Expertly Reviewed By: Serah Waweru, Esq., on April 10, 2023
Pursuing a workers’ compensation claim or returning to work after recovering from an injury comes with a few challenges. For example, you may be unfamiliar with Functional Capacity Evaluation (FCE), a series of tests that assess your physical and cognitive abilities after recovering from an injury. Yet, FCE significantly impacts workers’ compensation claims and may influence your career choices too.
This article is a complete guide to FCE and its role in workers’ compensation cases. It answers many questions, including:
- What does FCE stand for?
- Who performs functional capacity evaluation?
- Why is FCE important in workers’ comp?
- How are FCE results used in a worker’s compensation case?
- Is FCE reliable?
- And many more.
First, let’s briefly describe workers’ compensation or workers’ comp, as it is commonly referred to.
What is Workers’ Compensation?
Workers’ compensation is a form of insurance that gives financial benefits to employees who are injured or become ill due to their job. These benefits include financial assistance to cover medical expenses, lost wages, and disability compensation. However, employees generally give up their right to sue their employer for negligence or other workplace-related issues in exchange for these benefits.
Workers’ comp laws and regulations differ from one state to another. That said, the program generally ensures that workers receive much-deserved compensation for their injuries at work. But, on the other hand, it protects the employer from losing money to costly lawsuits.
Getting workers’ compensation after a workplace injury can be a lengthy process. Some of the steps involved in this process include the following:
- Reporting the injury to your employer
- Seeking medical treatment
- Claiming compensation
- Awaiting the employer or their insurance provider’s decision
Additionally, your employer may request that you take an FCE exam before paying out a settlement for your injuries. If that’s the case, you should know a thing or two about FCE and how it would impact your claim.
What Is FCE in Workers’ Comp?
FCE stands for Functional Capacity Evaluation. It’s a series of medical assessments used to determine an injured worker’s level of physical function following an injury or illness. A trained healthcare professional, such as an occupational or physical therapist, often does this evaluation in a medical facility.
Usually, the healthcare professional assesses several physical abilities during an FCE exam. These may include your strength, range of motion, endurance, and mobility. In some cases, the evaluation may also include an assessment of your cognitive and psychological abilities that could affect your work performance.
How Is the FCE Exam Done?
An FCE exam may take several hours or more, depending on the tests the healthcare professional performs. The test components will vary depending on your injuries and job requirements. However, a standard FCE exam includes the following:
- A review of your medical history related to your injury or health condition
- A physical examination to assess abilities such as your physical strength, stamina, flexibility, range of motion, and more
- A job-specific examination to determine your ability to perform tasks related to your job
- A functional examination to assess your ability to perform general tasks such as lifting, pushing, pulling, or carrying objects
- A psychosocial examination to evaluate your behavior and emotions, among other traits
During the exam, the healthcare professional closely monitors your reactions and how your body responds to the various tests. While at it, they’ll guide you on what to do to ensure they conduct the tests safely and effectively.
Once done, the healthcare professional prepares a comprehensive report summarizing your results and FCE scores. An FCE score is a number, usually on a scale of 0 to 10 or 100, representing your ability to perform a task. Additionally, the report may include the healthcare professional’s recommendations for job accommodations, modifications, rehabilitation services, or other interventions.
How To Fail a Functional Capacity Evaluation?
The purpose of an FCE exam is to evaluate your functionality while performing tasks related to your job and other daily physical activities. As a result, the outcome depends on your willingness and ability to perform the tasks the healthcare professional asks you to complete during the assessment. Therefore, there’s no way to ‘fail’ or ‘pass’ an FCE exam.
Here are some things you shouldn’t do during an FCE exam.
Exaggerating your symptoms: Avoid exaggerating your symptoms, pain, or physical difficulties during the FCE. This can lead to inaccurate test results and may impact your treatment plan, eligibility for compensation, or return-to-work process.
Withholding vital information: Be honest about everything, including your medical history and injuries. Withholding such information impacts the outcome of the exam and prevents the healthcare professional from conducting a fair evaluation.
Ignoring safety instructions: You must follow the evaluator’s instructions to avoid further injuring yourself. Additionally, you must inform the evaluator of any pain and difficulties you encounter while performing the tasks.
Altering the activities in the FCE exam: Avoid modifying the activities of the exam even if you know a different way of completing the tasks.
Failing to cooperate with the evaluator: It is important to be cooperative and follow the evaluator’s instructions during the FCE to ensure that the test results accurately reflect your functional capacity.
Refusing to take the FCE exam: Refusing to participate in the FCE may impact your eligibility for benefits or treatment and FCE settlement and delay your return to work process.
Common Challenges in FCE Processes
Because many employers request FCEs when handling workers’ comp cases, you may wonder whether the results are accurate and reliable. Here are some challenges that may affect the authenticity of the FCE exam.
