WHY A FUNCTIONAL CAPACITY EVALUATION?
We firmly believe
in the medical necessity of an IME coupled with an FCE. This test is
performed at the time of an Independent Medical Evaluation. The
combination of these procedures provides the most realistic insight as
to impairment/disability, causation, apportionment, and retained safe
work capabilities.
A Functional
Capacity Evaluation (FCE) is a systematic process of measuring an
individual’s ability to perform meaningful tasks safely and dependably.
It is based on objective performance measurements that are analyzed and
recorded by state-of-the-art computer technology. An FCE is not an
observation or subjective determination of an individual’s self report
of abilities.
A Functional
Capacity Evaluation should be used in the determination of the safe
return to work of an injured employee; matching job demands to retained
capabilities. A Functional Capacity Evaluation can identify functional
weakness and strength deficits, allowing for proper treatment and
rehabilitation. An FCE also aids in establishing an impartial and
objective measurement of the worker’s capabilities; necessary for a
bureaucratic or judicial resolution and/or disability determination.
Leonard Matheson, Ph.D., indicated:
“An FCE is used as a model of service to improve the health
and function of our citizens so that they can return to work, resume
full-fledged participation in the economy, restore dignity to themselves
and to their families, and improve the overall financial and emotional
health of the nation.”
The relevance of a
Functional Capacity Evaluation in the State of Kentucky as objective
measurement of strength capabilities bears a direct relationship in the
calculation of extent of injury and impairment. Kentucky Statute defines
“injury” occurring on or after December 12, 1996, as:
“Injury means any
work-related traumatic event or series of traumatic events, including
cumulative trauma, arising out of and in the course of employment which
is the proximate cause producing harmful change in the human
organism, evidenced by objective medical findings.” Injury does
not include the affects of the natural aging process and does not
include any communicable disease unless the risk of contracting the
disease is increased by the nature of the employment. “Injury”, when
used generally, unless the context indicates otherwise, shall include an
occupational disease and damage to a prosthetic appliance, but shall
not include a psychological, psychiatric, or stress‑related change
in the human organism unless it is the direct result of a physical
injury.”
Therefore, in
Kentucky law, impairment and disability are directly related to the
“harmful change in the human organism.” An objective measurement of
strength and work capabilities is substantial proof of “injury” and may
directly reflect the long-term effects of “injury.”
Also in Kentucky,
an “Impairment Grid” was established for the calculation of benefits.
Under KRS 342-730 (1)(b) the Impairment Grid takes into consideration
the impairment rating by the AMA Guides and is multiplied by a
“factor” relative to the impairment percentage.
Then, KRS 342-730
(1)(c)(1) provides:
“If an injured worker does not retain the physical
capacity to return to the type of work that the employee performed at
the time of the injury, the benefit rate is multiplied by three (3)
times the amount otherwise determined.”
Therefore, the
Functional Capacity Evaluation becomes an integral part in claims
resolution. Measurements of the physical requirements of a job activity
may be measured by conventional means. The Functional Capacity
Evaluation then measures the retained strength capabilities of the
individual. This means of objective comparison determines whether the
individual possesses the strength capabilities of safely returning to
that job. The FCE, therefore, takes out of play the subjective
impressions of the evaluator. Therefore, should the patient possess the
strength capabilities required for the previous job, the permanent
partial disability benefits would not be tripled.
Statistical
analysis of the direct and indirect costs of restricted-duty workdays
and absence are typically $500 to $700 per day and may affect 12% to 15%
of a company’s average payroll. Directly, the cost of medical care,
rehabilitation, TTD, and claims processing is significant. However, even
when the injured worker is on restricted duty, the indirect costs of
hiring temporary help, overtime hours, additional training and
supervision, as well as reduced output result in increased cost to the
employers. The Functional Capacity Evaluation is an objective
measurement that more scientifically determines maximum medical
improvement and, therefore, cessation of TTD and return to work.
Furthermore, it is a tool by which measurements can be formed to place
the patient in meaningful work activities and, therefore, decreasing
direct and indirect costs.
In summary, the FCE
increases the credibility of the Impairment Analysis System. It provides
objective measurements of function relevant not only to the safe return
to work of the injured employee, but also directly reflecting maximum
medical improvement and compensation awards. It is a means to better
help prevent reinjury.
