Functional Capacity Evaluations in Louisiana Workers Compensation

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Functional Capacity Evaluations in Vocational Rehabilitation in Louisiana Workers Compensation

In most instances where the employer or the workers compensation insurance company cannot provide a modified job for an injured employee, but where the employee's doctor releases the employee to work with restrictions (such as light duty), the workers compensation insurance company will appoint a vocational rehabilitation counselor (or "vocational rehabilitation specialist") to conduct a Labor Market Survey, and in some cases a Functional Capacity Evaluation (FCE), to identify jobs within the employee's geographic area that actually available and that are a match with the employee's skills and present physical ability (as per the doctor's written restrictions).

So, during the vocational rehabilitation process, the workers compensation insurance company will often have the injured employee undergo a Functional Capacity Evaluation (FCE), which is basically an examination by a physical therapist in order to determine the employee's physical ability to perform specific physical functions.

A Functional Capacity Evaluation (FCE) typically consists of a series of physical exercises administered over several hours. Usually, the FCE includes standing, climbing, lifting weights, carrying boxes, squeezing calipers, and other similar activities.

The workers compensation insurance company will use the Functional Capacity Evaluation (FCE) to attempt to ascertain an employee's work capabilities and form the parameters of what type of work activity the employee is able to perform.

The workers compensation insurance company pays for the functional capacity evaluation, and often repeatedly works with the same therapists administering the Functional Capacity Evaluation, in order to get the results that the insurance company wants.

The FCE therapist then uses the measurements from these activities to produce a Functional Capacity Evaluation report that identifies the type and duration of physical labor that the injured employee can perform.

The workers compensation insurance company will then use this Functional Capacity Evaluation (FCE) report to claim that the employee can return to employment, and thus does not deserve lost wage benefits.

So unfortunately, the bottom line is that, like most of the actions taken by the workers compensation insurance companies, the purpose of a Functional Capacity Evaluation (FCE) is to give the insurance company the ability to terminate the employee's indemnity (or lost wages) benefits. 

Thus, a Functional Capacity Evaluation (FCE) is almost always used to the detriment of the employee, not the the benefit of the employee, because it is used to eliminate an employee's lost wages benefits.

What Exactly is a Functional Capacity Evaluation in Louisiana Workers Compensation?

In Louisiana workers compensation, a Functional Capacity Evaluation (FCE) is basically a series of tests administered by by a physical therapist that attempts to simulate the physical requirements of the employee's job or other potential jobs for the injured employee.

So essentially, a Functional Capacity Evaluation (FCE) serves to test the physical abilities of an injured worker in Louisiana workers compensation.

Functional Capacity Evaluation (FCE) typically consists of a series of physical exercises administered over several hours, but the FCE could take up to eight hours.  Very rarely would a Functional Capacity Evaluation last longer than a single day.

A Functional Capacity Evaluation (FCE) will mainly measure the employee's strength, flexibility, and stamina, sometimes cognitive abilities.

What Tests Are Performed in a Functional Capacity Evaluation?

Common tests in a Functional Capacity Evaluation (FCE) include:

    • Standing;
    • Climbing;
    • Stooping;
    • Balancing;
    • Lifting weights or other items;
    • Carrying boxes or other items;
    • Squeezing calipers;
    • Pushing and pulling;
    • Positional tolerance;
    • Range-of-motion testing;
    • Hand dexterity testing;
    • Cognitive tests; and
    • Other similar activities.

During these tests, the functional capacity therapist will examine and attempt to record both the injured employee's ability to complete the tests and the amount of pain which the tests cause the injured employee.

What are the Goals of a Functional Capacity Evaluation?

Specifically, a Functional Capacity Evaluation will attempt to answer the following questions:

    1. Can the injured employee return to work safely?
    2. What type of work can the injured employee safely return to?
    3. What types of work accommodations could possibly allow the injured employee to return to work?
    4. What type of job can the injured employee physically handle?
    5. What type of physical lifting tolerances can the injured employee safely handle? 
    6. What are the injured employee's physical and cardiovascular endurance limitations if able to return to work?
    7. What are the injured employee's tolerances (both time-wise and position-wise) for standing, sitting, walking? 
    8. How intense and prolonged is the injured employee's pain?

So basically, the workers compensation insurance company will use the Functional Capacity Evaluation (FCE) to attempt to ascertain an employee's work capabilities and form the parameters of what type of work activity the employee is able to perform.

