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Using a Functional Capacity Evaluation to Support Your ERISA Disability Claim
26June 17

Using a Functional Capacity Evaluation to Support Your ERISA Disability Claim

functional capacity evaluation - Erisa Claim When you find yourself unable to perform the duties of your job, it can be a terrifying situation. You may be struggling with medical conditions and an increased need for time off. You may be worried about losing your job. However, most private employers must provide you with time off if you are suffering from a medical condition that renders you disabled. Additionally, if you have disability insurance through your employer, some of your financial needs may be met during that time. However, it can be difficult to prove to the insurance company that your conditions are so severe that you’re unable to perform job duties and qualify for disability benefits. A functional capacity evaluation can help.

What Is an ERISA Disability Claim?

If you have disability insurance through your private employer, that claim likely falls under the Employee Retirement Income Security Act of 1974 (ERISA). Although there are few exceptions, most employer sponsored disability plans, both long and short term, must comply with ERISA. ERISA protects plan participants by mandating that insurance companies treat all participants fairly and provide necessary information to file and appeal claims. Your insurance provider should give you all the information necessary to file a disability claim, and they should work with you to submit appropriate evidence. However, it can still be difficult to determine exactly what your insurer needs in order to approve your claim.

What Is a Functional Capacity Evaluation?

When proving that you are unable to perform the duties of your job, you must provide objective evidence that you are unable to function in ways that make it impossible to complete the requirements of your job.  You must have a thorough job description from your employer as well as any witness testimony or industry standards for additional duties not on the description. With this information, a medical provider can determine whether you’re able to perform those duties described or not.

A functional capacity evaluation (FCE) will provide a broad overview of what you can and cannot do. It will help your doctor assess what level of work you can do – heavy, medium, light, sedentary, or none. While completing the assessment, your doctor will have you complete a series of physical and non-physical tasks that will evaluate your abilities in the following areas:

  • Lifting
  • Pushing and pulling
  • Sitting and standing
  • Walking
  • Crouching and stooping
  • Grasping and manipulating
  • Reaching
  • Concentration and attention
  • Memory
  • Endurance
  • Logical thinking
  • Engagement in simple, routine, repetitive tasks
  • Following directions

You can expand on these areas depending on your specific job duties. The tasks your doctor asks you to complete in the office will coordinate with one of these functional abilities. Your doctor will record your performance and compare it to the required tasks you must complete in your job. If you are unable to perform the tasks required by your job, you may be considered disabled.

What If Your Doctor Does Not Complete FCEs?

Some doctors do not complete disability paperwork, and others charge expensive fees to compete it. This can be daunting when you’re unable to work and already concerned about finances. In such an event, you may seek a doctor that specializes in disability applications, or your insurance company may send you to a sponsored doctor for an independent medical examination (IME). In both situations, the doctor you see will likely complete an FCE. You must be completely honest and detail all of your symptoms to the doctors. They will also evaluate your likelihood of malingering, or exaggeration. Comply with all directions given by insurance companies and doctors when evaluating your functional capacity.

How to Prepare for an FCE

Before undergoing an FCE, you can do the following things to prepare:

  • Keep a Diary – Although your subjective descriptions of your symptoms do not hold weight with the insurance company, your doctor needs to know how your conditions are affecting every area of your life. Your doctor will objectively determine whether the things you claim make sense according to other findings. In your diary, document your pain on a scale of 0 to 10, all symptoms you experience, and how every area of your life is affected by your inability to function.
  • Make a List of Prescriptions and Treatments – Any doctor performing an FCE needs to know your complete medical history. Although your doctor should already know your medical history, an independent doctor may not. They should receive your medical records in advance of your exam; however, you should also jot down a brief history of medications and treatments you’ve received as well as how they have impacted your conditions. This will allow the doctor to have a full picture of your medical history and how it has affected you personally.
  • Understand Your Conditions – Your doctor will ask you many questions regarding your medical conditions. It is best if you fully understand what he or she is talking about before answering. If your doctor asks you if you’ve experienced episodes of syncope, you need to know that means “fainting.” Do not be afraid to research your own conditions or ask for additional information prior to your FCE exam. This will allow you to better understand the questions your doctor asks during the exam.

A Disability Attorney Can Help

Filing an ERISA disability claim can be complicated. You must comply with all of the requirements and deadlines of your insurance company. In order to expedite the process, you should contact an experienced NJ Erisa Claim attorney to fight for you.

To learn more about a functional capacity evaluation or to file a claim or appeal a denial of disability benefits, contact the New Jersey disability lawyers at Uscher, Quiat, Uscher & Russo, P.C. today at 1-800-797-5575.

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