Functional Capacity Evaluation: What You Need to Know.

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Are you wondering why your insurance company is making you undergo a Functional Capacity Evaluation?  Typically, continuing your benefits for more than 2 years requires proof that you cannot work in any job that pays 80 percent or more of your previous income.  In most cases, your insurance company will require you to undergo in a Functional Capacity Evaluation to determine the extent of your physical abilities and limitations. The Functional Capacity Evaluation is an evaluation that is usually performed by a physical therapist.  After that, your insurance company will likely submit the results of the Functional Capacity Evaluation and other information to a vocational expert who will perform a Transferable Skills Analysis ("TSA").

The entire point of the TSA exam is to determine whether you are able to perform the material duties of any occupation, other than your own, in which you are able to earn 60 percent or more of your pre-disability income. Thus the Functional Capacity Evaluation is a critical component of the Transferable Skills Analysis, because it will serve as the basis for determining whether you are physically able to perform the duties of other jobs, for which you might otherwise be qualified based upon your education and experience, and a reasonable level of additional training or education.

It’s important for you to understand that the individual, who is performing the Functional Capacity Evaluation, is being paid by the insurance company. In our experience, the outcome of the Functional Capacity Evaluation is typically slanted in favor of the insurance company, and often ignores factors such as pain. So it’s critically important that you express any pain or discomfort you experience during the evaluation. You should not engage in social discussion or chatting, understanding that everything you say and do will become part of the Functional Capacity Evaluation report. These social niceties can be misinterpreted as indicators that you are feeling well and capable of working.

During the Functional Capacity Evaluation, you’ll undergo a physical examination to measure your levels of strength, ranges of motion, flexibility, stamina, and other physical factors. If you’re in pain when moving in certain ways, don’t try to get through it to prove how tough you are. If moving your arms, legs, or back is painful, tell the physical therapist that you’re in pain -- even though you don’t usually like to complain about it.

You also may be asked to lift different amounts of weight over your head or just to carry weight while walking. If you can do this easily, then say so. But if this is difficult for you to do so, be sure to make the examiner aware of that.  You probably will be asked how far you can walk without discomfort and whether you can easily sit down and stand back up. If you have radiating back and leg pain, these simple movements may in fact be difficult and/or very painful for you. If so, again, tell the examiner about your limitations immediately so that there is an accurate description of your situation.

The Results of the Physical Exam Will Be the Basis for the Transferable Skills Analysis

Clearly, you have to understand the purpose of the Functional Capacity Evaluation, and its impact on the Transferable Skills Analysis, in order to protect yourself from having an incorrect picture of your disability transmitted to the insurance company. If you’re entitled to long-term disability benefits, make certain that you do not inadvertently undermine your own case.  Then, the insurance company's vocational expert will have an accurate picture of your disability, which he will then use to determine whether you can work in another job that will pay you 80 percent or more of what you earned before becoming disabled.

Finally, the insurance company will know the exact date and time of the exam. When it comes time for your exam, you should expect that you will be followed and filmed when you leave your house, arrive and depart the exam location, and return to your home. You can also expect to be followed and filmed for two days following the exam. So while you might usually be successful in putting up a good appearance for short periods of time, your efforts may give the appearance that you are not disabled.

The insurance companies have many resources available to them, which they will use to prevent you from receiving long-term disability benefits. You need an experienced attorney who knows how to navigate through the very complex body of law that stands between you and your monthly disability check. Call us today, and we’ll battle with the insurance company, and fight to get you the benefits you deserve.

Call today for a free consultation with J. Brooke Hern, Esq., chair of the firm's long-term disability benefits practice.