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.
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