A Comprehensive Functional Capacity Evaluation Guide
Workers’ compensation is an insurance paid by employers to cover workers. In the event of a workplace injury or work-related illness, employees can file a claim to receive benefits — including wage loss benefits and medical benefits, among others — to cover expenses while they recover.
However, to file and process a claim, it becomes important to prove the injury and to objectively quantify the seriousness of the injury. It is especially important to evaluate how much an injury or illness impacts a worker’s ability to perform their work tasks.
When a worker has healed and is allowed to return to work, employers and insurers also need to evaluate whether a worker is actually ready to return to work — and in what capacity. Insurers and employers want to be certain workers don’t return to work so soon that they pose a risk to themselves and others. A workers’ compensation functional capacity evaluation (FCE) addresses some of these issues.
What Is a Functional Capacity Evaluation?
An FCE may be ordered by an attorney, an insurance provider offering health coverage or by your employer. The FCE is a series of tests used to evaluate your work-related physical abilities. The tests in an FCE will always be performed by an evaluator certified to conduct these examinations.
A functional capacity evaluation is designed to be safe and to provide impartial information about an injury or illness. The tests that are part of an FCE will evaluate a worker’s:
- Range of motion
- Physical strength
- Lifting ability
- Stamina and ability to carry objects
- Other abilities required for their job
In essence, a functional capacity evaluation helps to address the idea of injury or disability. Sometimes, a disability or injury is obvious. However, determining how injured someone is and how much their injury affects their ability to work is more challenging. An FCE works to define injury and to professionally evaluate the level of ability in a standardized way, which is often needed to determine the correct level of benefits. Rather than just labeling all injured workers as “incapacitated” or “injured,” a functional capacity evaluation takes a look at each worker in an individualized way to determine the best way to proceed.
A functional capacity evaluation is also one way an injured worker’s ability is matched to the demands of the job. Each FCE is adapted for the specific injury and the specific job title the worker has. The role of the FCE is to determine how well an employee’s current abilities match the demands of their job.
For example, if a postal worker needs to carry bags of mail and walk long distances as part of their job, a functional capacity evaluation may involve testing the worker’s ability to walk and carry heavy weights if they have suffered a back injury. If the FCE determines the worker cannot walk long distances, then the worker may not be able to return to the same duties but might be able to handle a desk job at the post office instead.
In another case, an office worker with a similar injury may be cleared to return to work, or the FCE report may recommend the worker sit for no more than two hours at a time. In each case, the functional capacity evaluation determines recommendations for each specific injury and person, since every injury and illness is different.
Why Are Functional Capacity Evaluations Important in Workers’ Compensation Claimants’ cases?
A functional capacity evaluation for a disability or illness helps to determine whether you can return to work. If you can return to work, an FCE can help determine whether you must return to work in a reduced capacity or whether certain accommodations must be made. Functional capacity evaluations are important in workers’ compensation cases because:
- They can help determine whether you can return to work. Trying to decide when an employee can return to work is an important step in the healing process. The FCE is one tool that can help gather data to answer this question.
- They can determine whether you need to return to work at a reduced capacity to avoid re-injury. Returning to full work duties too soon can cause re-injury, especially if a worker overstrains a muscle that has not healed yet or pushes it too far too soon. The goal in every case is to help an employee return to work safely.
In a functional capacity evaluation, a qualified evaluator can determine any limits the worker (or employer) needs to consider. For example, a functional capacity evaluation may determine a worker can sit for no more than two hours at a time or cannot carry objects weighing more than ten pounds. A worker may be told they can only return to sedentary work, or they may be cleared for heavy-duty work. Knowing these rules and obeying them can help ensure complete recovery from a workplace injury.
- They can prevent additional workplace injury. In addition, knowing the possible limits and risks of a worker can prevent injuries to other workers. If a worker cannot carry heavy items, for example, an FCE can help determine this — reducing the risk that the employee will drop a heavy box on a co-worker’s foot, for instance, because they overestimated their abilities. A functional capacity evaluation reduces the risk by keeping workers out of the workplace if they do not have the right capacity levels for their duties.
