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Functional Capacity Evaluation and Disability Insurance Benefits: What You Need to Know

Tucker Law Group
May 27, 2021

If you are unable to perform the primary duties of your occupation due to a disabling condition, you may rely on long term disability insurance benefits to replace your income. However, securing long term disability insurance benefits can be difficult. Disability insurance carriers are notorious for denying and terminating claims unfairly. For instance, insurers often use functional capacity evaluations (FCEs) as a tool to assess your ability to do your job and as a tactic to terminate benefits.

Do you have questions about your disability benefits and the FCE? Here is what you need to know about the functional capacity evaluation and disability insurance benefits:

What Is a Functional Capacity Evaluation (FCE)?

Functional Capacity Evaluations, often called FCEs, are used to measure how much you can engage in work activities that involve movement of the body. The evaluation involves different types of activities that the body has to do, such as:

  • Sitting
  • Standing
  • Walking
  • Lifting
  • Pushing
  • Pulling
  • Bending
  • Twisting
  • Climbing

Understanding FCEs and Your Disability Insurance Benefits

FCEs are performed by physical therapists and are widely viewed as being useful in disability insurance claims. Disability insurers often use FCE testing to get an opinion about whether someone can do sedentary work, or a sitting job. When done by an honest vendor with testing that shows an individual’s limits, an FCE can be very helpful to a person who is making a disability insurance claim.

However, not all FCE vendors are honest. What happens when your long term disability (LTD) insurance company sends you to a physical therapist that they use all the time? Is your LTD insurance company attempting to terminate your disability benefits? In most cases, if you receive a functional capacity evaluation, the insurance adjuster is trying to terminate your benefits.

Is an FCE an Attempt to Cut Your Benefits?

People often think their LTD insurance company will treat them fairly, but our experience has shown that insurers use vendors that are less than objective. Insurers often use frequent-flyer vendors that do these tests over and over for their insurance company clients. These vendors offer predictable results, and their FCE reports are often detrimental to a long term disability claim.

When an LTD insurance company contacts you to send you out for an FCE, you should immediately contact a disability attorney to find out what you need to do to protect your benefits.

Learn more from disability attorney John V. Tucker in our video library.

FCE Testing Is Considered Reliable by Courts

In Ness v. Aetna Life Insurance Company, a case decided in June 2017, the Judge considered it entirely reasonable for the insurance company to rely upon an FCE test where the injured person only passed 45% of the validity criteria. That means the Judge considered it reasonable for Aetna to rely upon an FCE that was 55% unreliable.

Get Legal Advice When Your LTD Insurance Company Wants to Get an FCE

If your disability insurance company wants you to attend an FCE, or you are considering going to an FCE yourself, call one of our experienced ERISA disability insurance attorneys at (866) 233-5044 or contact us online. At Tucker Law Group, our nationally recognized attorneys help clients every step of the way, from filing the initial claim to filing a lawsuit. We can help you protect your long term disability insurance benefits.