What to ExpectDuring Functional Capacity Evaluations

Functional Capacity Evaluations (FCE) are usually done after the injured worker has completed physical therapy and/or a work conditioning program. They are typically ordered by the treating physician when the injured worker has reached maximum medical improvement. The purpose of a FCE is to determine your work capacity and whether you are able to return to your job. FCEs are usually administered by a therapist and can take between 2-6 hours. Depending on your injuries, the FCE may test the following:

• How long you can sit, stand or walk
• How many pounds you can lift, carry, push and pull
• Your ability to grip and grasp
• The ability to bend, stoop and reach
• Your ability to climb, crouch or crawl.
• The ability to utilize tools.

Functional Capacity EvaluationsDetailed Report

A detailed report will be submitted to your physician for review. The FCE is a tool that your doctor uses to determine whether to place you on permanent activity restrictions. While in most cases the treating physician will generally agree with the FCE findings, some physicians will modify or add restrictions at their discretion.

Functional Capacity EvaluationsValidity

Built into the FCE are tasks that measure whether you are giving a sincere effort—referred to as validity testing. Grip testing is a common validity test performed in FCE's. Your heart-rate will be monitored throughout the exam. If your heart rate doesn't reach a certain threshold (i.e. 80% of your maximum heart-rate) following certain tasks, this is interpreted as self-limiting behavior and the entire FCE could be deemed invalid.

Medicare's Interests and Your Workers' Comp Claim

If you have a pending workers' compensation claim and are a Medicare recipient or believe that you will be eligible for Medicare within 30 months from the date of your workers' compensation settlement, you must consider Medicare's interests when you settle your case. This is true because Medicare does not want to pay for treatment that you may need in the future because of the work injury. If you do not consider Medicare's interests, you may jeopardize your future Medicare benefits for any medical care that you may need in the future.

There are three ways to consider Medicare's interests if you have an open workers' compensation claim. You may settle your case and agree to keep your medical rights open. If you settle your case in this matter, your workers' compensation carrier would still have to pay for any future treatment that you need because of the work injury. Most insurance companies do not want to settle a case this way because they want cases closed and off their books.

The second way to consider Medicare's interests is to have your workers' compensation case tried by the Arbitrator. If the Arbitrator finds in your favor, your medical rights remain open as a matter of law in Illinois. The workers' compensation insurance company still would be responsible to pay for any future medical care that you would need.

When you've suffered an injury at work, you may receive notice that a nurse case manager has been assigned to your case. Below are a few quick answers to common questions employees have regarding what nurse case managers are and what their purpose is in regards to your workers' compensation claim.

What is a nurse case manager?

A nurse case manager (or NCM for short) is a nurse hired by the workers' compensation insurance carrier to be involved with the employee's care and treatment related to the work injury. Typically, nurse case managers will discuss the employee's care and treatment with the employee and his or her treating physician, coordinate the scheduling of appointments, and draft reports summarizing the medical care and treatment, which are then sent to the workers' compensation carrier.

Will the NCM attend every appointment I go to?

Generally, no. Nurse case managers typically only appear for appointments that you have with your treating physician, when decisions about your care and treatment would be made. For example, if you are participating in a course of physical therapy, the NCM would not appear for each of these appointments. Additionally, nurse case managers also may participate telephonically, so they do not actually appear in person at the employee's appointments.

Work injuries are stressful and painful. That stress and pain can be compounded if you suffer an intervening injury while recovering from your work injury. If that intervening injury happens while you are rehabbing from a work injury, that injury also is covered by the Workers' Compensation Act in Illinois. There are two types of intervening injuries that we commonly see.

The first type of injury is an injury that takes place while you are in physical therapy actively treating for your work injury. If you injure yourself in physical therapy, whether you injure the same part of your body or a different part of your body, such an injury is covered under Illinois workers' compensation law. You are entitled to receive all necessary medical treatment, compensation for lost wages caused by this intervening accident, and even compensation for permanent injuries caused by such an intervening accident. If you suffer such an injury in physical therapy, tell your physical therapist and doctor immediately. Timely documenting such an injury is critical to protecting your rights.

