How Disability Insurers Use FCE Results to Challenge Your Work Restrictions

A Functional Capacity Evaluation (FCE) is a series of tests designed to measure your physical abilities. While it may seem like a neutral assessment, disability insurance companies often use FCE results as a powerful tool to challenge, reduce, or deny your claim. They can be stressful and physically demanding, and the final report can feel like a direct contradiction of your daily reality.

Understanding how insurers interpret these evaluations is the first step toward protecting your rights. At Bartolic Law, we have seen countless clients face denials based on misleading FCE reports. This blog will break down the common tactics used by insurers and provide guidance on how to respond effectively.

Lifting and Carrying Tests

One of the most critical parts of an FCE is the assessment of your ability to lift and carry various weights. The report will specify the maximum weight you could manage on an occasional, frequent, or constant basis. Insurers seize on these numbers to argue that you can perform certain jobs.

For example, an FCE might conclude you can lift 20 pounds occasionally. The insurer will then match this finding to job descriptions in the national economy that require “light” physical exertion. They use this data to claim that even if you cannot return to your previous job, you are capable of performing “any occupation” with these lifting requirements. This tactic often ignores the full context of your limitations, such as pain, fatigue, or the inability to sustain this activity over a full workday.

Postural and Sedentary Limits

Insurers also scrutinize FCE findings related to your postural and sedentary abilities. The evaluation measures how long you can sit, stand, walk, and your capacity for activities like reaching, bending, or stooping.

If your doctor has provided restrictions, for instance, that you cannot sit for more than 30 minutes at a time, the insurance company will look for any part of the FCE that contradicts this. The report might state that you were observed sitting for 45 minutes during the test without complaint. The insurer will use this isolated observation to argue that your doctor’s restrictions are too severe and that you are capable of sedentary work, which typically requires sitting for up to six hours in an eight-hour workday. They apply the same logic to standing, walking, and other postural limits, creating a narrative that undermines your treating physician’s expert medical opinion.

Reliability and Effort Factors

Perhaps the most subjective and damaging part of an FCE report is the section on “validity” or “sincerity of effort.” The therapist administering the test makes a judgment call on whether you gave your maximum and consistent effort. This can be based on observations like your heart rate, grip strength consistency, or perceived pain behaviors.

If the report suggests a “lack of full effort” or that your performance was “self-limiting,” the insurance company has a powerful weapon. They will argue that the entire FCE is invalid because you were not trying your best. This shifts the focus from your actual physical limitations to your credibility. The insurer uses these validity scores to discredit not only the FCE results that support your disability but also your own reports of pain and symptoms. It becomes an attack on your character, designed to paint you as someone exaggerating their condition for financial gain.

Addressing Disputed FCE Findings

Receiving a claim denial based on a skewed FCE report can feel defeating, but it is not the end of your case. You have the right to challenge these findings. Taking strategic action is crucial to turning a denial into an approval.

Here are the essential steps you should take:

• Obtain a Copy of the Full Report: Request the entire FCE report from your insurance company, including all the raw data and the evaluator’s notes.
• Consult Your Treating Physician: Share the FCE report with your doctor. Ask them to write a detailed rebuttal that directly addresses the inaccuracies. Your doctor can explain why the FCE results are inconsistent with their objective medical findings and your long-term clinical history.
• Document Your Experience: Write a detailed personal statement describing your experience during the FCE. Note any pain you felt, how you felt in the days following the test, and any instructions or interactions with the evaluator that seemed unfair.
• Gather Supporting Evidence: Statements from friends, family, or former colleagues who have witnessed your limitations can be powerful. This “buddy evidence” helps corroborate your reported symptoms and functional deficits.

Your Trusted Legal Partner for Disability Appeals

Navigating a disability claim denial is a complex and frustrating process, especially when faced with a biased FCE report. Insurance companies have extensive resources dedicated to challenging your claim, but you do not have to fight them alone.

At Bartolic Law, our experience lies in disability appeals. We understand the tactics insurers use and know how to build a strong case to counter them. If your long-term disability claim has been denied based on an FCE, contact us for guidance. Your success is our priority, and we are here to provide the support and legal representation you need to secure the benefits you deserve.