A Workers Comp Functional Capacity Evaluation (FCE) Guide
What an FCE Is and How it Affects Your Work Injury Claim
Your treating doctor’s opinions on your remaining work capacity and level of permanent partial disability often determine what workers compensation benefits you get.
Knowing the value of favorable reports from a treating physician on disability status and legal and medical causation during litigation, claim adjusters and attorneys for injured workers and employers frequently contact doctors for supporting evidence.
But unfortunately, many doctors do not have training or interest in assessing medical work restrictions.
So instead of addressing these issues directly, your physician may give in to the insurer’s request that the doctor order workers comp patients to undergo a functional capacity evaluation (FCE).
And that may be why you are visiting my website.
Completing the workers comp FCE is a milestone in your occupational injury claim.
This article intends to answer some of the common questions that injured workers have with the functional capacity evaluation and its assessment of disability and what to do after an FCE to boost the potential settlement value of your workers comp case.
Contact us if your doctor or the claim adjuster asked you to undergo an FCE or if you have questions about how the FCE results might affect your workers comp case.
We have helped hundreds of injured workers resolve their claims successfully. And we want to get you every penny and medical treatment you deserve.
What Does FCE Stand For?
The acronym FCE stands for functional capacity evaluation.
What is an FCE?
A functional capacity evaluation is a set of tests, measurements, and observations to assess your physical abilities to safely perform work and daily living activities.
Who Uses FCEs?
Doctors, insurance defense lawyers, insurance claim adjusters, third-party claim administrators (such as Sedgwick CMS, ESIS, or Gallagher Bassett), medical case managers/nurse case managers, self-insured employers, and vocational rehab counselors may use or request FCEs in workers comp, personal injury (auto accident), Social Security disability, and long-term disability claims.
Injured workers and claimants’ attorneys, however, rarely ask for functional capacity evaluations because the injured worker already knows what they can and cannot do at work. You do not need a physical therapist to tell you what you are already experiencing.
What is the Workers Comp FCE’s Purpose?
The FCE’s purpose depends on who you ask.
Workers comp professionals often disagree on the true purpose of asking an injured worker to undergo a functional capacity evaluation.
Insurers argue that FCEs are a valuable tool to determine return-to-work ability.
However, injured workers and their attorneys submit that FCE results are weaponized in litigation and are worthless in determining what job activities a person can do forty hours per week, week after week.
Let’s take a look at both views.
Reasons Given by Supporters of FCEs for Occupational Injuries and Illnesses
Workers comp professionals who favor FCEs for injured workers argue the evaluations are an objective and measurable way of:
- Determining whether you can work
- Assessing what exertional level of work you can perform despite the effects of your occupational injury
- Evaluating if you can return to your pre-injury job with or without accommodation
- Measuring the effectiveness of a specific treatment protocol by comparing FCE performance before and after the treatment
Though these purposes are legitimate, I disagree with the FCE’s ability to answer these questions with validity.
Why Claimants and Their Attorneys Dislike FCEs: The Real Reasons that Employers, Insurers, and Claim Administrators Want Functional Capacity Evaluations
There are several reasons I find FCEs to be overvalued and inaccurate in workers compensation cases.
First, physical and occupational therapy clinics performing functional capacity evaluations often use FCE software.
The examiner enters data from your tests into the computer program, and the FCE software prints a report with conclusions about your work capabilities and the effort given during testing.
If the software’s algorithms are flawed or do not apply to all the health factors you present, the FCE results are invalid and likely overstate your capabilities.
Second, clinics performing workers comp FCEs have a financial incentive to use software whose methods overstate an injured worker’s abilities.
Employers, insurers, and claim administrators pay for FCEs in most cases. Therefore, the FCE facility has a reason to produce results that please employers and insurers, weakening your case.
Third, the ability to perform work activities for a few hours, or even a few days, does not mean you can maintain that performance full-time, week in and week out.
Therefore, the FCE may overestimate your remaining capacities.
Fourth, in my experience and opinion, employers, insurers (such as Travelers, The Hartford, and Liberty Mutual), and third-party claim administrators (such as Sedgwick, ESIS, CorVel, and Gallagher Bassett) use FCEs to:
- Strengthen the defense medical expert’s opinion (often the IME doctor) that you are not as disabled as you or the treating physician allege
- Persuade your treating physician that you are malingering (faking or exaggerating the severity of your injury and symptoms) so that the doctor will release you to full duty with no restrictions
- Ask your doctor to state that no further medical treatment is needed, reducing the value of future medical expenses related to the workers comp claim
- Decide if the pre-injury employer can offer light-duty employment, reducing the insurer’s financial exposure.
