Making the Most of a Functional Capacity Evaluation

Workers’ compensation payers typically use Functional Capacity Evaluations, known as FCEs, to help guide difficult return-to-work decisions.

A return-to-work FCE evaluates an injured employee’s physical ability to perform tasks in a safe, consistent way and compares the employee’s functional capability and consistency of effort to their job’s physical demands.

Although usually associated with return-to-work, FCEs can also identify physical causes for delayed recovery, point to the need for treatment changes, help unstick claims, assist in impairment ratings, or help settle claims. Plus, before embarking on a costly work-hardening or conditioning program, they can help determine if an injured employee is physically ready for those demands. Some companies use them before care begins to set treatment benchmarks, at the midpoint to provide direction in the treatment plan, or the end to see if vocational training is needed.

FCEs arrived on the workers’ compensation scene in the early 1980s when states began requiring quantitative data to improve the return-to-work process. Previously these determinations relied on physicians deciding without objective job-demand data.  Today, physical therapists and occupational therapists conduct most of the industry’s FCEs with some states also allowing physicians and chiropractors to do them.

There are more than 800 types of FCEs, and some companies offer tests that are not real FCEs. This may be why some in the industry have a bad impression of FCEs.  Don’t let a previous poor experience keep you from using a high-quality FCE.

Because FCEs are costly and major return-to-work decisions are riding on them, claims representatives need to select a quality FCE provider that can provide reliable and actionable reports. Not all physical therapists do FCEs; it requires specific training and equipment. Some managed care companies specializing in physical medicine in workers’ compensation have developed networks of credentialed FCE providers using numerous quality markers.

FCE quality indicators include its duration, which ideally is between three and six hours. Beware of the two-hour-or-less offerings. These are designed to test just one or two abilities, not endurance for a full day’s work.  Safety, reliability, and validity are indicators. When looking for an FCE provider, ask about these quality markers and request a sample report. 

How to Get What You Need

First, clearly state the purpose of the assessment in the referral.  For a return-to-work, job-specific FCE, include a detailed job analysis. It’s worth the time and effort to get details from the employer (preferably the supervisor) on the number of pounds to be lifted, pulled, or pushed and the frequency. How many hours do they spend at the computer at a time?  How much squatting, overhead lifting, twisting and turning do they do during the day?

Don’t rely on the injured person for this. Employees have told therapists that they lift 150 pounds when they don’t even weigh 150!  Keep in mind that O*NET (Occupational Information Network) descriptions are too broad to be useful. The more specific the input, the better the evaluation and the safer the employee will be on the worksite. 

Second, this is your chance to find out as much as you can about the employee’s functional capacity and effort. Ask as many questions as necessary; some referrals have 20 or 30. Here are some:

• Can the injured employee frequently lift 30 pounds?
• Is the injured worker putting forth as much effort as possible?
• How long can they stand during the workday?

Prepare the Injured Employee

Injured workers have shown up for FCEs expecting them to last for an hour and left when they learned it would take five hours. This frustrates patients and wastes the providers’ time and resources. Explain what an FCE is and how long it will take. 

They should wear loose-fitting clothing and athletic shoes and leave their watches, earrings and other jewelry at home.  And since it’s a long appointment, they may want to bring bottled water and a snack.

It’s important to convey that these are evaluations of physical ability, not an adversarial test they pass or fail. Let them know you want to be sure they’ll be safe and not injure themselves when they resume full duties. Encourage them to do their best.

When and What to Expect from the Report

A report should be received within days.

This report should be a clear, comprehensive assessment of the injured employee’s functional abilities and effort. It should:

• Restate the purpose of the exam and address it
• Quantify the injured employees’ functional capabilities
• Compare their physical abilities to the job’s physical demands
• Document the employees’ level and consistency of effort
• Recommend return-to-work status, timing, and any modifications to work environment or treatment plan

Expect language like; “the evaluation indicated that the employee demonstrated the ability to meet the physical demands of the job title based on the job description provided by the employer for an eight-hour day.” Alternatively, if the employee didn’t meet physical demands; “the injured employee’s functional ability does not match job demands for the above job title in the following areas…”

Bottom line: FCEs are valuable claims management tools. When the reports are clear, physicians can quickly absorb and use them. If you don’t receive a report you can understand and use, push back until you do. Remember, the FCE is an evaluation, not a test. When you receive a blood test, your medical provider interprets the results for you. Likewise, an FCE report should interpret the results of a series of physical tests for you.

By Anne Marciniak

Anne Marciniak, PT, DPT, is MedRisk’s Team Lead for Clinical Services. Based out of Cincinnati, Ohio, she has been licensed in Physical Therapy since 1994 with a focus on industrial rehabilitation. Dr. Marciniak has directed a variety of programs, including Functional Capacity Evaluations, work-conditioning and work-hardening, post-offer testing, ergonomics consultation, transitional work, injury prevention, and chronic pain management. She is an accredited Transitional Work Developer for the State of Ohio Bureau of Workers’ Compensation and has performed on-site industrial services for over 150 employers. Dr. Marciniak has presented more than 300 times to clinicians, physicians, case managers and employers on various industrial topics focusing both on worker safety and patient rehabilitation. She earned her Doctorate in Physical Therapy from Arcadia University in Glenside, Pennsylvania and conducted her undergraduate studies at the University of Vermont in Burlington.

Share This Article: