Individuals with disabilities should qualify for benefits if their employer’s long-term disability plan covers their condition.
Some severe injuries or illnesses cause permanent disabilities leaving no doubt a person can no longer perform their job duties. Other illnesses or injuries may be just as debilitating but harder to prove medically, leading insurers to deny claims. In these cases, a functional capacity evaluation (FCE) may be used to document the condition and establish how it limits your ability to work.
What is involved in an FCE?
When performed by legitimate providers, FCEs can be the best way to measure disabilities related to a person’s job duties. Most tests last two to six hours, while some last two days. At a minimum, an FCE measures your abilities and restrictions in these areas:
- Grasping and handling items
- Pushing and pulling
- Stooping and crouching
- Understanding directions
Tests are usually customized depending on your condition, medical diagnosis and prescribed treatment.
Preparing for a test
First and foremost, it’s crucial to regard an FCE as a legal test as well as a medical exam. Some insurance companies accept the results as proof of a long-term disability. In some cases, FCEs help avoid lengthy legal disputes. However, many insurers use their own doctors to interpret and dispute findings.
If you schedule an evaluation, you can help by documenting your condition, symptoms, pain levels and how your life is affected. This will help the doctor or therapist who performs the exam. You’ll also want to give them a complete list of your medications. Next, make sure that you understand your condition as outlined by your provider, as the FCE examiner will likely ask questions.
Before taking an FCE, it’s advisable to consult with an experienced attorney specializing in ERISA (Employment Retirement Income Security Act) law. Your lawyer can help ensure that your paperwork is done correctly, that the evaluator is fair and that the insurance company comply with the terms of their disability plan.