- Predict the likelihood that vocational rehabilitation would find modified duty earning at or near your pre-injury average weekly wage.
- Attack your credibility to weaken your case at a workers comp hearing
- Develop evidence to serve as the basis for stopping workers comp payments (including temporary total and temporary partial disability)
- Obtain conflicting evidence unfavorable to you when there is a dispute about returning to work and the severity of your permanent impairment
When is the Functional Capacity Evaluation Scheduled?
The workers compensation statutes do not provide a time limit by which you must have an FCE.
Nor do the statutes state that you must undergo a functional capacity evaluation or can have only one.
In my experience, the insurer may ask your doctor to prescribe an FCE at one of the following times:
- Soon after your work accident. Results of later FCEs given after receiving medical attention are compared to this first functional capacity evaluation to measure your recovery.
- When you have reached maximum medical improvement for the injury (only palliative treatment may be necessary for the future)
- When you are having difficulty performing light-duty work within your medical restrictions
- When the objective findings on diagnostic imaging do not support your subjective pain complaints
- When you are healing slower than the health care practitioners predicted
- When surveillance footage shows you performing daily living activities outside your medical work restrictions
Does My Doctor Have to Order an FCE to Determine My Permanent Work Restrictions?
No, the law does not require that your physician prescribe a functional capacity evaluation to determine work status.
Indeed, doctors often make return-to-work decisions and provide light-duty restrictions during the healing phase before you reach maximum medical improvement (MMI).
And historically, physicians used their diagnosis and clinical examinations to assess their patients’ remaining work capacity.
Indeed, the necessary work restrictions may be obvious if your diagnosis has been established.
For example –
- An Achilles tendon tear or foot fracture may impact the ability to drive heavy machinery such as forklifts
However, some doctors have moved away from these decisions over the years, instead relying on FCEs.
Why Do Some Physicians Prescribe FCEs?
Several things explain why physicians ask workers comp patients to undergo functional capacity evaluations more now than in the past.
First, health care practitioners such as occupational therapists have marketed their FCE services to other medical providers, self-insured employers, and insurers.
Second, many doctors chose their profession to diagnose, treat, and heal their patients instead of opining on work capabilities. And they prefer to stick to those acts.
Third, many physicians do not have education or training in assessing a person’s functional disability. And stating an opinion on medical work restrictions is outside some physicians’ comfort zone.
Fourth, requesting the FCE may appease the insurance carrier’s demands and pressure on the doctor (often through a nurse case manager) to release you to some form of work.
Fifth, punting the decision on permanent work restrictions to an FCE examiner allows the doctor to avoid dealing with the conflict between competing parties in litigation or provide an opinion on a contested issue.
Do I Have to Attend the Workers Comp FCE?
Yes, you must attend the FCE if your treating physician made a legitimate referral for an FCE and did not simply acquiesce to the insurer’s request that you undergo such an examination.
The functional capacity evaluation is considered medical treatment and vocational rehabilitation under workers comp.
Unjustifiably refusing to attend the FCE may result in the employer or insurer moving to stop your wage loss payments.
Where Will the Functional Capacity Evaluation Take Place?
The FCE will take place at a medical facility near where you live.
If you need transportation, the insurance company must provide it.
If you drive yourself, you are entitled to mileage reimbursement. So keep track of how far you travel and submit this information to the insurance company.
Who Administers and Interprets the FCE Tests?
Usually, a physical therapist or an occupational therapist licensed in your state administers and interprets the functional capacity evaluation.
Indeed, I have not seen a medical doctor or orthopedic surgeon administer FCEs in the more than 1,000 cases I have handled.
Who Pays for the Functional Capacity Evaluation?
In most cases, the insurance company will demand you undergo an FCE and pay for the evaluation.
Indeed, the only time you might pay for the FCE is if you ask for one, but your treating physician refuses to prescribe it. Then you can seek the FCE on your own and will likely have to pay for it.
But this situation is rare.
And in my opinion, you would be better off getting a second medical opinion than paying for an FCE if you disagree with your treating doctor’s statement on work capacity.
How Much Does an FCE Cost?
The cost of the FCE usually depends on your geographic location.
