All About Functional Capacity Evaluations for Workers’ Comp
July 22, 2023 · 5 min read
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As you receive workers’ compensation benefits, the insurance company may ask you to complete a functional capacity evaluation (FCE). An FCE helps everyone involved in the workers’ comp process to understand whether you can handle the physical or mental requirements for you to return to work.
It’s understandable to be nervous, but Atticus is here to address your worries and explain what you should expect from your FCE. Ultimately, the best way to get the benefits you deserve is to do everything to the best of your ability throughout the evaluation and present your condition truthfully to the evaluator.
What is a functional capacity evaluation?
A functional capacity evaluation, or FCE, is a medical assessment that tests your physical or mental ability and limitations for doing work-related tasks.
The main goal of an FCE for someone getting workers’ comp benefits is usually to determine if you can return to work. FCEs also provide information that can affect your treatment plan and return-to-work programs, like which light-duty tasks you can do.
Depending on the provider you see, an FCE can take anywhere from four to eight hours. Your assessment might also happen in multiple sessions over a couple of days.
Functional capacity evaluation vs. independent medical exam
During an IME, your doctor provides their expert (but subjective) opinion of your ability to work. An FCE has much stricter tests and benchmarks, making it more objective than an independent medical exam. For that reason an FCE also tends to take longer.
What happens during an FCE?
Most functional capacity evaluations start with an interview with the evaluator and a review of your medical record. From there, you’ll go through a series of tests to assess your muscular function and ability to do certain physical activities. In some cases, your exam could include a mental health assessment.
During an FCE, the evaluator might test your ability to:
Lift and carry different weights
Push and pull
Move your hands
Crouch and kneel
The evaluator will choose the tests you go through based on your specific workplace injury or illness and your original job duties. They’ll want to see if you can handle the physical and requirements of your job.
Who performs a functional capacity evaluation?
A functional capacity evaluator, who is an occupational therapist or other physician specially trained to perform FCEs, will perform the assessment. The evaluator will then send their results to your workers’ comp treating physician.
When should you expect to get an FCE?
An FCE usually happens near the end of your workers’ treatment. When your employer or workers’ comp doctor requests that you complete an FCE, it likely means they think you’ve reached maximum medical improvement (MMI) and are ready to go back to work. The evaluation gives them an objective measure of your condition, which can help them justify the end of your medical benefits.
Can you fail a functional capacity evaluation?
Your FCE isn’t a matter of passing or failing. It’s just a test of your physical ability to see what support you still need in order to return to work.
If you have an upcoming FCE, the best approach is full honesty and to perform all tests to the best of your ability. Evaluators are also trained to assess someone’s condition, so they’ll be able to tell if you’re pretending to have more or less function than you actually have.
Lying or attempting to fail a functional capacity evaluation on purpose could also lead to the end of your workers’ comp benefits. In serious cases, you could even face fines and other legal action.
After your FCE, if you feel the results don’t accurately reflect your physical ability, you may be able to challenge the results. But it will be difficult to get your workers’ comp board or a judge to rule against the evaluator’s report.
What happens after your FCE?
After you complete your functional capacity evaluation, you’ll have a follow-up appointment with your workers’ comp doctor to review the results. Your doctor will also ask you about how you felt before, during, and after the FCE to get an idea of how your body is recovering after physical exertion.
Then your doctor, your employer, and your employer’s insurance will use the FCE results to decide if you can return to work. They might clear you to go back or recommend more treatment. If your injury or illness will have a permanent impact on your ability to work, you may also transition to long-term workers’ comp benefits, called permanent disability benefits.
The best way to get help maximizing your benefits is with a workers’ comp lawyer. A local lawyer will know the ins and outs of your state’s laws, including what benefits you should be receiving.
If you don’t agree with your FCE results or your treating physician’s decision to send you back to work, a lawyer can also help you to appeal for the additional medical benefits and payments you need while you recover. Even though an FCE aims to be objective, the decisions that your insurance or doctor makes based on it are still subjective.
Atticus can help you find an experienced workers’ comp lawyer near you. Start with our short workers’ comp quiz and if it looks like a lawyer could help your case, our team will reach out to learn more and match you with a lawyer. Getting matched is free and your lawyer won’t charge anything upfront.
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Frequently asked questions about workers’ comp benefits
How long your benefits last varies by state, but you usually have until you reach maximum medical improvement. There are also long-term options if you can’t return to work after injury.
How long does workers' comp cover medical bills?
Workers’ comp medical benefits generally last until you reach maximum medical improvement. At that point, if you qualify for long-term (permanent disability) benefits, you’ll likely receive a settlement offer to help cover future medical care and lost wages.
What if I disagree with changes to my benefits?
If you disagree with any changes to your benefits, like after an independent medical exam or functional capacity evaluation, find a local workers’ comp lawyer to learn your options. You can likely appeal a decision or negotiate higher benefits.
Will a workers’ comp lawyer help me get better benefits?
A workers’ comp lawyer can help you negotiate for more or higher benefits. As an example, the average workers’ comp settlement is five times higher for people who have a lawyer versus people who don’t. Those gains also more than offset the cost of a lawyer.
How long ago did you get an injury or illness at work?
Victoria Muñoz is an attorney on Atticus’s Workers' Compensation team. She’s a licensed attorney, a graduate of Stanford Law School, and has counseled hundreds of people seeking workers' compensation. In her free time, she enjoys hiking and spending time with her pup.
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