How a Functional Capacity Evaluation (FCE) Can Impact Your Long-Term Disability Claim

When filing a long-term disability (LTD) claim, insurance companies often require claimants to undergo a Functional Capacity Evaluation (FCE). This assessment is designed to evaluate your physical and/or cognitive abilities to determine whether you are capable of performing the essential duties of your occupation or any other work. While an FCE can provide valuable insights into your condition, it can also significantly influence the outcome of your LTD claim.

Here, our nationwide claims attorneys at Disability Insurance Law Group explain why understanding what an FCE entails and how it affects your case is crucial for protecting your rights.

What Is a Functional Capacity Evaluation?

An FCE is a comprehensive, standardized test administered by a trained evaluator, such as a physical therapist or occupational therapist. The purpose of the evaluation is to objectively measure functional abilities and limitations.

It typically involves tests to assess:

• Physical capabilities: Strength, flexibility, endurance, balance, and range of motion.
• Cognitive abilities: Memory, concentration, and decision-making skills (if applicable).
• Task performance: Your ability to perform work-related tasks, such as lifting, carrying, sitting, or standing for prolonged periods.

The evaluator’s findings are documented in a detailed report, which the insurance company then reviews as part of your LTD claim.

How Is a Functional Capacity Evaluation (FCE) Used to Assess Eligibility for Disability Benefits?

Disability insurance companies often use an FCE to assess whether a claimant qualifies for long-term disability benefits. However, how the results are utilized can sometimes pose challenges to a claim.

Here are the key ways an FCE is used in the evaluation process:

• Detailed Evaluation of Functional Abilities: An FCE analyzes your physical and/or cognitive capabilities. It outlines your specific limitations and how these impact your ability to perform work-related activities.
• Comparison to Medical Records: Insurance companies often match FCE findings with your medical records to support or challenge your disability claim. Medical experts may also use the results during hearings or appeals to argue for or against your case.
• Alignment with Job Requirements: The report generated from an FCE evaluates whether your physical abilities align with the demands of your current job. This can determine if you can continue in your role, perform a modified version of it, or transition to an alternative position.
• Identifying Restrictions and Accommodations: FCE results can pinpoint specific work restrictions and suggest accommodations to help you perform your duties safely and effectively. This information can be critical in negotiations with your employer or insurer.
• Establishing a Functional Baseline: The FCE creates a snapshot of your current physical condition, serving as a baseline for tracking progress if you undergo rehabilitation. Disability insurers may request additional FCEs later to monitor changes in your functional abilities over time.
• Guiding Rehabilitation Efforts: The results can help rehabilitation professionals design a personalized therapy or return-to-work plan tailored to your needs and limitations.

While an FCE can offer valuable insights into your condition, it is essential to approach the process carefully and understand how your disability insurer may interpret the results. Consulting with our experienced nationwide disability insurance attorneys can help you navigate potential challenges and protect your rights.

How an FCE Can Impact Your LTD Claim

The results of an FCE can play a pivotal role in determining whether your LTD claim is approved, denied, or terminated.

Here’s how:

• Supporting Your Disability Claim: A well-conducted FCE can provide strong evidence to support your claim by objectively documenting your physical or cognitive limitations. This can be particularly helpful if your medical records alone do not sufficiently demonstrate your inability to work.
• Challenging Your Claim: Insurance companies may use the FCE results to argue that you can return to work. For example, suppose the evaluator concludes that you can perform light-duty or sedentary tasks. In that case, the insurer might deny or terminate your benefits, even if you cannot perform your regular occupation.
• Highlighting Inconsistencies: Insurance companies often scrutinize FCE results to identify inconsistencies between your reported symptoms and your performance during the evaluation. Any perceived discrepancies could be used to question your credibility.
• Potential for Bias: In some cases, insurance companies may choose evaluators biased toward their interests. This underscores the importance of ensuring the FCE is conducted fairly and objectively.

How Should I Get Ready for a Functional Capacity Evaluation (FCE) for Disability?

Start by discussing the evaluation with your long-term disability insurance attorney.

At Disability Insurance Law Group, we can help you understand whether undergoing an FCE is necessary and guide you on how to approach it. If you move forward with the evaluation, consult with your doctor and physical therapist to assess whether it is safe for you to participate and to prepare for the physical demands.

Familiarize yourself with the responsibilities of your job, and bring along a comprehensive job description to provide the evaluator with context. You may also need to gather relevant documents, including medical records and other materials, for your disability claim.

Wear comfortable, loose-fitting clothing on the evaluation day and follow your prescribed medication schedule to manage your condition. These steps can help ensure you are well-prepared for the evaluation and provide accurate information to support your disability claim.

How Disability Insurance Law Group Can Help

At Disability Insurance Law Group, we understand how critical an FCE can be to the outcome of your LTD claim. Our experienced attorneys are dedicated to protecting your rights and ensuring that insurance companies treat you fairly. If an FCE is part of your claim process, we can help you prepare, address potential challenges, and advocate for your benefits.

Don’t navigate the process alone. Contact our nationwide LTD insurance claims attorneys for a free consultation by calling 954-989-9000 or online. We’re here to provide the guidance and support you need to secure the benefits you deserve.