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ERISA Law

What Are Functional Capacity Evaluations?

Leah Small

January 30, 2025

What Are Functional Capacity Evaluations?

Sometimes it is necessary for claimants to submit supplemental evidence in support of their claim for long-term disability (LTD) benefits. Functional capacity evaluations (FCEs) are one example of such evidence that can help reinforce a claim by objectively demonstrating how the claimant’s condition impairs their function under their policy’s definition of disability.

These comprehensive assessments test a person’s physical capabilities and ability to return to work. While claimants can schedule their own, private FCE, there are also times an insurance company will request that a claimant attend one.

Whether your insurer has sent you a notice to attend an FCE, or you are planning to use this evaluation as part of your supplemental evidence, it is important to understand what these evaluations are and why they are important.

In this article, CCK Law will explain:

  • How functional capacity evaluations work
  • What is tested during an FCE
  • How functional capacity evaluations can help LTD claims
Who We Are: Chisholm Chisholm & Kilpatrick is a leading public interest law firm based in Providence, Rhode Island. For over 25 years, we’ve been helping long-term disability claimants get the benefits they need and may be able to help you too. Call us today at (800) 544-9144 for a free case evaluation with a member of our team.

How Do Functional Capacity Evaluations Work?

Occupational therapists often administer functional capacity evaluations. They are highly trained in this field and provide claimants with objective evidence for their claims. Others—such as physical therapists and exercise physiologists—are also qualified to administer FCEs.

What Is a Functional Capacity Evaluation?

These evaluations determine a person’s ability to return to work. FCEs can measure specific physical work activities associated with an individual’s job or measure their physical capabilities generally and thus their ability to return to work in any job. Therefore, every functional capacity evaluation is different. Nonetheless, such evaluations typically last from four to six hours. Sometimes FCEs can span two consecutive days.

Functional capacity evaluations will vary from person to person, but they all have similar components. Usually, these evaluations begin with an interview between the therapist administering the FCE and the claimant.

This interview typically includes questions about the claimant’s employment and medical condition. The therapist may have a copy of their job description, and it is prudent for the claimant to request a copy for themselves so that they may confirm its contents. Moreover, the occupational therapist will also review the claimant’s medical records.

What Physical Abilities Are Assessed During an FCE?

When an LTD claimant attends an FCE, the therapist will usually test them for some (or all, depending on the specific evaluation) of the following physical abilities:

  • Lifting and carrying objects
  • Pushing and pulling
  • Sitting and standing
  • Walking
  • Balancing
  • Kneeling
  • Crouching
  • Object handling
  • Hand manipulations
  • And others

FCEs also measure a person’s pain. For example, the therapist might ask the claimant about their pain level and location for every physical assessment they complete. This pain monitoring can be beneficial if the claimant suffers from a chronic pain condition.

Note: While functional capacity evaluations historically only tested individuals on their physical abilities, many FCEs now include cognitive components as well. Moreover, FCEs typically include different forms of “validity testing” as part of the evaluation. This will demonstrate whether the person being evaluated is putting forth a full effort.

How Does a Functional Capacity Evaluation Help a Long-Term Disability Claim?

Functional capacity evaluations are beneficial for long-term disability claims since insurance companies prefer objective evidence. For example, an insurance company will prefer an X-ray result over self-reported symptoms. FCEs provide a claim or appeal with objective evidence of a person’s ability to work.

Some medical conditions naturally do not have a lot (or any) objective evidence (e.g., fibromyalgia). In these scenarios, an FCE can be invaluable to help demonstrate that the condition is disabling. However, FCEs can sometimes work against a claim. This occurs when the findings of the evaluation do not support that a person’s condition interferes with their ability to work.

Fibromyalgia: Are Long-Term Disability Benefits Possible?

Nonetheless, an FCE can help a long-term disability claim in a few ways:

  • Helping to show insurance companies the extent and severity of the condition
  • Helping claimants overcome benefit limitations within their policy
  • Helping reinforce the opinions of treating doctors

Call Chisholm Chisholm & Kilpatrick Today

Obtaining long-term disability benefits can be difficult and stressful. If your insurer denies your initial claim, then you have the right to file an administrative appeal. The evidence you submit should directly address any issues your insurer found with your initial claim, which they will state in a denial letter. Functional capacity evaluations may be necessary to address these issues.

Chisholm Chisholm & Kilpatrick has been helping LTD claimants since 1999, and in that time we’ve gone up against all the big-name insurers. We know how they operate. CCK Law works with outside experts who can administer an FCE to reinforce your claim for benefits. Our team understands how difficult this process is. Therefore, we can collect and submit all evidence for your claim or appeal on your behalf—including functional capacity evaluations.

Call CCK Law today at (800) 544-9144 for a free case evaluation with a member of our team. Whether your claim is ERISA or state-governed, we will analyze your case and determine if we can assist.

About the Author

Bio photo of Leah Small

Leah joined CCK in September of 2016 an Associate Attorney in the firm’s litigation practice and now serves as a Supervising Attorney. Leah’s practice focuses on representing individuals in the application, appeal, and litigation of life, health, short-term disability and long-term disability insurance benefits under the Employee Retirement Income Security Act (ERISA) and under private insurance contracts. Leah’s practice also includes litigation of personal injury, business, and contract disputes in both state and federal court.

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