Functional Capacity Evaluations

After a worker sustains a work related injury in the course and scope of their employment duties, the worker will need to obtain medical treatment.  This treatment varies depending on the type of injury, and can range from physical therapy to surgery to acupuncture.  The workers’ compensation process will also require that the employee submit to extra testing to provide information to determine issues such as whether the worker is permanently or temporarily disabled and the extent of the disability.  One examination the worker may have to submit to is called the Functional Capacity Evaluation.

The Functional Capacity Evaluation (FCE) is an examination performed by a physician, physical therapist, or other medical professional to measure the level of the injured worker’s functioning.  The purpose of the test is to evaluate and document the injured worker’s ability to perform, or not perform, the essential job related tasks.  The physician will then review the information and evaluate several different areas.  These areas include the demands of the job, when the employee should return to work, whether the employee can realistically return to the same job he or she held before sustaining injury, the employee’s abilities demonstrated when not on the job, the potential required rehabilitation or medical intervention.  Employees may be asked to submit to either a Job Specific FCE, which will determine the employee’s ability to perform the specific tasks for the job they were in at the time they were injured, or a general purpose FCE, which is typically used when the job the employee was in at the time of injury either no longer exists or has been filled during the employee’s absence.  After the FCE is completed, the physician or medical professional will prepare a particular report reflecting their findings.

The FCE will serve as a touchstone for insurance adjusters, attorneys, and employers to all determine whether an employee is ready to return to work and in what capacity.  The FCE can often serve as a reference when determining the employee’s disability rating.  It is possible that in the future, another treating physician will not be able to assign a higher disability rating than what is found in the FCE.  The employer also needs to have a comprehensive understanding of the contents of the FCE.  The FCE will tell the employer what types of accommodations may be necessary for the employee to return to work.  Employers are obligated to provide reasonable accommodations to employees when they return to work during a workers’ compensation case.

We have extensive experience helping our clients understand the workers’ compensation process.  Contact us today for a consultation to talk about your business.

What is a Medical-Legal Evaluation?

If an employee sustains a work-related injury, there is a lengthy process of reports, evaluations, and paperwork involved in a claims process. This starts immediately with the worker reporting the incident and the employer reporting to its insurance company. Part of the process involves a medical-legal evaluation. If either the employer or the employee does not agree with the opinion of the employee’s treating physician, they may request a medical-legal evaluation in order to obtain a new medical opinion.

A medical-legal evaluation is a special kind of doctor’s appointment scheduled for the employee. This appointment will involve the employer’s attorney (or the insurer’s attorney), the employee’s attorney, the employee, and a neutral doctor. The neutral doctor is called a Qualified Medical Examiner, and this doctor will have completed special training through the state to obtain this license. The doctor’s job in these situations is to evaluate the employee’s injury. The doctor will determine a variety of medical issues, including whether the injury was a work-related injury, if the injury was sustained in the manner described by the employee, and the degree of disability. The doctor will also assess what type of improvement has occurred, whether the impairment resulting from the injury is permanent, and whether future medical treatment will be necessary. Finally, the doctor may provide an opinion on whether the employee will ever be able to return to the same line of work. Of note is that this doctor does not provide treatment to the employee. The doctor or team of doctors providing treatment or therapy to the employee will be a different set of doctors entirely. The purpose of the doctor associated with the medical-legal evaluation is to be neutral, and not the same medical professionals involved in the rest of the employee’s treatment.

Recent trends in California case law demonstrate there are interesting issues surrounding telemedicine and medical-legal evaluations. In a 2016 case, the WCAB rejected the effectiveness of a medical-legal evaluation where the evaluator performed his examination via interactive audio/video telecommunication and used a designated chiropractic specialist to conduct the physical examination while he was only present electronically. The WCAB concluded that it was not certain whether such a method complied with California regulations that require the doctor have at least 20 minutes of “face time” during the evaluation.

Medical-legal evaluations can be a key component in challenging an employee’s medical status. and I have extensive experience with these evaluations. Call me today at (714) 516-8188 and let me help you with your pending workers’ compensation case and with deciding such an evaluation is right for your case.

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