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Functional Capacity Test-Help!

J.J.GreyJJ.J.Grey Posts: 2,961
edited 06/11/2012 - 8:27 AM in Health Insurance Issues
I had a failed back surgery in Dec 07 and am currently on LTD and waiting for my SSD hearing with an ALJ. Well, I haven't had any problems with my LTD carrier until today. My PM doc is also the one that performed the surgery on me. After the surgery (I have been seeing him for 4 years) he told me that the surgery was failed and that he had done everything that he could for me. My only option was to take long term pain meds and apply for disability. He said that he would be behind me 100% and that as long as he was in practice he will continue to treat me with meds. He was in it for the long haul. He has been the doc filling out all of my LTD forms. In the beginning I had to have disabilty forms filled out every other month. (quite expensive because I am charged for this). It was a 2 page form and the second page asked questions like how long can patient sit?, stand?, walk? How much can patient carry? Things like that. The last question was do you feel that this patient needs a functional capacity exam? My PM would always put an X on that page and say we do not rate. After about the 3rd time that he did this I got a letter from my LTD carrier stating that the form would have to be filled out completely or my payments would stop. I took it to my family doc and he thankfully filled it out that I could do none of those things for even 2 hours. The next time that I saw my PM I told him that the fact that he would not fill the entire form out has created a real hardship on me. Keep in mind that over the past year this guy has turned out to be a real jerk, contradicting himself from one visit to the next. He said OK, I will fill the next form out but I am going to say that you do need a FCE. I was never sent another form to be filled out by my LTD. Today I got a call from a nurse at my LTD carrier saying that she was reviewing PM's notes and he wrote in my chart that I need a FCE. She said that she put a call in to him and if he really still feels that way than they will have to have one done on me. I have heard real horror stories about these! I also go to an LTD forum and saw tons of people talking about how the test is biased and will lean towards the person paying the bill for it. Also, they will make you do something that you can't normally do and because you did it for that 1 split second (no matter how much pain it caused) they will say that you could do it in a full time job. I am terrified! I am truly disabled and not able to work. We are holding on by a thread and if my LTD payments were to stop right now we would lose everything we have quickly. I put a call in to my docs office but he has been such a jerk towards me lately that I doubt it will do any good. If anyone here has undergone one of these tests I will really appreciate any info on it that you could give. Thanks.


  • I too am facing the same situation. It will be 1 yr in Feb that I've been on disability and I applied for SSDI. My LTD company sent a form for my primary doc to fill out and he said he couldn't do it and would send me to occupation therapist. Apparently there is some hold up with my health ins co. They won't pay for this unless my primary doc sends them a ton of documentation. That was about 2 wks ago and I'm still waiting to hear back from primary doc to find out if they can send me to the OT. They have to make the appt cuz of my insurance. I don't know if this is going to hold up my disability payment in Feb or not. I am scraping by now as it is and can't imagine not getting that payment.

    Let me know how you make out. I am hoping this neuro will give me meds that will help with nerve pain and I can return to my new job selling insurance in about a month. Yes, I am being optimistic.

    Hang in there and try to stay positive.
  • keep you updated. My LTD co is going to pay for mine. I wish that I could get it covered through my insurance. It may not be as biased that way. Hmmm... I wonder if I could get my own health insurance to cover it. I think that I will check with my GP about that. I haven't actually got the letter with the appt date and time yet. They (LTD) were waiting for my PM to call them back. If he gives them a script for it then they will schedule and pay. This would not even be an issue if he had not written in my file that he feels like I need one. I could really strangle him for this. I would be just like you if I had to miss even 1 payment. From what I have heard of these tests the insurer will pick out a few tiny things that you can do for a couple of seconds and say that you could do them all day. From what I have heard these tests are nothing but trouble. I am hoping that a member here might post that they had a good experience with it but I am doubtful. Good luck Michele and you keep me posted too.
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  • I just had mine a couple of weeks ago, so it is still fresh on my mind. I'll share my experience.

    My doctor ordered a 2 day eval and I would highly suggest that you ask for the 2 day test versus just one day.

    The evaluation was performed by a physical therapist trained in doing these kinds of evaluations. He has done over 100 so I felt confident that he knew what he was doing. He asked me to wear shorts and some sort of a tank top or t-shirt that scooped down in the back so that he could see how my neck and shoulder muscles reacted to the things he had me do.

    When I first arrived at the facility, he had me fill out some paperwork. Be aware that the test begins from the time you get out of your car (if they can see you through the window to the parking lot). The paperwork part took about 15 minutes, and then he took me to an exam room where he proceeded to do a neurological assessment, including all reflexes and having me stand on my toes and try to walk forward, then on my heels doing the same, and then just doing a raise to my heals lifting exercise, one foot at a time for 10 repetitions. He basically needed to observe my whole body, not just my neck. I think this is uniform throughout, as the whole purpose of hte test is in determining what type of work you can get back to.