- They can help objectively resolve disputes about level of injury. Sometimes, a worker and employer or insurer will not agree about level of disability or injury. In these situations, an FCE from a professional can help provide authoritative information about capacity and readiness to work.
- They can provide more information about an injury or illness. In many ways, workers’ compensation claims are about gathering a lot of data. An injury or illness can be difficult to quantify. For example, two employees with broken arms may have very different capacities for work depending on the worker, job duties and type of fracture. A functional capacity evaluation gathers more information so decisions can be made in each unique case.
- They are more accurate. Researchers have found that professionally-administered FCEs are more accurate in evaluating capacity than injured workers self-reporting their abilities. Part of the reason is that while attitude and belief about ability can impact how well a worker does in any test, a functional capacity evaluation is based on standardized tests to evaluate actual ability. It is also administered by professionals who know how to determine those levels of ability. While not infallible, they are one of the more accurate ways to determine ability to return to work.
- They can help determine your qualifications for workers’ compensation, Social Security or other benefits. A functional capacity evaluation can also help determine whether you need occupational therapy or other forms of support. In many cases, an FCE report makes a recommendation for treatment or can allow a worker to receive appropriate levels of benefits, helping them with recovery.
Are FCEs Used in Other Cases?
A functional capacity evaluation is often an important part of a workers’ compensation case, but it is not the only place this type of evaluation is used. An FCE can also be useful in:
- Car accident cases where someone has been injured
- After any catastrophic injury where capacity needs to be evaluated
- For developing a treatment plan before rehabilitation
- To adjust the process and to evaluate how far a patient has progressed after rehabilitation
Any time a person’s physical or cognitive capacity needs to be evaluated for a specific reason, an FCE can be useful. Some employers even used modified functional capacity evaluations to determine physical capacity for high-risk jobs that have intensive physical demands.
What Happens During an FCE?
Before a functional capacity evaluation is ordered, a workers’ compensation claimant will usually be required to undergo an IME (independent medical examination) with a medical provider of the employer’s or insurance company’s choosing. If the IME finds a claimant can return to work, the FCE is usually ordered to offer a further evaluation and to get more information about the worker’s current abilities and condition. However, the worker or their attorney can also order a functional capacity evaluation at any time.
The request for an FCE will arrive in writing. You will get a letter explaining the functional capacity evaluation and the process. It is important to read this letter so you understand where and when you have to arrive and so you know what to expect. Before your functional capacity evaluation, your examiner will receive your file and will review it. They may also speak to the person who conducted your IME (if you have had one).
One of the first things that will happen at the evaluation is the evaluator will introduce themselves, review the reason for the FCE and will give you the opportunity to ask questions. The evaluator will also review your medical records and may conduct musculoskeletal screening. The functional capacity evaluation is one-on-one, meaning there will not be other people being evaluated in the room with you.
You may be asked to fill out some paperwork, just as you would at many doctor’s appointments. If you have trouble sitting or writing because of your injury, you can ask for help with this part. You may be asked to review the forms with the evaluator.
The largest part of the FCE will usually consist of a series of tests. You may be asked to:
- Get on a treadmill
- Move your hands or other parts of the body
- Handle or manipulate objects
- Undergo hand-eye coordination tests
- Push or pull
- Undergo cognitive tests
- Lift weights
- Test your grip
- Stack boxes
- Undergo dexterity tests
- Take step exercises
Your job will determine which tests you must undergo. For example, if your work involves carrying boxes, you will have to lift weights to evaluate how much you can lift. If your job requires cognitive function and if your injury or illness has affected this function, cognitive tests may be part of your FCE. When you are given an exercise, you must continue it until you can no longer do so or until the evaluator tells you to stop.
The exercises can take several hours or may be performed over two consecutive days. The evaluator will observe your range of motion and your ability to perform these exercises, as well as your efforts. Any symptoms such as trembling or sweating should be noticed and written down by the evaluator. The evaluator may also ask questions about the tests as you perform them, or afterwards, to gauge your level of pain. These tests should not hurt and are designed not to exacerbate symptoms or your condition. If you are in pain or you are struggling, report this to the evaluator.
