Functional Capacity Evaluations and Independent Medical Examinations in LTD Claims

Hi, I'm Nick Ortiz. I'm a long-term disability attorney in Florida. Today I'm here to talk to you about functional capacity evaluations and independent medical exams.

So the first is a functional capacity examination, oftentimes referred to as an FCE for short. The first question that people have is, "Am I required to undergo a functional capacity evaluation?" It really depends on what your insurance contract says. I oftentimes say that, in response to a lot of questions that people have in long-term disability claims, you need to go back to what your insurance policy states are the requirements. In many policies, you are required to undergo any medical testing required by the insurance company, but you really want to look at what your policies says before you subject yourself to any testing.

The second question that we have is "What exactly is an FCE?" A functional capacity exam is designed to try to determine what your abilities are, so for example, how much weight you can pick up, how much weight you can push, pull, how much you can carry across the room, what's your ability to stand, how far you can walk. Do you have any restrictions in bending and stooping and crouching and crawling. It's really designed to try to determine what your abilities are.

That's why it's called a functional capacity exam, but let me tell you some of the realities of an FCE. Unfortunately, I personally don't think they're very useful for two reasons. Number one is if you're trying your best, then it might show that you have abilities that really exceed your true day-to-day abilities. On the flip side, if you feel like you can't do something or tell them that you're not able to perform one of the activities they're asking you to perform, then they'll just say that you weren't trying hard enough or the results are invalid, so oftentimes, there's really no winning situation under an FCE, and that's why I personally don't think that they're very valuable, but sometimes you still need to undergo them nevertheless. One thing that should happen is, once you get the report, you should go over it with your doctor to see if your doctor can respond to any of the findings in the FCE report.

The other type of report that the insurance company might order is an independent medical exam. Now to be honest with you, we think that the term independent is really inappropriate in this case because these exams are really not so independent, which is why we prefer to refer to them as compulsory medical exams because you're forced to undergo them. So in an IME, the doctor is basically doing an exam to determine what your various diagnoses are and may also give some opinions as to what your resulting limitations are in terms of your ability to sit, stand and walk, but it's a little bit different from an FCE in that he's not doing specific measuring of your ability to perform various tasks.

If you want to talk to an experienced long-term disability attorney about your rights and responsibilities as to whether you must undergo an FCE or IME, then please feel free to give us a call at 850-308-7833. Otherwise, if you're just looking for additional information about the long-term disability process, I encourage you to request a free download of my book that I wrote called the Top 10 Mistakes That Will Destroy Your Long Term Disability Claim, which you can attain at www.freeltdbook.com. Thank you. We look forward to hearing from you.