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Functional Capacity Evaluations (FCEs) & Long-Term Disability Insurance

At DarrasLaw, we’re in the business of helping long-term disability insurance claimants prove to their insurance companies that they’re entitled to monthly insurance benefits. Unfortunately, that can be very tricky in many cases.

Your disability insurance provider will put together every piece of evidence it can in order to justify denying your claim. Therefore, you, along with your long-term disability insurance attorney, need to compile all the evidence you can in support of your claim. A functional capacity evaluation may be useful during this process.

So, what is a functional capacity evaluation, and how might one help you collect on your disability insurance claim?

What Is a Functional Capacity Evaluation (FCE)?

A functional capacity evaluation, or FCE, is an assessment carried out by a specialist physician or occupational therapist. The assessments typically consist of a comprehensive suite of physical tests; they can go on over two days, and usually take up at least one full day to complete. Some experts recommend two-day FCEs because the longer evaluation period allows for a more complete assessment of your illness or injury and restrictions and limitations.

The tests carried out during functional capacity evaluations include assessments of:

  • Fatigue levels
  • Postural intolerances
  • Lifting and carrying abilities
  • Ability to carry out gross and fine motor tasks
  • Range of motion
  • Ability to stand, sit, and walk
  • General strength
  • Balance

Crucially, the evaluator will observe you carefully throughout the exam to make sure you’re giving every assessment your maximum effort. This is necessary because the test is designed to push you to your limits, and because there is a huge incentive for claimants to underperform on assessments. Evaluators, being highly experienced, will be able to gauge your level of exertion by observing factors like the quality of your movement and your apparent levels of pain along with blood pressure readings.

As well as carrying out physical tests, the evaluator will ask you questions about your illness or injury and how it has impacted your ability to perform in the workplace. The information evaluators gain from these questions forms a crucial part of their final report.

How You Should Prepare for a Functional Capacity Evaluation

Functional capacity evaluation assessments can be quite physically demanding, depending on your disability and the severity of your symptoms. There are certain steps you should take to ensure the process isn’t any more uncomfortable or stressful for you than it needs to be.

Firstly, you should remember to wear comfortable clothes, ideally garments designed for sport or other physical activity. You may also consider arranging with a friend or family member to give you a ride home after the test, as you may experience fatigue or a worsening of physical symptoms after a day of testing.

During evaluation, you should be careful not to overly exert yourself to a point at which your wellbeing is at risk. If you experience dizziness, unbearable pain, or extreme fatigue at any point during a test, inform your evaluator immediately and wait for them to tell you what to do. Your inability to complete an FCE test will not invalidate it for the purposes of your long-term disability insurance claim.

Does Your Functional Capacity Evaluation Decide Your Long-Term Disability Insurance Claim?

Generally, insurance companies do not absolutely require claimants to undergo a functional capacity evaluation in order to receive monthly benefits. However, insurers do demand sufficient evidence that your illness or condition meets the definition of disability their policy sets out. Depending on the nature of your injury and the type of full- or part-time work you do, a functional capacity evaluation can be a big asset to you when you’re trying to meet that standard.

FCEs are best suited to claims involving disabling physical symptoms, including:

FCEs generally do not include assessments for mental health issues. They are also limited in terms of their assessment of eyesight and hearing problems. If your disability involves symptoms from any of these categories, you may need to seek a separate medical assessment alongside your functional capacity evaluation.

How a Long-Term Disability Insurance Lawyer Can Help With Your Functional Capacity Evaluation

The first function your long-term disability insurance attorney will have in relation to a potential functional capacity evaluation is to advise you on whether or not it’s the right course of action. Remember, FCEs are not suitable for the assessment of every illness or injury.

Should you and your long-term disability insurance lawyer collectively decide to proceed with a functional capacity evaluation, your lawyer will be able to help you decide which specific assessment and service provider will be most appropriate in your case.

Your disability attorney will also be able to inform the professional in charge of your functional capacity evaluation about your personal, vocational, and medical details ahead of your appointment. Your attorney will also be able to transfer medical records on your behalf. This will help the evaluator prepare for your FCE ahead of time and to compile a more comprehensive report on your case. It will also help to relieve stress for you by taking some of the essential tasks associated with your claim off your hands.

At DarrasLaw, we’ve helped frustrated long-term disability insurance claimants from every state win their cases against uncooperative insurance companies. If you need help, we’re here for you.

Contact us today to schedule a free initial policy analysis or free claim assistance with one of our award-winning long-term disability insurance and Florida ERISA attorneys. If you’ve already submitted an initial ERISA claim only for your insurance company to deny it, it’s crucial to be timely and comprehensive when filing your administrative appeal. Don’t wait to start the process.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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