In addition to the physical exercises, the evaluator will ask a number of questions, including:
- Inquiries about the injury
- Questions about your pain
- Queries about which activities affect your symptoms
Once you have spoken to the evaluator and have completed all the tests, you can go home. The evaluator will prepare a report based on the information revealed in the FCE. This report will also include an opinion about whether you are able to return to your job and whether you can return at full capacity. This report is then sent to the person who requested the functional capacity evaluation — whether it’s your employer, the insurance company or your own lawyer. The report will be reviewed and can be used to modify, suspend, continue or terminate your workers’ compensation benefits.
Depending on the specific request, an FCE will also typically involve a review of physical ability and function related to the worker’s job duties, a description of the effort the worker put in, adaptations needed, recommendations for treatment and other details. Some functional capacity evaluations will also include job match ideas or data.
I Need a Functional Capacity Evaluation for My Workers’ Comp Claim — What Do I Do?
If you have been asked to undergo an FCE, contact your attorney (if you have one). Your attorney will want to know every step of your claim. Other than that, there are several steps to help you undergo the tests:
- Arrange transportation to and from the functional capacity evaluation. You may be tired after the exercises, and you don’t want to have the stress of trying to find a parking spot or walking from parking to where the evaluation is being held.
- Dress comfortably. Keep in mind you may be asked to step on a treadmill or take part in other physical activity, so dress accordingly and make sure you wear practical clothing. Do not dress in a way that prevents a full range of motion.
- Bring any documentation you are asked to bring. You will generally need your ID, for example, and may need some paperwork to prove your insurance coverage.
- Be prepared for the length of the FCE. A functional capacity evaluation can take four to six hours, although the process can take longer or take less time, depending on what is being tested. Some FCEs are carried out over two days. Give yourself plenty of time and allow for delays. Keep in mind you may be tired after your FCE and try not to schedule anything immediately after. Give yourself some time to rest.
- Stay calm. It’s natural to be nervous about your FCE, but stress can affect your performance. Try and get a good night’s sleep and go into the FCE with a positive attitude.
- Be honest and try your best. If an evaluator feels you are not trying, their report will reflect this — which could harm your case.
- Don’t try to be a hero. While you want to try your best, keep in mind the FCE shouldn’t hurt. If anything does cause you pain or doesn’t feel right, speak up.
- Keep in mind that the functional capacity evaluation is only one part of the puzzle. Your capacity can also be evaluated by an impairment rating, return to work (RTW) and other tests. You can even seek out another FCE, so give the tests your best, but don’t assume all your benefits or your entire case will hinge on this one outcome.
I Need a Provider for an FCE for a Workers’ Comp Case — Where Can I Turn?
Usually, employers and others will want a functional capacity evaluation if a worker has been injured and has likely reached maximum medical improvement. Usually, an FCE is used toward the end of a workers’ compensation claim, when a worker is close to returning to work.
If you’re an employer, attorney or other professional looking for objective and thorough functional capacity evaluations or other medical evaluations, there are several things you will want to look for in a provider:
- Experienced and qualified evaluators. Qualified evaluators can perform FCEs correctly and have extensive experience doing so, meaning you get higher-quality reports and information.
- A range of related services. A service that can fill out forms, offer medical depositions and other services is often useful since you can use the same provider for a variety of steps in the workers’ compensation process.
- Fast, hassle-free service. Delays in scheduling and other services can mean costly delays in resolving cases, so look for a prompt provider.
- Detailed reports. You want reports that will be submitted with a short turn-around time but will contain impartial recommendations as well as detailed information to support the recommendation.
If you need a functional capacity evaluation, The IMPACT Health Clinics has certified physiotherapists, thorough reports and professional evaluations you may be looking for. With our prompt schedule and focus on client care, our job is to make your case simpler. We offer a range of services, including:
- Functional capacity evaluations
- Video depositions
- Record reviews
- Oral depositions
- Form completion
- Cold case resolution services
- Narrative letter writing
As professionals, we have the team of board-certified doctors needed in a variety of disciplines to evaluate a worker. We also take care of all the details, so you just need to contact us and explain your needs — we handle all the steps of the FCE. If you’d like to find out why professionals call us for their workers’ compensation, car accident and other cases, call Turning Point Physical Therapy for booking at 780-451-8611 for booking or visit our website http://www.turningpointphysio.ca