Anxiety may affect your behavior and response during the FCE exam. As a result, you may be unable to complete some tasks, risk getting injured during the exam, or fail to communicate with your evaluator. As a result, the FCE report may not conclude accurate exam findings.
If you feel anxious during an FCE exam, inform the evaluator to help them understand how your anxiety may affect the results. The evaluator may also help you relax and feel comfortable during the test.
Some workers report inaccurate information about their injuries or abilities during an FCE exam for fear of being unable to go back to work or losing benefits. Unfortunately, this affects the accuracy of the FCE results.
FCE exams are conducted by trained professionals who provide objective and accurate information about a worker. Despite this, individuals with other intentions may manipulate the outcome of these tests, affecting their authenticity.
For example, a worker may deliberately mislead the evaluator during the test to obtain results that favor their interests. Additionally, different evaluators may interpret the same FCE exam differently, resulting in discrepancies.
Validity Testing in FCE
Validity testing is an important component of a Functional Capacity Evaluation because it helps ensure that the evaluation results are accurate and reliable. Validity testing involves using various methods to assess the authenticity of the FCE.
For example, the evaluators may compare an individual’s FCE results with their medical records to determine whether they have similar findings. They may also conduct medical tests to confirm the individual’s FCE results.
Here are examples of tests used to validate in an FCE exam.
Content Validity Testing
Content validity testing weighs the relevance and appropriateness of an FCE assessment to a worker’s job. This test ensures that the evaluator assesses the worker’s abilities in relation to their job to provide an accurate and valuable report.
Concurrent Validity Testing
Concurrent validity testing involves comparing a worker’s FCE results to other measures of physical ability. For example, the evaluator may compare a worker’s results to a strength and endurance test to ensure that the FCE is accurate.
Predictive Validity Testing
This testing involves using the results of the FCE to predict an individual’s ability to perform job-specific tasks. The evaluator then compares these predictions to actual job performance data to ensure that the FCE is accurate.
FCE evaluators may also use other methods to improve the accuracy and reliability of an FCE exam. For instance, they may conduct repeated tests to determine if the results are consistent. They may also use some equipment to test the same physical ability and compare the results.
Overall, validity testing is an important component of an FCE because it helps ensure the evaluation results are accurate and reliable. Additionally, it helps the evaluators, employers, and workers make informed decisions regarding returning to work, FCE settlement, treatment plans, and other factors.
Why Is FCE Important in Workers’ Compensation Cases?
An FCE contains comprehensive information about a worker’s physical abilities, which an employer uses to guide them through the worker’s return-to-work process. For example, the report may guide the employer through the following:
- Developing a treatment compensation plan for the worker
- Determining whether the worker is fit to return to their pre-injury job
- Determining the tasks to assign the worker
- Estimating the worker’s compensation benefits
- Identifying the worker’s physical abilities and limitations
- Recommending appropriate workplace modifications to accommodate the injured worker’s needs
FCE reports come in handy for workers too. For example, this report can be reliable evidence in solving disputes arising from a workers’ compensation claim. It also helps workers understand their abilities and avoid duties that may cause them more injuries.
READ ALSO: How Workers’ Comp Settlement Chart Works
Can I Have a Functional Capacity Evaluation for Lower Back Pain?
You may have an FCE exam if you develop lower back pain due to your job. First, the evaluator assesses your physical abilities while performing tasks specific to your job. Then, they’ll prepare a comprehensive report that you may need to claim compensation for your injury.
What is the Cost of a Functional Capacity Evaluation?
The functional capacity evaluation cost varies depending on various factors, such as the type of FCE conducted, the length of the evaluation, and the healthcare provider performing the assessment. Fortunately, most workers don’t have to incur the cost of an FCE exam, especially if their employer requires it for work-related injury compensation.
How Long After the FCE Test Do You Get a Letter From Workers’ Comp?
The timeline for receiving a letter from workers’ compensation after an FCE test may vary depending on the case and the situation’s complexity. Typically, receiving your response from Workers’ Comp may take a few days or weeks.
Is Settlement in Workers Comp Determined by FCE?
Your employer and the insurance provider may require an FCE report to determine your settlement after a workplace injury. However, it’s not the only factor they consider while deciding the appropriate compensation.
What Is a Functional Capacity Evaluation CPT Code?
A Functional Capacity Evaluation CPT code is a unique number that an FCE healthcare provider uses to bill an insurance provider for an FCE exam.
Final Thoughts on Functional Capacity Evaluation and Workers Comp
Functional Capacity Evaluation is a valuable tool for both workers and employers in managing workplace injuries and promoting workplace safety. By understanding how FCE works and its role in the workers’ compensation process, injured workers can better advocate for their health, well-being, and safety at work while also supporting their productivity.