Following the Functional Capacity Evaluation (FCE), the worker's treating physician will typically review the Functional Capacity Evaluation (FCE) report and often make a recommendation on whether the employee is capable of returning to work, and, if so, to what type of employment the injured employee is capable of returning.

Requests for Functional Capacity Evaluations in Louisiana Workers Compensation

The Academy of Orthopedic Physical Therapy defines a Functional Capacity Evaluation as a “a comprehensive performance-based medical assessment of an individual's physical and/or cognitive abilities to safely participate in work and other major life activities.”

Basically, a Functional Capacity Evaluation can be used to determine what type of work (if any) an injured employee is capable of returning to should this employee not be capable of returning to his or her prior job position.

For this reason, an injured worker will generally be obligated to undergo a Functional Capacity Evaluation (FCE) if a proper request is made.

Who Can Request a Functional Capacity Evaluation?

Functional Capacity Evaluations are typically requested by:

    • Physicians;
    • Attorneys;
    • Insurance claims adjusters;
    • Medical case managers;
    • Employers;
    • Vocational rehab counselors; and
    • Injured workers.

Basically, any party with an interest in a workers compensation claim is entitled to request a Functional Capacity Evaluation. Usually, this means:

    • The injured employee or the injured employee's representatives;
    • The injured employee's medical providers;
    • The employer or its representatives; or
    • The workers compensation insurance company or its representatives.

Usually, however, it is either the employee's treating physician or the workers compensation insurance company (or its representatives) who typically request a Functional Capacity Evaluation during a workers compensation claim.

A workers compensation Judge could also order a Functional Capacity Evaluation on his or her own, though this rarely actually occurs.

Also, a Functional Capacity Evaluation cannot be administered without the employee's consent.

But, if an injured worker refuses to participate in the Functional Capacity Evaluation, his or her workers compensation benefits - including lost wage benefits - may be reduced or eliminated.

However, typically, a workers compensation Judge would need to determine that the injured worker does not have a valid basis on which to refuse participation in the Functional Capacity Evaluation.

Why are Functional Capacity Evaluations Requested?

Functional Capacity Evaluations are routinely utilized in workers compensation claims, and can be used to address a number of issues, such as:

    • Determining an injured employee's ability to return to work;
    • Forming the parameters of what type of work activity the employee is capable of performing;
    • Determining a permanent impairment rating; and
    • Determining the need for medical care. 

In fact, according to the Academy of Orthopedic Physical Therapy, frequent indications for a Functional Capacity Evaluation include, but are not limited to, the following:

    1. Functional testing performed as part of the work rehabilitation process such as safe entrance into an advanced work rehabilitation program. This may involve the Examiner selecting the most relevant tests for gap analysis between the individual's safe abilities and the job demands. The results are used for program development, to assess progress during the episode of care and as the basis for work recommendations and accommodations, if appropriate.
    2. The individual has been participating in ongoing treatment and performance measures used during treatment may be used in combination with further testing to reach conclusions about the individual's ability to safely participate in work and other life activities during their recovery.
    3. The individual has reached maximum rehabilitation potential. Current physical and/or cognitive abilities are requested to assist with claim closure.
    4. The individual is working, but difficulty performing job tasks has been reported or observed. A job specific FCE should clearly identify whether there are gaps between safe functional abilities and job demands.
    5. Healthcare provider's report that there is a discrepancy between the individual's subjective complaints and objective findings, and the FCE is requested to identify the individual's level of participation, consistency, and behaviors during the evaluation.
    6. Physical and/or cognitive abilities data are needed for case management, disability determination, determination of loss of earning capacity, litigation settlement, or case resolution.
    7. Physical and/or cognitive abilities are needed to help with a job-placement decision.
    8. Physical and/or cognitive abilities are needed to assist with future rehabilitation or vocational planning.

Also, the injured worker's treating physician often requests a Functional Capacity Evaluation in order to obtain information about the worker beyond what the physician would be able to determine during a typical evaluation of the worker by the physician (which would usually consist of just a short office visit with the doctor in which a physical examination is performed).

A Functional Capacity Evaluation allows the treating physician to obtain more extensive data to employ in generating his or her opinions, which must be expressed with reasonable medical probability and be of the quality that they would be considered as substantial.

Since these options are critical not only for the medical treatment aspects, but also for the legal aspects of a workers compensation claim, it is important that the treating physician have as much accurate information available about the employee's condition as possible.

Thus, for example, a treating physician will often want to review a recent Functional Capacity Evaluation report before signing off on any potential positions provided in a Labor Market Survey during the vocational rehabilitation process.

