Saturday, March 2, 2013

FCE Spurs Unum Approval


Long Term Disability (“LTD”) insurers use similar tactics to deny or terminate benefits when the treating doctors support the claim.  One of those tactics is sending claimants for a Functional Capacity Evaluation (“FCE”).  An FCE is a battery of tests to see what your physical capabilities are with regard to work.  The results of the FCE are normally weighed against the U.S. Department of Labor standards, as set forth in its Dictionary of Occupational Titles, which classifies work into progressively more strenuous categories sedentary, light, medium, heavy, and very heavy work.

The insurers have arrangements for the same people, normally physical therapists (“PTs”), to perform the FCEs.  In order to maintain those arrangements, I have seen cases where the PTs conducting the FCEs conclude the claimant can perform a certain category of work even when the FCE data fails to support it.  That is precisely what happened in Alfano v. Cigna.  In order to avoid an insurer from relying on a faulty FCE, I sometimes advise my clients to have an FCE.  An independent FCE prevents a PT from giving a conclusion inconsistent with the FCE data. 

I represent a 43 year old securities trader with psoriatic arthritis.  That occupation is light, which requires standing and walking most of the day.  I advised the claimant to have an FCE for his feet, and the data revealed a severe impairment.  The treating doctors concluded the claimant lacked the ability to perform light work based upon the clinical findings.  The LTD claim was approved in three months, which I attribute to the FCE objectively corroborating the treating doctors’ opinions.

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