Usually, physical therapy practices charge from $500 to $1500 to conduct the workers comp functional capacity evaluation and write a report.
How Long Do FCE Tests Take?
You should expect the day of your FCE to be long and grueling. Indeed, you might struggle to complete many of the tasks, especially when you have been on medical leave for a work injury for an extended period.
Generally, the functional capacity evaluation will involve three to eight hours of testing over one to two days.
Some FCE tests, however, take longer to complete.
What Happens During an FCE?
Types of Functional Capacity Evaluations
There are two functional capacity evaluation types: the General Purpose FCE and the Job Specific FCE.
Job/Occupation Specific FCEs
The Job Specific FCE measures your ability to perform the physical demands of a specific job, usually your pre-injury job.
The Job Specific FCE determines whether you can return to your pre-injury work and, if not, what modifications and accommodations you’ll require.
In my experience, job-specific functional capacity evaluations are used most of the time in workers comp.
Any Occupation/General Purpose FCEs
In any occupation functional capacity evaluation, the examiner tries to find jobs that you can perform based on your remaining capacity (or what the FCE examiner says it is).
In my experience, any occupation FCEs (or similar tests) are more common in long-term disability claims and applications for Social Security disability benefits than workers comp.
What the FCE Examiner Should Do Before the Tests
Regardless of the type of FCE you undergo, the FCE examiner should have taken the following steps before you arrive for testing:
- Reviewed the reason for the FCE referral, noting your treating physician and the testing’s purpose
- Read your medical records, noting how you were hurt, your diagnosis, the results of objective diagnostic testing (MRIs, CT scans, X-rays), surgeries performed, and other chronic medical conditions.
- Reviewed a written job description for your pre-injury employment
The FCE examiner should use the pre-injury job description to classify that employment under the U.S. Department of Labor’s “Selected Characteristics of Occupations as Defined in the Revised Dictionary of Occupational Titles.”
This publication classifies jobs into the following physical demand levels:
- Light (occasionally lift to 20 lbs. and frequently lift to 10 lbs.)
- Medium (occasionally lift 20 to 50 lbs., frequently lift 10 to 25 lbs., and constantly lift 10 lbs.)
- Heavy (occasionally lift 50 to 100 lbs., frequently lift 25 to 50 lbs., and constantly lift 10 to 20 lbs.)
- Very Heavy (occasionally lift over 100 lbs., frequently lift over 50 lbs., and constantly lift over 20 lbs.)
Before starting the tests, the FCE examiner should also conduct an intake interview to determine your date of birth, height, weight, personal beliefs on what you can do, and other background information.
Further, the evaluator will ask you to sign an informed consent form, acknowledging the risk for injury and soreness and who the examiner will release the FCE results to.
What Paperwork Do I Have to Complete before the FCE?
The FCE examiner should give you the paperwork they want you to complete at least one week before the tests.
I recommend reviewing this paperwork with your attorney to determine if you must complete it.
Some questions have no relevance to your claim and are improper.
What Tests are Given During the FCE?
The FCE examiner may ask you to undergo the following types of tests during the evaluation:
- Psychosocial Screening and Comprehensive Pain Assessment to rate your perceived disability, fear-avoidance beliefs, anxiety, and depression: These tests include the McGill Pain Questionnaire, Dallas Pain Questionnaire, Oswestry Back Disability Questionnaire, PHQ-9, Pain Disability Index, Functional Pain Scale, Tampa Scale for Kinesiophobia, Orebro Musculoskeletal Pain Screening Questionnaire, and more.
- Heart Rate Analysis
- Blood Pressure Testing
- Aerobic Abilities Testing
- Material Handling Testing
- Postural Abilities Testing
- Coordination and Flexibility Testing
- Work Simulation Testing (such as carrying items you handled on the job or climbing and descending ladders or stairs)
- Five-Position Grip Testing
- Rapid Exchange Grip Testing
- Hoover Testing
- The Visual Analogue Scale
- PACT Spinal Function Sort
- Dexterity Testing
- Valpar 9 Whole Body Range of Motion
- Mobility Testing
- Repetitive Movement Screening
- Strength Testing
The purpose of these tests is to assess your ability to:
- Lift (floor to waist, waist to shoulder, and overhead)
- Carry
- Push
- Pull
- Walk
- Stand
- Bend
- Crouch
- Squat
- Kneel
- Crawl
- Stoop
- Rotate
- Climb
- Grasp
- Manipulate objects
The FCE Report
The FCE examiner will prepare a written report within a few days of the testing, noting the results and conclusions.
