Functional capacity evaluations can help or hurt your comp efforts

Misconceptions about functional capacity evaluations may be costing you big bucks and an opportunity to help injured workers return to work safer and sooner.

FCEs are designed to objectively measure an injured worker's level of function to determine how best to proceed. The purpose is threefold, said Roger M. Nelson, vice president of expert clinical benchmarks, an academic and research subsidiary of Pennsylvania-based MedRisk.

Improve the likelihood of safe return-to-work job/task performance.Identify functional decrements.Determine the presence and degree of disability.

FCEs can be a valuable tool, but many employers and insurers are using them for the wrong reasons and are ultimately wasting money, he said.

"People are using this test as a mechanism to check for the so-called malingerers," Nelson said. "It's often done as the last hurrah for the patient when all other rehabilitation processes have gone and no one knows what to do."

The end of treatment is the wrong time to do an FCE, he said. "When the patient starts to level off in terms of outcome -- his response to care -- that's the time for an FCE. At that time, the FCE will allow you to make decisions as to whether he should go back to his current job or be moved from vocational rehabilitation to another job or task or be retrained."

Some people are also using FCEs to detect fraud in a comp claim.

"I think that the way people often use FCEs is analogous to how they use an IME. They're not the same," said Ruth Estrich, MedRisk's chief marketing officer.

"An IME gets invoked when there is not progression, when there's concern there might be fraud involved, there's concern the patient is potentially milking the situation," she said. "The IME is often invoked to get an outside opinion to allow the adjuster to close the case."

Effective FCEs. Developing an accurate FCE requires the right preparation and administration. The four-hour test needs to accurately reflect the injured worker's job tasks.

The first and most important step is to get an accurate job description from the employer. Nelson and Estrich then advise discussing it with the claimant to see whether it matches his preinjury tasks.

The next step is to have the right person doing the test. "It's incumbent on the person doing the FCE to be a good behavioralist to replicate what the person does in his eight-hour-a-day, 40-hour-a-week shift," Nelson said.

Part of that process involves understanding and making judgments based on the human factor. For example, a person with low back pain might be reluctant to move from a sitting to standing position because of the pain involved. A perceptive FCE administrator can acknowledge the person's fear but explain that the pain is not pathological and will not cause further injury.

Using the FCE at the appropriate time and as part of a coordinated effort by the physician, nurse case manager, and physical therapist can ensure an injured worker is on the right path to recovery and gets back on the job safely.

Read more at the WorkersComp Forum homepage.

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