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Is A Functional Capacity Evaluation An Attempt To Cut My Benefits?

Tucker Law Group
March 1, 2017

Has your insurance company sent you a functional capacity evaluation? You are probably right if you think this may be an attempt to cut off your benefits.

In most cases, if you receive a functional capacity evaluation, the adjuster is trying to cut off your benefits. These evaluations by the insurance company’s doctors almost always say that you can work, and this will effectively cut off your benefits.

The Functional Capacity Evaluation, or FCE, is a four-hour test that is conducted by a physical therapist, and it is designed to show how much you can engage in work and work-related activities. It is a good indicator, but you need a credible vendor. The problem is that insurance companies use the same vendors over and over, so chances are that you’ll be seen by a therapist who has worked with the insurance company many times before, and this means that your evaluation won’t be fair.

Let’s consider the case of a former client of mine. Michelle sustained significant limitations from a back injury. She couldn’t sit, stand, bend over, or lift very much, which prevented her from working. The insurance company sent her for an FCE with their vendor, and we responded by scheduling our own FCE the next day with a fair vendor that works for both insurance companies and attorneys alike. Their vendor said she could do work that was sedentary, and also that she was faking to make money. In contrast, the FCE with our vendor showed her significant limitations, and this confirmed what her doctors had been saying all along. Watch the video to learn more.

If you have questions about what to do when your insurance company wants you to get a functional capacity evaluation or FCE, I want you to call me at (866) 233-5044. I welcome your call.

Video Transcript
The disability insurance company wants to send you for something called a functional capacity evaluation. Are they trying to cut your benefits off? I'm John Tucker, I'm a disability attorney and I handle long term disability cases all over the country. I’ve handled cases against all the major insurance companies — Aetna, Cigna, Standard, Lincoln, MetLife, Unum — we’ve handle a case against your insurance company.

I've never seen an insurance adjuster that wasn't trying to cut somebody off when they sent them out for a functional capacity evaluation. I'm not kidding, I've never seen a functional capacity evaluation ordered by an insurance company say that my client was not able to work. Every time it says they can work.

So what's a functional capacity evaluation? It’s a four-hour test done by a physical therapist that's designed to measure how much you can engage in work activities that involve movement of the body. Sitting, standing, lifting, walking, crouch, pushing, pulling all the things that the body has to do to do different types of activities. A functional capacity evaluation often called an FCE, is usually the best indicator of what a person can do. The problem is you need a credible vendor, you need a credible physical therapist who will do a fair test.

Insurance companies want to use them because they're so good at showing what somebody can do. The problem is they use the same company's over and over, they taint the well. You're not getting a fair exam when you go to their FCE examiner. So what can you do?

Let me tell you a story about one of our clients Michelle. Michelle had some very significant limitations from a back injury, she couldn't sit for very long, stand for very long, she couldn't bend over, couldn't lift very much, all things that prevented her from doing any kind of work. Well, the insurance adjuster was sending her out for an FCE and we knew that was a setup. So they scheduled there's for a certain date, we scheduled ours for the next day. Now, what was the difference?

They have their vendor they used over and over and over. One of those vendors that won't even do evaluations for people like me, attorneys that represent folks like you. I scheduled Michelle with a fair physical therapist one I knew that was credible, who actually did evaluations for insurance companies and for attorneys like me. Well, low and behold Michelle went to their physical therapist and he said not only that she could do sedentary work, sitting almost all day, he also said she was faking. He used the term malingering that means faking for monetary gain.

Well, the next day Michelle goes to the fair physical therapist. That evaluation showed she had significant limitations with her sitting with her standing and with her lifting like I said before. It verifies what her doctors have been saying all along. The most important thing about the reliable credible physical therapist was he also said that the testing build in validity factors. It actually has elements of the test that try to determine if you're faking in Michelle's case, she passed with flying colors — 100 percent valid. Well if we haven't ordered our own FCE, Michelle would have been stuck with their FCE and she would have lost her case.

So if they're trying to send you for a functional capacity evaluation, yes they're trying to cut you off. Call me at the number on your screen, let's talk about your case and your rights. I’m John Tucker. Thanks for watching.