Why Functional Capacity Evaluations Matter in Workers’ Comp Claims

By: Kim Radcliffe, DHA, MHA, PT, SVP, Apricus Product Management, Enlyte

October is National Physical Therapy Month. A time to promote the benefits of physical therapy, recognize physical therapists, and emphasize the importance of physical medicine in recovery. In keeping with this goal, we’re sharing some valuable information on Functional Capacity Evaluations (FCE) and the role physical therapists play in guiding informed decisions. 

Complex claims often come with uncertainty, and a well-timed FCE can bring clarity, but only if used with purpose. Done right, an FCE helps move claims forward. Used too early or without clear direction, it can stall progress or increase costs.

Understanding the Role of an FCE

An FCE is a standardized, objective evaluation of an injured employee’s physical capabilities in relation to specific job demands. It’s typically conducted by a trained health care professional, such as a physical therapist or occupational therapist and measures:

• Strength and endurance
• Range of motion
• Postural tolerances (sitting, standing, bending, etc.)
• Functional limitations and tolerances

The goal is to clarify work readiness, identify permanent restrictions, or guide next steps.

The Right Time to Schedule an FCE

FCEs are most valuable when the injured employee has reached maximum medical improvement (MMI), conflicting medical opinions need clarification, or you need objective data to support return-to-work decisions or settlements. Avoid premature referrals that complicate rather than clarify claim direction.

Common Pitfalls to Avoid

FCEs are only as effective as the clinical reasoning and context behind them. Common missteps include unclear purpose. Is it for return-to-work, disability rating, or litigation? Consider timing and don’t order during treatment or before MMI. Avoid unvetted providers who may lack specialty experience or standardized reporting. Without proper coordination, adjusters risk investing in evaluations that fail to advance the claim or worse, contradict other medical opinions. 

How Specialty Solutions Add FCE Value

Specialty providers can help adjusters get the most from an FCE. Not just by scheduling them, but by timing FCE requests appropriately to ensure clinical soundness. Specialty coordinators deliver:

• Clinically vetted referrals aligned to the appropriate phase of care
• Access to credentialed providers with workers’ compensation expertise
• Clear guidance on referral intent, documentation, and use
• Seamless coordination with case managers and treating providers

Well-timed FCEs confirm readiness for return-to-work, support restrictions, and speed claim resolution. They can also be a powerful tool, but only when used intentionally. With a specialty solutions partner, adjusters can gain more than access to evaluations including the clinical insight and coordination needed to make smarter, faster decisions. 

Specialty providers deliver a full suite of integrated services, including a robust physical medicine program, a nationwide network of quality providers, and in-house licensed physical therapists for clinical oversight. Whether it’s an FCE, home health, diagnostics, durable medical equipment, or another service, specialty providers simplify the process, reduce delays, and help injured employees get what they need, when they need it.

About the Author

Kim Radcliffe is a licensed Physical Therapist with over 25 years of experience in leadership within the health care industry, with a focus on evidence-based medicine and quality care. Kim has over 15 years’ experience specifically in workers’ compensation, having developed the largest prospective physical medicine network which included robust clinical oversight. 

Kim is also a regular contributor to our Specialty Solutions Spotlight where this article originally appeared. To ask and find the answers to more work comp specialty questions visit the Apricus website and subscribe to our monthly series. 

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