Functional Capacity Evaluations are a “type” of Independent Medical Examination that measures your physical ability to stoop, stand, walk, bend, reach, lifting, finger movements etc. The result is written within the functional capacity definitions of “sedentary, light, medium or heavy” functional capacity, each having its own criteria in terms of lifting and activity ability. The examination is usually given at a physical therapy facility by licensed Physical Therapists.
To begin, FCEs require a prescription from your primary care physician. To this end, insurers actually solicit the prescription from your doctor without you knowing about it. In reality, most patients with back problems would have a very hard time doing an FCE, risking further injury and pain. Not caring at all about that, insurers will literally talk your doctor into a prescription for an FCE.
FCEs are beloved by the insurance companies because in 95% of the written reports, FCEs document the insured demonstrated “sedentary functional capacity.” This is terrible for the ERISA folks undergoing “any occupation” investigations where “sedentary capacity” is all that’s needed to be thrown off claim.
Hence, the cloak and dagger, covert efforts of insurers to obtain buy-ins for FCEs. In my recent posts I’ve mentioned that insurers are aggressively requesting both IMEs and FCEs in order to deny more claims to cover COVID losses. My recommendation has always been for insureds and claimants to have discussions with their primary care physicians about the potential of insurance FCE requests.
However, those discussion in today’s environment may not result in favorable responses for insureds. Treating physicians themselves are choosing NOT to complete the “Functional Capacity” sections of update forms without having the back-up of official FCEs. Many physicians are actually requiring patients to submit to FCEs before they will fill out update forms, making the entire process even more frustrating and harassing for insureds.
My recommendation is that if you physically cannot do physical activity due to your impairment, inform your doctor of your risk for further injury. And, be on the lookout for sneak peek requests to your doctor’s office for FCEs for examinations you didn’t know about. As I said FCEs are profitable during “any occupation” investigations and can be requested frequently.
