AMA Guidelines for Functional Capacity Evaluations (FCE’s)

Functional Capacity Evaluation, Return to Work

In 2009 the AMA Guide to the Evaluation of Functional Ability: How to Request, Interpret and Apply Functional Capacity Evaluations, the authors define FCE as “the objective measurement of a person’s ability to perform functional work activities.” Medical reasons for an FCE include:

  • Injury prevention
  • Work-related injury or illness management
  • Chronic injury or illness evaluation

Let’s focus on the use of the FCE in a work-related injury or illness management program. The book discusses the benefits of routine assessments in the rehab process. By doing mini-FCEs at periodic intervals, the progress of the injured worker toward meeting short and long term goals can provide valuable information and direction for healthcare providers. Having an accurate job analysis with physical demands is also key to this process and will allow a more aggressive approach to returning the injured worker to work safely. Often, an FCE is not ordered until near Maximum Medical Improvement (MMI), which may result in a lot of wasted time and money, as well as an “invalid” result. Also, as the book noted, having an evaluator who is capable of providing a clinical, as well as work-related, functional ability evaluation is critical to success. As the AMA authors note, “Because medical opinions of function are subjective, FCE’s based on objective testing are used to add to the medical information obtained.”

Mini-FCE’s or Fitness for Duty testing can also be used to determine the possible reasons for delayed recovery and prompt the health-care providers to “frankly discuss any sub-maximal or inconsistent effort with the patients, as well as establishing expectations that must be met for treatment to continue.” Again, waiting until the end of medical treatment may be too late. These evaluations also can identify the worker’s safe abilities as they relate to their ability to perform job tasks to assist in returning the worker to modified or transitional work earlier. As soon as there seems to be a delay in progress, a mini-FCE should be requested to determine the reason as well as direction of future treatment. In certain cases, employees may wish to return to work and have asked their physicians release them, but without objective evidence of their safe physical capacity, they may return too early and risk re-injury.

FCE’s are also used to assist vocational case managers in placement efforts for the injured or disabled worker.
For many years, attorneys, adjusters, case managers and employers have all relied on the subjective opinion of a
physician to determine whether an injured worker can do a particular job. The physician is providing a guesstimate or best clinical judgment of that person’s ability to do the job. The AMA notes a growing awareness that “physicians are not formally trained to define a person’s occupational capabilities and therefore are unable to accurately declare a person as totally disabled for working, or conversely, capable of gainful employment.” So, why do we continue to ask physicians to sign off on job descriptions which are many times inaccurate?

William Sommerness, an attorney, states, “The most important testimony is that from the Physical Therapist or Occupational Therapist because they are the ones who…can do the best job of explaining the client’s attitude and performance.”

The final takeaway is that physicians are highly trained in determining an employee’s medical stability in being in the workplace, but the best tool to determine the employee’s safe functional ability to perform the job functions is with the use of a Functional Capacity Exam. It can be done at any time in the rehab process, and sooner is better than later. Contact Job Ready today to determine which exam may be best for your needs.