Have you recently been in a car accident? Then you’ve probably heard about the numerous assessments your insurance agency would require you to take, like your Functional Capacity Evaluation or FCE which measures your functionality or ability to perform various tasks and activities.
The beauty of having an insurance plan is that, in cases like car accidents, you could be entitled to an Income Replacement Benefit from your auto insurer. This requires your insurer to release funds to you during your inability to perform your job and earn an income for yourself.
However, insurance companies are inclined to check on you every once in a while to validate your inability to work and determine your eligibility to continue receiving Income Replacement Benefits.
To properly determine your eligibility, they will likely send you to a health professional to be assessed in what they call a Functional Capacity Evaluation. Insurance companies favor Functional Capacity Evaluations due to the testing being considered as an objective measure of your ability to remain functional when performing tasks and activities.
The results of a Functional Capacity Evaluation are used to determine whether you can return to your prior occupation or something in the same field, or if you can start doing other types of work, or if you’re simply unqualified to perform any type of work at all.
A kinesiologist or registered Occupational Therapist performs the Functional Capacity Evaluation and is responsible for administering three components to the evaluation.
The physical evaluation is performed to determine a person’s functionality when performing a wide array of activities like walking, sitting, standing, pushing, pulling and kneeling as well as lifting and any body movements that are crucial in day to day activities especially those that are most necessary in performing any type of work.
The assessor is responsible for observing your ability to perform such tasks and noting exactly how long you can perform the task, they are also responsible for recording the amount of weight you can maneuver and observe if you required adjustments before performing any of the tasks given.
Usually, the results of the Functional Capacity Evaluation are used to compare your current ability and the demands of your job.
The assessor is also in charge of determining your pain threshold while you perform the tasks given. The actual method may vary but it usually involves your input on the pain (if any) you experience while performing your tasks.
Perhaps the most critical part of the evaluation is determining whether you are exerting maximum effort to perform the tasks. This is evaluated based on the consistency of the different components of the evaluation among other factors.
The assessor is responsible for making sure that the results of your Functional Capability Evaluation are reliable and consistent.
However, a few things to be wary of are expressed by Najma Rashid, a partner in Howard Yegendorf and Associates.
She states that FCE is only one of the many assessments your insurance company needs to determine your capabilities to work. Most of the evaluations conducted are finished within the day, usually under seven hours.
This is slightly alarming since an FCE may not be completely reliable no matter how precise the results are. This is because the ability to work is not something you can easily measure in less than seven hours.
There are a lot of factors that go into a typical workday, not to mention the activities you have to perform prior to working such as showering, eating, preparing your clothes, traveling and attending to your work’s requirements.
There are also instances of persons able to perform work every once in a while, but when encountering a progressive work week will experience an increase in symptoms that only impair them even further.
She further shares that an FCE is mandatory if your insurance company is following the procedures mandated by the Statutory Accident Benefits Schedule. However, some instances will allow you to refuse, having a trusted attorney alongside you to notify you of instances like such are favorable.
There is no need to be afraid of participating in the evaluation. Rashid urges participants to put forth their best efforts and says that they may refuse to do some tasks where they know it will cause them harm or further injury.
If, in any case your Income Replacement Benefit is terminated due to your insurance company determining that you are fit to work yet you feel you are otherwise unfit, it is necessary to find a good attorney if you don’t already have one and discuss your options.
A good attorney might suggest additional evaluations you can use to prove that you are incapable of attending work and gauge whether you are fit to apply to the License Appeal Tribunal regarding your insurance company’s termination of your benefits.