    I was then fitted with a heart monitor, which I had to wear for the remainder of the test on both days. The purpose is so that he can see how your heart responds to the different activities. he explained to me that if my heart rate jumps with an activity and it doesn't come back down rather quickly, that is a good indication that he has just stressed out my body. They will monitor your heart rate with every activity that you do, taking a pre- and post-activity reading.

    They were very observant of every movement I made, watching the way I walked, my posture, my facial expressions, etc. The person doing the eval was very kind and went slow with me, stating that his #1 goal was to keep me safe.

    He had me do things like walking, squatting, lifting, pushing, pulling, hand coordination stuff, raising arms at different levels to do several activities. Things like nuts and bolts or threading a string through a chain. Another part was climbing stairs. Sitting, getting up from sitting, standing, more walking, etc. He tested hand grip strength and finger grip strength, leg strength, etc.

    Honestly I didn't think any one thing was too strenuous, although some things were very difficult for me to do. The pace was very slow, so I had time to prepare myself before moving on to the next activity.

    At the end of all the physical testing, he had me stand at a counter and fill out some more paperwork. I asked if I could sit down for this and he said no, that this was part of the evaluation.

    Overall, the first day wasn't as bad as I thought it would be. I do far more difficult things in physical therapy. However, my body screamed at me for the whole rest of the day and well into the night. I had severe muscle spasms and tremors, which I later found out is a classic symptom of the type of damage I have to my cord. That night was not fun at all. Basically the activity had shocked my neurological system and the tremors (like you are shivering because you are cold) would not settle down, and the spasms in my legs were enough to have me screaming and crying because they wouldn't let up. I didn't even cry out in pain when I labored and delivered my 5 kids, but those cramps were very intense. not to scare you, because I don't think this is a normal thing to happen.

    The second day was just more of the same thing. He basically repeated the stuff that was done on the first day to see if the fatigue from the day before changes the way I coudl do things the second day.

    The evaluator said it is like creating a painting. He said he will observe and watch everything I do, and when the 2 days of testing were over he would be able to create a painting that would show what kind of work I can do.

    I was fully cooperative with everything that was asked. I wanted to give full effort on everything. the evaluator told me that had he written the report based solely on the first day, it would be different than what he wrote after the combination of the two days. So I think it is important that you ask for a 2 day eval. Some insurances won't pay for the two days, and that is not fair to the patient.

    On the report it shows how many tests were performed and how cooperative I was. It shows a place where he would have marked if I refused to do any of the activities. He marked places where I attempted but could not do things, like getting up from a squatting position, looking down for periods of time to perform tasks on a table, etc.

    This evaluation is very important, so make sure you are honest with the person doing the evaluating. They will know if you aren't giving your full effort, and they will know when you DO give your full effort.

    I did not have sore muscles afterwards, just the spasming and tremors. But this test is a hard one on your body, so be prepared for a bit of pain afterwards. The second day I took along a heating pad for use in the car on the way home. Just popped it in the microwave at the testing place before leaving. I found this helpful. If you have any specific questions, please PM me and I'll try to answer the best I can.

    Good luck with the FCE. If you are honest and do your best, they should come to a fair conclusion.

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Cindy,
    Thanks for the info about your FCE. My NS just ordered one for me before my next surgery, I'll have to see what my insurance has to say about it. He said it will probably help out my SSDI appeal with the ALJ. I will post after my FCE.

  • I just recently as well went through a FCE exam. However my story quit a bit different as it was a four hour exam. This are not, in my opinion close to measuring someone's true capacity. The examiner was nice to me in person. I was given a 24 hour notice to appear. This is so you can't stop any of your medicine and make the pain what it is really. The current meds i have my former employer will noway allow those in the work place. I called the facility the day I was called about getting the paper work that needed to be filled out ahead of time, was told there was none.