How Are Functional Capacity Evaluations Handled in Louisiana Workers Compensation?

Who Administers Functional Capacity Evaluations?

Generally, Functional Capacity Examinations are performed by physician therapists known as Functional Capacity Examiners. 

The Academy of Orthopedic Physical Therapy defines a Functional Capacity Examiner as "a physical therapist or occupational therapist licensed in the jurisdiction in which the services are performed, who is able to demonstrate evidence of education, training, and competencies specific to the design, administration, and interpretation of FCEs."

Typically, physicians or doctors do not perform Functional Capacity Examination, because they do not have the requisite skills and experience to do so.

In fact, physicians are much more adept, and their time much better utilized, when providing medical treatment to patients, rather than gathering data for a Functional Capacity Examination. 

How Should Functional Capacity Evaluations Be Handled?

Again, the Academy of Orthopedic Physical Therapy defines a Functional Capacity Evaluation as a “a comprehensive performance-based medical assessment of an individual's physical and/or cognitive abilities to safely participate in work and other major life activities.”

The Academy of Orthopedic Physical Therapy also defines the four major components of a Functional Capacity Examination to include the following:

    1. An intake interview;
    2. A medical records review;
    3. A physical examination; and
    4. Content valid functional testing.

In fact, Functional Capacity Evaluations should be performed accordingly to the national guidelines published by the American Physical Therapy Association.

These guidelines published by the American Physical Therapy Association were developed to provide a current best practice, as opposed to a standard of practice. This means that a Functional Capacity Examiner may deviate from the current publication of the guidelines when necessary and appropriate in the course of using independent and judicious clinical reasoning.

In other words, the American Physical Therapy Association guidelines are what the examiner should do, not what the examiner must do.

In a Functional Capacity Evaluation, the Functional Capacity Examiner should rely on objective clinical measurements and observations during the examination, and combine that with objective evidence gathered from a physical examination and a review of medical records.

But at the same time, the Functional Capacity Examiner should also consider subjective evidence gathered from multiple sources, including self-reported pain, disability questionnaires and the subjective information provided by the injured employee.

Are All Functional Capacity Evaluations Handled the Same?

Functional Capacity Evaluations are not are equal, and are not all handled in the same exact way.

Also, the outcomes of a Functional Capacity Evaluation can vary greatly, based upon:

    1. The quality or background of the Functional Capacity Examiner;
    2. The physical condition of the injured employee at the time of the evaluation;
    3. The mental state of the injured employee at the time of the evaluation; and
    4. The thoroughness of the Functional Capacity Evaluation.

Basically, if the Functional Capacity Evaluation is not handled properly, the report and results of the Functional Capacity Evaluation cannot be counted on, meaning that they will not accurately assess the injured worker's disability or impairment.

Who Decides How Much Time is Needed for a Functional Capacity Evaluation?

The Functional Capacity Examiner is the decider of how much time is required to design, administer, and interpret the Functional Capacity Examination, based on the particulars of the specific workers compensation claim.

Typically, in order to determine how much time is needed for the Functional Capacity Examination, the Functional Capacity Examiner will look to: 

    1. The type of Functional Capacity Examination needed (disability, impairment, occupation-related, or other);
    2. The physical and/or mental requirement of the job position or occupation in question; and
    3. How severe, intense  and long-lasting the impairments of the injured worker are.

Usually, a Functional Capacity Examination takes only several hours.

And in most cases, a Functional Capacity Evaluation will not last for more than 8 hours over a 1 to 2 day period. But more time may be needed, particularly in the following situations:

    1. The injured employee has chronic physical and/or mental impairments;
    2. The injured employee has reached Maximum Medical Improvement and permanent work restrictions are required;
    3. Information is needed about an injured employee's ability to safely handle work-related activities over a period of multiple days; and
    4. The injured employee reports chronic fatigue or delayed onset pain.

But on the flip side, a shorter Functional Capacity Evaluation may be proper in the following situations:

    1. The injured employee has acute physical and/or mental impairments;
    2. The injured employee has not reached Maximum Medical Improvement and only temporary work restrictions are necessary for a return to work;
    3. Only baseline functional abilities are required for participation in a work rehabilitation program; and
    4. The injured employee only needs to provide helpful information regarding his or her ability to work. 

The Functional Capacity Examiner will ultimately be the decider of how much time is required to design, administer, and interpret the Functional Capacity Examination, though any party - including the injured worker or the injured worker's attorney - could challenge the methods or the results of the Functional Capacity Examination, based on these decisions of the Functional Capacity Examiner.

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