Disability Claims Solutions


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doctor I don't knowPart of the “new normal” for 2020, already evidenced by several claims I’ve reviewed, is the recent tendency of treating physicians refusing to complete “Functional Capacity” sections on update forms without the result of formal FCEs. Some PCPs refuse to complete forms at all!

As we know, all insurer forms always include sitting, standing, walking, lifting, and carrying information in order to assess physical medical restrictions and limitations. Physicians today are more reluctant to sign off on functional capacity information without Functional Capacity Evaluation results to back them up.

While in the past, treating physicians took “a wild guess” based on their own personal observation and clinical reviews of patients, more recently physicians refuse to complete paperwork at all without FCE results.

On an individual basis I’m wondering whether patient insurers aren’t contacting treating physicians to request FCEs prior to filling out forms. Or, physicians have been contacted by insurers causing physicians to be paranoid about functional capacity and putting their reputations on the line.

One thing is certain – physicians are NOT aware how disability insurers interpret FCE   information and use it to deny claims. FCEs are the primary backup used by insurers to prove “sedentary capacity” for work (alternative occupatons) after 24 months.

While I don’t believe treating physicians are agreeing with insurance companies’ bad faith, I do think treating physicians are now taking the necessary steps cover their own derrières.