Is Your Valid FCE Really Valid?
It may not be. There is a tendency to accept a Functional Capacity Evaluation (FCE) as an objective measurement of everything a claimant can and cannot do. However, it may pay to delve deeper as not all FCEs are created equal. Understanding what to look for and when to challenge a valid FCE can be the difference between a simple loss of use becoming a job change or even a wage differential award.
There is no standard method of performing an FCE so there is no measure of what is appropriate. There are, however, differing schools of thought on the types of evaluation and that evaluation method will impact the result. Some facilities use a standardized testing model, regardless of the claimant or the return to work goals. Facilities may lack the expensive equipment and/or job specific testing necessary to assess the key factors for a job specific skill set. From an employer’s perspective, the more closely testing mimics true job functions, the more accurate the results. Facilities which standardize tests across the board may charge less for their evaluation but produce less than desirable outcomes.
Who your evaluator is and his or her background will impact an FCE. A full physical evaluation is an important component. Some practitioners simply fail to perform a full physical evaluation. Many practitioners, such as athletic trainers, may not be qualified, to perform full physical evaluations either independently or under the direction of a physician. Regardless of the reason, without a full physical examination, the evaluator lacks baseline measurements necessary for comparison to activity levels and thus consistency cannot be accurately assessed. Physical examinations are also key to determining effort and malingering, both of which impact validity measures in an FCE.
An evaluator may have biases in the evaluation process which effect outcome. He or she may have a connection with the referral source or the claimant. The evaluator may also influence results directly by allowing retesting or cueing the claimant to foster a valid examination.
Beyond standard history taking and pain scales, it is also important to understand the medical history of the claimant. Is the claimant on medication, for example, which may impact heart rate measures used in validity testing models? Are there other unrelated conditions which potentially impact abilities and, in turn, FCE outcomes? A quality examiner knows how to assess the impact of the claimant’s medical history on the examination and will address those issues in the evaluation.
Validity testing itself includes a great deal of variance. FCE equipment should be calibrated often. Equipment can become damaged easily and is expensive to fix and thus is often not adequately maintained. Equipment which is not well maintained and regularly calibrated may impact validity results.
Different evaluators and evaluations require a claimant to pass different percentages of validity testing so it is possible for the same evaluation to be valid under one model and invalid under a different model. Other evaluations employ minimal validity testing when it should be performed throughout the evaluation. For example, heart rate monitoring should be performed with each exercise as it establishes trends and a mode of comparing effort levels throughout the evaluation. A quality FCE test will provide actual measurements throughout the process, not summaries or unsupported conclusions.
Particularly with skimpy FCE reports, subpoena the facility’s full file relative to the evaluation to assess see what, if any, notes the practitioner kept relative to the testing completed. Chances are the evaluation process was not well documented and the practitioner will have a hard time supporting the findings in a deposition. The practitioner should be required to defend conclusions with specific documentation.
Get an audit. Do not take the valid FCE as valid on its face. We invest in IMEs to evaluate treating medical opinions. An FCE is simply another opinion which can be challenged by a qualified professional. That individual can offer insight into testing methods and often identify deficiencies upon which to challenge conclusions in a purportedly valid FCE.
FCEs are largely impacted by the qualifications, skill, experience, and training of the examiner. Investigate the examiner’s background. Inquire as to the number of evaluations he or she has performed. Does the examiner have a bias in terms of the referral source or is the evaluation performed at a physician based facility where the claimant treated or received therapy? How well does the evaluator understand the mechanics of the injury, the claimant’s medical history, and the job functions being tested?
It is important to remember FCEs are not black and white measurements of ability. Particularly where a report lacks specificity or the end result falls a little shy of the return to work goal, review the FCE with a critical eye and discuss with your counsel avenues for challenging the evaluation process and in turn the end result of your “valid” FCE.