The second type of intervening injury comes from overusing the part of your body opposite the part originally injured in a work accident. Assume that you injured your left arm in an accident at work. As a result, you have limited use of the left arm. Consequently, you have to use your right arm more than you normally would. Soon, that right arm begins to hurt. You see your doctor and learn that your right arm now is injured, too. Fear not! In Illinois, this type of injury also is covered by the Illinois Workers' Compensation Act. You are entitled to all necessary medical treatment, compensation for your lost wages, and compensation for permanent injury caused by this overuse.

Section 12 of the Illinois Workers' Compensation Act gives employers a right to request that injured employees submit to an independent medical examination (IME) by a physician or surgeon of their choice. The employer or insurer will pay for the costs of the IME and is also required to provide the injured employee with a mileage check and reimburse the employee for travel expenses (i.e. parking, meals). The injured employee is required to attend the IME. Failure to do so will result in the suspension of workers' compensation benefits.
A common question asked by many of my clients is – What should I expect at an IME? Like a visit to your own doctor's office, upon arriving you may be required to complete paperwork asking you to provide a history of your accident, describe your subjective complaints, list your current medication and give a rundown of your treatment history. The IME examiner will also ask you to describe your accident or give a description of the type of work you perform. It is important to give an accurate history of your accident and complaints.
Often times the physical exam takes no more than 10 minutes.common complaints I get from clients are that the examiner was standoffish and had poor bedside manner. Don't let this discourage you! In reality, IMEs are never truly "independent." Insurance companies hire these physicians to issue opinions and often use the same doctors over and over again because they know what to expect. The insurance companies pay the doctors anywhere between $1000-$1500 for an exam. It's also important to note that a doctor-patient relationship is not established by way of an IME. This should be made clear by the examining physician from the outset. This also means that there is no confidentiality privilege and the IME physician can, and very likely will, report anything you do or say during the exam to the employer/insurance company.
Following the IME the physician will write a report. The report will address causal connection, whether additional treatment is needed and whether the employee is able to return to work. It is common for a doctor performing an independent medical examination to determine that your condition is not work-related and/or that you can go back to work without any restrictions. Many even find no evidence of injury or determine that your condition is part of the "natural aging process."
The insurance company can deny workers' compensation based on the opinions of the IME physician, regardless of what your own treating physician says. Keep in mind however; the IME physician's opinion is not the final word! Your treating physician will likely have a very different opinion than the IME physician. At that point it becomes a "battle of the experts." Depending on the situation your attorney may want to take an evidence deposition of both doctors and the matter may need to be litigated in the Illinois Workers' Compensation Commission. If you do not have an attorney at this point, it is highly recommended that you hire one. Otherwise your chances of getting your benefits reinstated are slim.
Remember that you may be observed from the time you arrive the office until the time that you get in your car to leave the appointment. This is important because often times the IME report will state how you got in and out of your car, how you opened the door, how you sat in the chair, how you walk, how you were able to get on the examining table etc. The examiner will be on the lookout for any inconsistencies between your reported disabilities and their observations of these seemingly mundane activities. For example the report the doctor might note on the report -"The claimant stated that he has difficulty lifting, pushing or pulling more than 10 pounds. However, on his arrival he was observed pulling open the door with no difficulty. The door requires 15 pounds of force to pull open." IMEs are not only used to deny workers' compensation benefits, but also used to chip away at the injured worker's credibility.
Knowing what to expect during an IME can alleviate a lot of the anxiety associated with this experience. Below are some helpful tips that I give all of my clients who are scheduled for an IME:

1. Get there on time! Most IME physicians' office will cancel your appointment if you are late. Although the IME can be rescheduled, the insurance company will treat this as if you no-showed your appointment and suspend your benefits. If you do not have a means of getting to the IME, transportation should be provided to you by the insurance company or employer, but you must arrange for this well ahead of the exam.
2. Be honest and cooperative with the examining doctor. There are times where one may come across an IME physician who has an unsympathetic or even hostile attitude. The best way to handle this situation is to not react. Cooperate with the exam and answer the questions as best as you can.
3. Most importantly, do not exaggerate your complaints or symptoms. Some injured workers feel they have to convince the IME physician that there complaints are "real" and as a result, intentionally or unintentionally, embellish their subjective complaints and exaggerate their reactions to clinical tests. This always backfires! Most physicians can easily tell when an examinee is malingering. In fact, IME physicians incorporate a series of tests in their exam, called Waddell Signs, which purportedly correlate with symptom magnification. Exaggerating your symptoms and complaints can only hurt your case.