A Functional Capacity Evaluation Can Bolster Your Long Term Disability Claim
- Matthew Maddox
- Feb 22, 2023
- 10 min read
Updated: Apr 1, 2024
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 New Jersey and New York long term disability lawyers at The Maddox Firm can help prove your short or long term disability claim.
What Is a Functional Capacity Evaluation?
A Functional Capacity Evaluation or Functional Capacity Assessment serves as a comprehensive and systematic assessment aimed at meticulously determining an individual's physical capabilities and restrictions, especially in the context of their professional responsibilities. This evaluation is crucial for individuals seeking to understand the extent of their physical abilities following an injury or a prolonged illness and how these might impact their capacity to execute specific job-related tasks effectively.
Conducted primarily by skilled occupational therapists or physical therapists, an FCE comprises an extensive array of tests and evaluative measures. These are carefully designed to assess various physical attributes, including but not limited to, muscular strength, cardiovascular endurance, flexibility, range of motion, and overall functional prowess in a work setting. The evaluative process is highly individualized, with tests specifically chosen and customized to reflect the physical demands and requirements of the person's specific job role. For instance, if a job entails manual labor, the FCE might focus more on tests that assess the ability to lift, carry, or move heavy objects. Conversely, for a desk-bound professional, the emphasis might be on stamina, flexibility, and the capacity to maintain certain postures for extended periods.
Activities incorporated into an FCE can vary widely but often involve simulated work tasks such as lifting, carrying, pushing, pulling, bending, reaching, and performing repetitive motions. These activities are not arbitrary; they are strategically selected to mirror the actual work tasks the individual is expected to perform, providing a realistic assessment of their work-related capabilities and limitations.
Upon the completion of an FCE, the findings are compiled into a comprehensive and detailed functional capacity report. This report is instrumental in providing a clear, objective, and evidence-based perspective on the individual's capacity to perform their job following their medical issue. It evaluates the person's work-related functions in light of their physical limitations and capabilities, offering invaluable insights into possible workplace accommodations or adjustments that might be necessary.
This detailed functional capacity report serves multiple purposes: it not only guides the individual and healthcare providers in understanding the extent of work-related physical abilities but also acts as a pivotal piece of evidence in the context of a disability claim. When submitted to an insurance company, the FCE report can significantly influence the determination of the individual's eligibility for disability benefits, offering a solid foundation for their claim by highlighting the concrete impacts of their physical condition on their professional life.
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.
Musculoskeletal Disorders: Chronic back pain, arthritis, fibromyalgia, and other musculoskeletal disorders can impair an individual's ability to perform routine work activities. An FCE can quantify these limitations in terms of strength, flexibility, and the ability to maintain postures.
Chronic Pain Conditions: Chronic pain can be debilitating and affect various aspects of physical function. An FCE can help document the impact of chronic pain on an individual's ability to engage in work, especially when pain fluctuates or intensifies with certain activities.
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.
Cancer and Post-Treatment Conditions: Individuals recovering from cancer or undergoing treatment may experience fatigue, weakness, or other symptoms that affect their work ability. An FCE can provide an objective assessment of these 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 disability insurance company will only approve your 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. See below for a more detailed listing of the types of testing you can expect from a functional capacity assessment.
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.
Functional Capacity Report: Once the evaluation is complete, the evaluator will typically compile a detailed functional capacity 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.
What Types of Tests Will a Functional Capacity Evaluation Include?
An FCE utilizes a series of diverse tests designed to assess an individual's ability to perform various physical tasks, reflecting their capability to engage in work-related activities. These tests are comprehensive and are typically customized to align with the individual's job requirements or daily living activities. Here's an overview of the common types of tests and assessments that may be included in an FCE:
Strength Tests: These tests measure the individual's muscular strength, including upper and lower body strength. They might involve lifting weights, carrying objects, or using dynamometers to assess grip and pinch strength.
Endurance Assessments: These are designed to evaluate the individual's stamina and ability to perform activities over a prolonged period. It could involve repeated or sustained activities to see how long the individual can maintain a certain level of physical effort.
Flexibility and Range of Motion (ROM) Tests: These assessments measure the flexibility of various joints and the range of motion they can achieve. It's crucial for determining how movement limitations might affect the ability to perform specific work tasks.
Balance and Coordination Tests: These tests evaluate an individual's stability and coordination, essential for many job functions, especially those that require physical agility or the operation of machinery.
Functional Mobility Tests: These assess how well an individual can move about, including walking, climbing stairs, crouching, or bending, which are common activities in many workplaces.
Dexterity and Fine Motor Skills Assessments: These tests focus on the individual's ability to perform tasks that require fine motor control, such as assembling small parts, writing, or typing.
Postural Analysis: This evaluation looks at the individual's ability to maintain various postures, such as sitting, standing, or stooping, which are relevant to many job types.
Simulated Work Tasks: These are tailored to mimic the specific job duties of the individual being evaluated. For example, if someone's job involves repetitive packing, the FCE might include a simulated packing task.
Pain Assessment: While subjective, evaluators will note pain responses during various tests to assess how pain might limit work capacity.
Cardiovascular Endurance Tests: These might be included to assess the heart rate, blood pressure, and fatigue levels during physical exertion, especially for individuals with cardiovascular concerns.
Lifting and Carrying Tests: Evaluating the maximum weight an individual can safely lift and carry is a common component of an FCE, reflecting a critical aspect of many job functions.
Hand Function Tests: These evaluate grip strength, hand-eye coordination, and the ability to perform tasks requiring manual dexterity.
How Can The Maddox Firm Prove My Disability Claim?
We always recommend consulting with a long term disability 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.
Whether you are looking for assistance in navigating the short term disability or long term disability claims process, appealing a claim denial, or litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine 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. Our New Jersey and New York long term disability attorneys help clients nationwide.