What is a Functional Capacity Exam?

When you file for long-term disability (LTD) benefits, the insurance company may request that you submit to a Functional Capacity Examination or FCE. A FCE is designed to test your ability to perform certain activities—the material duties—of your job.  It measures your ability to perform these key duties in a matter of degrees.  Know that a FCE does not test your ability to perform only those material duties for your job, but also your ability to perform duties required by other occupations that may suit your experience, training, and education.

long-term disability insurance claim

A FCE Tests Your Residual Functional Capacity (RFC)

The FCE utilizes a series of physical tests to determine a claimant's “residual functional capacity” (RFC) which is the level of work a person can perform.  The Social Security Administration (SSA) defines the different RFC types as follows:

  • Sedentary: An office job that involves sitting up to 6 hours a day, stands or walks up to 2 hours a day, and can lift and carry small things (less than 10 pound) like files and other light office equipment.
  • Light: Requires the claimant to be able to stand or walk up to 6 hours a day, frequently lifting or carrying between 10-20 pounds. Think, a bank teller or cashier.  Most medical and dental professions are also considered light jobs.
  • Medium: Requires standing or walking for at least 6 hours, sitting for two, as well as the ability to carry between 25-50 pounds throughout the day. This would be akin to a factory worker, nurse, or waittress.
  • Heavy: Involves lifting up to but no more than 100 pounds at any given time. A foreman on a job site would be a good example.
  • Very Heavy: Requires the claimant be able to lift more than 100 pounds while frequently lifting and carrying over 50 pounds throughout the day. Mason workers, landscapers, construction crew would fit into this category. 

The FCE will require the claimant to go through a series of tests in a setting akin to physical therapy and carry items of varying weights, walk on a treadmill, sit for periods, etc. to determine the claimant's maximum RFC in a work environment.  While these tests are instructive, the fact that they occur over only a 3-4 hour period, rather than a full 8-hour workday does limit the accuracy of their findings. 

FCE Results Can Help or Hurt You

If your policy is employer- or group-sponsored, it is likely to be governed by E.R.I.S.A.  Most of these policies require you to submit to a FCE.  However, many privately issued LTD policies can include the same requirement.  If your LTD insurance carrier has requested you undergo a FCE, this is a critical point in your claim and you should contact an experienced LTD insurance attorney to assist you in making sure the FCE is fairly conducted and results in accurate findings.  Our experienced attorneys at Taylor, Warren, Weidner & Hancock never charge any fee or cost or require any obligation on your part to simply assist you with your LTD claim and ensure you are treated fairly during the process. 

It is possible your FCE could accurately demonstrate your disabling condition and your limitations, making it obvious you cannot perform the material duties of your job and support your claim for LTD benefits.  On the other hand, it could result in a finding that your medical condition does not prevent you from performing either the material duties of your own occupation or any occupation suited to your training, background, and education.  We have seen this occur often as the examiners hired to conduct the FCE are retained, and paid, by your LTD insurance carrier.  Meaning, they have a financial incentive to find against you and in favor of your LTD carrier.  This is why it is imperative that you have an attorney who is looking out for your interests and fighting for your recovery.

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