    When i arrived at the facility I was given a huge packet of paper to fill out. Lucky for me I brought a cheat sheet with me. Filling the paper work out is part of the exam. Next step was a oral interview. About 20 minutes in I asked to get up as I felt the pain coming from setting. Of course the examiner didn't listen and it was on. He then looked at the monitor to check my heart beats and it was beating at 130 per minute. He then took my bp, which showed 140/105(I don't have high blood pressure). He asked me to go walk around and do whatever I needed to make it come down as he didn't feel it was safe to continue. I went outside and layed in a flower bed for a bit to get the pressure in my neck down. Finally came back in and it was at 125 the heart beats so we proceeded on. I complied with every request made of me. By then end of the exam I wasn't sure if i was coming or going as the pain just continued to get worse. Upon my departures I debated wether it was safe for me to drive home as something was incredibly wrong with me. My entire body was throbbing. I was only 10 minutes away at best from home. I made it home and checked my BP and it was at that time 155/114(yes my machine is calibrated correctly). As the night wore on the pain continued to climb. I have no idea how many percocet I took and I layed here crying. I called the doctors emergency number who ordered the exam and eventually found out that emergency number is only good from 8-5. The horrible pain finally subsided about a week later. I missed Thanks giving with my family cause i Just couldn't function.

    So i truly believed when the results came out it would show all that. Well the answer is no. The report that was given to the doctor who ordered the exam had nothing about my BP and what happened with me getting mentally confused. The report was written in a fashion against me. The only part that couldn't be denied is that I gave maximum effort. The report asked for patients heart beat and he had to put it in. In the comments section he would write little comments to try and off set it. Because of how high my heat beats were beating they had no choice but to say that I gave maximum effort in all categories. In hind sight, I should have gone to the emergency room, as my family had urged me to do. I had read the horror stories as well, but really didn't believe that would happen. The examiner was so nice to me. Since that time my pain has never returned to the base line pain. After completion of the test the Doctors made me MMI(maximum medical Improvement). I have since had another surgery and no matter what I say they have no ears. The last surgery has brought on a new set of issues but they won't treat them as I'm MMI. They will still order the drugs for me but will and can not do any other forms of treatment outside of that.

    My suggestions for a FCE are to make sure you do what is asked of you. You don't want to be found non-compliant. Second it needs to be a two day test. I would demand that test and if your carrier denies it make sure the ordering doctor clearly notes in your charts. If you end in horrible pain either go to the ER or depending on your situation see your primary the following day so it can all be noted. Clearly find out ahead of time why the test is being ordered and who is making the request. Also, try and pick the facility yourself. If your in the world of work comp this is not designed to help you but rather hinder you. More than likely if you are work comp it is the final stage of your treatment. Under the laws of my state if you don't submit to the test your benefits will be terminated but then your benefits are close to being terminated anyway. If it is work comp go to the laws of your state and clearly learn and understand your rights. You don't want to end with a pre-existing condition and no treatment or help. If you have a attorney involved make sure they know you have been asked to to do this test. Often times the request will come from a doctor which means your attorney will not be aware of this information. If your work comp remember the attorney works for money, the doctors work for work comp and you have to be your advocate. For myself, the pain I am left in, there is no monetary reward that can replace medical treatment or help. Everyone wants to talk dollars and cents and find it disgusting to say the very least.

    One last thing that I have found used in these exams is "the neck disability index" or "the back disability index" you can google these and find them. There is a scoring method to them. On the Fce this is a pass or fail test as well. You more than likely have seen this before and not realized it.
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  • Of course I was scared as many of you are to have this test done. I did not experience any of the horror stories at all. I was completely honest and up front and tried my best with every test. Mine was a one day test and I had no idea what I was in for. Many of the tests they do are repetitive. They do them 3 times to see if you are being deceptive. This is mostly on the strength tests. They have a machine that tests your strength. If your numbers are not close it can mean you are being deceptive. I had no idea they were watching every move I made but when I saw the report it actually stated things I was doing when the therapist was not in the room. I was having problems sitting which I normally do after ten minutes and this was noted in the report. My PM dr requires this test. My test came back as I could not even work at a sedentary (sp?) level. This means the equivalent of a desk job which is what I did. The test said I could not do this.
    I did think the therapist (I guess that is who administered the test) was making me do things that I absolutely could not do. I did try everything. However, after each test she asked me how I felt. This was also noted in the report.
    I was not able to complete many of the tasks. And I agree with the others who said after this test you are left in extreme pain. As a matter of fact, after the test was over when I was leaving she walked me to the door. At that time I was just using a cane, I fell as soon as we got outside. My legs just gave out on me. (This was not in her report)
    I had read what many people had to say about these tests and many said they did have a negative affect for the disabled person in applying for SSDI or LTD benefits. Having read this and knowing I had to take the test I decided to just be completely honest and do what I could do. In my case having flunked the test completely it did actually helped me in proving my disability. So I did have a good outcome. Sorry about the long post but wanted to give as much info as I could. Just remember you are being watched from the moment you leave your vehicle to the time you get back in your vehicle. I can no longer drive and after falling my husband had to help me get into our car.
    I just have one more thing to say after going through all this. I think it is just awful that we as disabled people have to prove we are disabled. We live our lives in pain and try to just get through each day. We try to keep our dignity in tact. I have tried to have a positive outlook as much as possible. I know there are alot of people out there trying to get benefits when they aren't really disabled but it is very sad for those of us who are in constant pain to be put through more pain to prove we are telling the truth. Something just isn't right with that.
    Good luck to any of you who are going to have this test. If you have any questions please feel free to ask and I will try to help or at least tell you my experience.
  • I have learned a lot from reading your experiences and I am thankful to have gotten my SSDI prior to my back injuries. It is hard that you have to go on proving that you're in pain and can't work anymore. We face this everytime we go see doctors and when refills for pain meds are needed. I wish pain could be measured that way the legitimacy can be proven once and for all and people can take our word for it.