This report should include the results of each test or survey performed and statements about your effort, demonstrated physical capabilities, and whether you can return to your pre-injury job with or without accommodations (and what those accommodations would be).
Tips for Doing Well on the Functional Capacity Evaluation
Here are some general tips to prepare for your workers comp FCE:
- Arrange transportation immediately. You want to be relaxed during the FCE. If you are scrambling for a ride at the last minute, this may affect your performance.
- Dress comfortably. You will be performing physical activities, so make sure you dress comfortably. Wear athletic shorts or pants and tennis shoes. Do not wear a suit and tie.
- Bring water. An FCE can last for several hours. Bring water so that you remain hydrated.
- Give your best effort, but don’t overdo it. The FCE is supposed to measure what you can do over a 40-hour work week. If you’re in pain, speak up and tell the FCE examiner.
- Don’t take your pain medication before the FCE. We understand that this may be uncomfortable, but some pain medications can hide your pain – which provides an inaccurate measurement of your true abilities that overstates what you’re capable of doing.
- Always act as though someone is watching you. From the moment you pull in the parking lot to the moment you leave the parking lot, the FCE examiner may be watching you to see if you’re telling the truth and giving an honest effort.
Does My Treating Physician Have to Sign Off On (Adopt) the FCE Results?
No.
Your treating doctor may reject the FCE results and state that you have additional restrictions due to your occupational injury.
For this reason, I often tell injured workers not to worry about an unfavorable FCE report in and of itself.
So long as your treating physician stays supportive and keeps your work restrictions the same, you may be able to keep receiving workers comp payments.
Generally, the case law provides that a treating physician’s opinions receive greater weight than opinions from other health care practitioners, including FCE examiners.
I suggest seeing your treating physician soon after the FCE to discuss how you felt during and after the tests. This type of medical report can boost your treating doctor’s opinions on work capacity and persuade them not to adopt the FCE results blindly.
How to Challenge Unfavorable FCE Results
Close to half of the FCE results I review (or more) question the injured worker’s effort, suggest malingering (faking or lying about symptoms) for monetary gain, or conclude the worker can do more than they (or their treating doctor) think.
Do not sit back and take these results.
If you disagree with the FCE and your physician’s acceptance of the results, I recommend taking the FCE examiner’s deposition and using discovery tools to develop evidence in these areas:
Question the FCE Examiner’s Training, Licensing, and Familiarity with the Tests
Ask the physical therapist about their training, licensing, and familiarity with the functional capacity evaluation method.
Sample questions include:
- Where did you go to school?
- What professional certifications and licenses do you have?
- How many years have you been a physical therapist?
- What FCE software did you use? There are more than five types of FCE software, each using different methods.
- What training did you receive in administering this specific FCE type?
- What user and interpretation manuals did you receive and review before conducting the FCE?
- How many of these FCEs have you given?
- What percentage of these FCEs were completed at this insurer’s request?
- How do you determine that the FCE is valid? State all criteria.
- What independent research can you provide showing that this FCE method is reliable?
- Can you tell me the US Dictionary of Occupational Title’s definition of sedentary and light employment?
- Do the FCE results state whether my client can perform every activity with this physical demand level?
Address Other Health Conditions and Medical Impairments Affecting FCE Performance
Other medical conditions and treatment methods can affect your FCE performance and results.
Therefore, you should present evidence about these conditions and question the FCE examiner about how these medical impairments could skew the results.
Examples of medical issues affecting FCE results include:
- Carpal tunnel syndrome
- Cognitive difficulties
- Diabetes with peripheral neuropathy
- Hypertension
- Illiteracy
- Medication to lower your blood pressure
- Obesity
- Old age
- Pain medication that may cause drowsiness, dizziness, fatigue, or brain fog
- Past injuries
- Post-concussion syndrome causing headaches
- Pulmonary problems such as black lung disease
- Preexisting conditions such as degenerative disc disease, degenerative joint disease, and osteoarthritis
- Psychiatric problems such as anxiety, depression, or Post Traumatic Stress Disorder (PTSD)
- Reading comprehension difficulties
- Skin conditions such as excessive sweating could affect the leads and data used to determine the results
Challenge Whether the “Malingering” Tests Mean What the FCE Examiner Says They Mean
Many FCE reports question the injured worker’s credibility regarding symptoms, relying on positive Waddell’s signs, inconsistent grip strength testing, and pain questionnaire results.
