
Chronic pain: FCEs are often suggested for individuals with chronic pain conditions, such as fibromyalgia, arthritis, and cervical and lumbar conditions, to determine their functional limitations and ability to perform work-related tasks.
Cardiovascular conditions: FCEs can be suitable for individuals with cardiovascular conditions, such as heart disease, to determine their physical abilities and limitations.
Pulmonary conditions: FCEs can also be used to evaluate individuals with pulmonary conditions, such as chronic obstructive pulmonary disease (COPD), to determine their physical abilities and limitations.
FCEs can be used to evaluate a wide range of medical conditions that affect physical functioning and the ability to perform job duties. If your disabling condition causes physical symptoms (such as pain, fatigue, and/or muscle weakness), the FCE may be an appropriate option. The specific tests and measurements used during an FCE can be customized to your condition and the physical demands of your job.
How Does a Functional Capacity Evaluation Support My Disability Claim?
While office visit notes, test results, imaging, and other medical records can provide evidence of your disabling symptoms, they may not give a detailed picture of how your condition affects your ability to perform specific job duties essential to your job role. An FCE will offer your insurance company a comprehensive and thorough breakdown of how your disabling condition affects your ability to carry out your occupational duties.
Here are some of the ways an FCE can help support your disability claim:
Objective evidence: An FCE provides objective, quantitative data about your physical abilities and limitations. This can be helpful in supporting your claim because it can provide evidence that your condition is limiting your ability to perform work-related tasks.
Specific job demands: An FCE can evaluate your ability to perform specific job tasks, which can be important in determining whether you are capable of performing your previous job or any other job that may be available to you.
Credibility: An FCE includes embedded validity measures that ensure the results cannot be faked. This means the data and resulting report provide your insurance company with objective medical evidence of your physical restrictions and limitations.
Remember, your insurance company will only approve your disability claim if you provide sufficient evidence of how your condition prevents you from working. This can be more difficult if your job is sedentary (i.e., working at a desk most of the day). For example, you may suffer from neck pain that makes it impossible to stare at a computer screen for hours at a time or back pain that makes it too painful to sit in an office chair for the full workday. An FCE will provide evidence of your inability to keep your head in a static position or sit in a chair for extended periods without excessive breaks.
An FCE can be a valuable tool in supporting your disability claim by providing objective evidence about your level of physical functioning and any limitations that prevent you from working.
What Should I Expect From a Functional Capacity Evaluation?
An FCE typically involves a series of tests and measurements that are designed to assess your physical abilities and limitations in relation to work-related tasks. Here is an overview of what you can expect from an FCE:
Medical and vocational history: The evaluator will typically start by reviewing your medical history, including any injuries, surgeries, or illnesses that may be relevant to the evaluation. The evaluator will also ask about the nature of your occupation to ensure that the test reflects the typical tasks you would be expected to perform at work.
Physical examination: The evaluator will perform a physical examination to assess your strength, flexibility, range of motion, and any pain or discomfort you may be experiencing.
Functional tests: The evaluator will then conduct a series of functional tests that are designed to simulate the physical demands of work-related tasks. These tests may include lifting, carrying, pushing, pulling, and repetitive motions.
Duration: The FCE is typically performed over either one day or two days. The length of the evaluation can vary depending on the specific tests that are included, but it typically takes several hours to complete.
Report: Once the evaluation is complete, the evaluator will typically compile a detailed report that outlines your physical abilities and limitations in relation to work-related tasks and offer their opinion on your ability to work.
It's important to remember that an FCE is designed to be a comprehensive evaluation of your physical abilities and limitations, and you may experience some discomfort or fatigue as a result of the tests. However, it's important to communicate any pain or discomfort you may be experiencing during the evaluation to ensure that the results are as accurate as possible.
How Can The Maddox Firm Prove My Disability Claim?
We always recommend consulting with an ERISA attorney when filing, appealing, or litigating a short or long term disability claim. The experienced team at The Maddox Firm has helped hundreds of clients with conditions causing pain, fatigue, and muscle weakness successfully file for short or long term disability. We also regularly refer clients for functional capacity evaluations.
Here are some ways The Maddox Firm can help you with a functional capacity evaluation in support of your short or long term disability claim:
The Maddox Firm will examine your disability insurance policy. Disability insurance policies can be lengthy, complex, and difficult to understand if you aren’t familiar with the terminology. The Maddox Firm will examine your policy and explain the terms to you so you understand what your insurance company requires for benefit approval. By reviewing the policy, we can also determine what level of evidence is needed to get your claim approved. This allows us to formulate a strategy for your short or long term disability claim.
The Maddox Firm will gather all of your medical and vocational evidence. The Maddox Firm knows what evidence your insurance company will demand in order to approve your claim. We will request and obtain existing medical records on your behalf, as well as review vocational evidence such as your resume and official job description. We can then determine if additional evidence is required to get your disability claim approved.
The Maddox Firm will help you obtain any needed additional evidence. The Maddox Firm can refer you to providers for additional testing, including an FCE. We routinely refer our clients to undergo FCEs and review the resulting reports. The Maddox Firm typically recommends clients opt for a two-day FCE. A two-day FCE entails two days of testing in a row. This way the results will reflect any degradation of your physical functioning on the repeat test, thus offering further evidence of a lack of endurance and inability to meet your occupational demands.
Once you have undergone the FCE, we will coordinate with the evaluator to ensure the final report reflects the full extent and severity of your physical impairments. We check the report for accuracy and any missing information that your insurance company will question. We will also coordinate with your treating physicians to review the report and obtain statements of support that the FCE results align with their medical opinions of your disability.
The Maddox Firm will handle all communications with your insurance company. When you retain The Maddox Firm, we will immediately take over any communication with your insurance company. We make certain that all required paperwork is received, completed, and reviewed by your insurance company in a timely manner. If your insurance company requires an interview with you, we will prepare you for the meeting and sit in to ensure that your insurance company does not overstep its bounds.
The Maddox Firm will handle an appeal or litigation on your behalf. If your disability claim has already been denied, or your benefits are terminated, The Maddox Firm can handle your appeal or litigation with your insurance company.
We always recommend speaking with a trusted attorney before filing or appealing a short or long term disability claim. Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.