    Sorry for going off topic, I now realize how hard this testing is on people. The only testing I have done was the Owestry disability form inside the doctor's office at my initial consultation. I hope you guys had a favorable decision so that you can get benefits entitled to you.
  • My results were much like spunkys, with the report coming back that I would likely not be able to work even a sedentary job. This was difficult for me to see in writing, because although I knew it in my head, I was holding out that there would be something I could be retrained in so that I could feel productive.

    Tam and I have talked back and forth about our FCEs and I think her evaluation was not fairly done. When I contrast how compassionate and understanding my evaluator was with the experience she had, I shudder and it makes me mad that some people are treated like she was. As if having 5 neck surgeries isn't enough for one person to deal with, but to be treated like that is not called for, in my opinion. I had plenty of notice, and even called the facility to set up a time that would work for me. Like I said earlier, mine was done over 2 days, with the first day being about 4 1/2 hours and the second day about 3 1/2. My evaluator was very good to me, and I honestly think had I not been dealing with a lesion in my cord I would not have had the horrific spasms and tremors that followed. Sure I would have been sore, but that is to be expected.

    I think this evaluation will be very beneficial in my quest to be approved for SSDI, if I ever bring myself to apply. I'm still trying to deal with all the emotional issues that come with admitting that I am disabled.

    Today I met with the physician who ordered the test, and she said the test really had no surprises for her. She knew what the outcome would be, but it was a formality that had to be done.

    I keep telling tamtam that she needs to move to Idaho. We have better doctors and a better work comp system...but she won't come to the snowy cold...

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • You guys are so awesome! I truly appreciate all of the information that you have shared about these tests. In a way I am not afraid of the test because I know that I have legitimate pain. In another, I am terrified because I know how underhanded these LTD companies can be. BTW- I am not a workers comp case but rather a failed back surgery. This is just my LTD company that I had through my last employer. I know that even if they were able to pick something out of the FCE to use against me that I could get an attorney to fight it because even if you were able to do something for a couple of seconds that does not mean that you could do it for an 8 hour day. My fear is that they will stop my payments while I fight them and it would not take much for us to lose everything that we have very quickly. But check this out-
    My PM's office called me this morning and said that my doc wanted to see me today. I figured that it was in reference to my call to him yesterday. His office is 1 hour away from me. Much to my surprise what he really wanted was to give me an EKG. He read a report yesterday that had a study of Methadone patients that concluded that it can cause heart arythmia (sp) in certain patients(I am a methadone patient). It was so weird. Anyway, I talked to him about the LTD company calling yesterday and he tried to convince me that an FCE would be in my best interest. He said that if I did not want to have one he would tell them that he changed his mind and did not feel that I need one. So, I had him say that I do not need one. I feel sure that it will come back to bite me because the next form asking my physical limits will probably come quickly. My PM will not fill that out so I am probably going to end up having one anyway and having to pay for it myself. I think that I would almost rather do that because at least I will be able to pick the doc with the help of my GP. I so appreciate all of you responding to me so quickly. I have really been quite upset about the whole thing. I will keep everyone posted as to how I make out.

    Spunky21 - I totally agree with your last statement. I told the nurse at my LTD company yesterday that I can't understand why everyone thinks that anyone would go through all of this hassle and fake their pain just to have the great reward of living on chump change the rest of their life with no benefits at all. Not a fun way to live.
  • This is a statement from a very reputable ERISA attorney that I got at another forum. This is very important info for anyone facing this test-

    Please ensure that your lawyer is prepared to address the policy language regarding the right to examination.
    Many policies do not mandate FCE's and many of us lawyers take the position that an FCE is neither mandated by the contract, nor a valid indicator of work capacity, nor safe to perform.

    I typically do not permit my clients to attend such exams, and request that the insurer identify the contract language mandating such exam (they cannot).

    The insurer will undoubtedly take the exam results and skew them into you having full time work capacity.

    Be careful.

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