However, the medical literature does not support using these tests to conclude that a patient has unexplained symptom magnification or is a malingerer.
Documents to Request from the FCE Examiner
Subpoena the physical therapist’s file and request the following papers:
- All hand-written notes from your FCE
- The FCE software manual
- All forms completed by you before the functional capacity evaluation
- Any correspondence, including emails to and from the FCE examiner and the insurer or its agents, regarding the evaluation and your performance
- All billing statements related to the FCE and year income from providing functional capacity evaluations
- Raw testing data
- Copies of written job descriptions to review their accuracy and completeness. Under workers comp law, you are incapable of performing your pre-injury job if you cannot do every single task required of you at the time you were hurt, even if you did it rarely.
What Happens if I Get Reinjured or Exacerbate the Injury During the FCE?
The FCE tests are strenuous and given when you have been inactive (or not working) for an extended period.
Unfortunately, this combination of factors may result in pain exacerbation or injury during the FCE.
You have a few ways to deal with concerns over reinjury during the FCE.
First, discuss the concerns with your doctor when the FCE is prescribed, requesting either no FCE or a short-form FCE.
Second, send a letter to the FCE examiner with your concerns if your doctor asks you to undergo the functional capacity evaluation despite your hesitation.
I hope notifying the FCE examiner will prevent re-injury.
But if it doesn’t, you can seek emergency medical treatment and file a change in condition claim to hold the employer and insurer responsible for wage loss and medical care related to the injury suffered during the FCE.
Is My Workers Comp Claim Closed After the Functional Capacity Evaluation?
No.
Your workers comp claim continues after the FCE.
You may continue to receive wage loss and medical benefits.
Does the FCE Determine the Timing or Amount of My Workers Comp Settlement?
Every workers comp claim has certain stages where it makes sense for the parties to consider settlement with a cash buyout of future medical expenses.
One such stage is the receipt of your FCE results.
After your treating physician reviews the FCE report, you will have a better idea of:
- Your permanent restrictions from the occupational injury,
- What jobs you can do within those restrictions (and how much they might pay), and
- Whether the pre-injury employer can accommodate your limitations.
The insurance company has two options if the employer cannot accommodate whatever restrictions you receive after the FCE:
- Keep paying wage loss benefits or
- Start providing vocational rehabilitation services, which are costly and rarely successful
These factors and the fact that you can predict future medical costs more accurately when you have reached MMI make settlement after the FCE common, but not mandatory.
Who are the FCE Providers in Virginia?
If you and your attorney decide to get an FCE of your own, I recommend researching the following functional capacity evaluation providers in Virginia:
- Alliance Physical Therapy with locations throughout Virginia
- Bon Secours in Motion with locations in Hampton Roads
- Centra Industrial Rehabilitation in Lynchburg, Farmville, and Gretna
- CORA Physical Therapy in Bedford, Midlothian, Lynchburg, Hardy, Vinton, Daleville, and Danville
- Dynamic Rehab Therapy in Fairfax
- Hampton Roads Orthopaedics and Sports Medicine with locations in Newport News, Yorktown, and Williamsburg
- Industrial Health with multiple locations in Northern Virginia and Maryland
- Ivy Rehab Network with locations in Charlottesville, Chesapeake, Culpeper, Falls Church, Mechanicsville, Midlothian, Newport News, Orange, Richmond, Waynesboro, and Zion Crossroads
- Lucas Therapies in Roanoke
- NOVA Chiropractic & Rehab Center of Sterling
- Peninsula Physical Therapy & Associates in Hampton
- Physical Therapy Solutions in Richmond
- Pivot Physical Therapy with locations across Virginia
- Rehab at Work
- Select Physical Therapy in Richmond
- Sheltering Arms in Richmond
- Southeastern Physical Therapy with locations throughout Hampton Roads
- Virginia Therapy and Fitness Center in Reston
The functional capacity evaluation is just one part of the workers compensation puzzle.
But it is an important part that can increase or decrease your claim’s value by tens of thousands of dollars in benefits or a lump sum.
An experienced workers comp lawyer can help you prepare for the FCE and determine the necessary steps after receiving the FCE results.
Ultimately, the goal is to keep your benefits and increase the settlement value after the FCE.
Call now for a free consultation.
My firm helps injured workers across Virginia, and we want to protect your rights, so you get every dollar you deserve.
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