A functional capacity evaluation or FCE is an often day long process where an occupational therapist puts you through a series of tests to determine what your work capabilities are and if you need any physical restrictions. So if you ever hear about someone having permanent restrictions of no lifting more than 20 pounds (or something else), it’s likely that they went through a FCE.
While these tests do happen a lot in Illinois workers’ compensation claims, it’s important to know that they happen after your doctor feels you are at maximum medical improvement (MMI) which in plain English means you are as good as you are likely going to get and there isn’t much more they can do for you.
Once you have a FCE you either can return to work with your old employer if they can accommodate your restrictions or would begin the process of vocational rehabilitation to find work with a new company.
A caller who was aware of all of this had a great additional question. What should she do if she needs more medical care after the FCE?
While some insurance companies will try to argue that being at MMI means they don’t have to pay for any more bills, that’s simply not true. The reality is that just because you aren’t expected to get better, that doesn’t mean that you can’t get worse. For some people to prevent this means taking pain medications. For others that means continued pain management treatment or physical therapy. For some it could mean you need a surgery down the road and for others it might just mean you need to check in with your doctor every few months.
Whatever your situation, it’s important to know that you can and likely will get medical care after a FCE and it’s still the responsibility of the insurance company to pay for it. Beyond that, before you settle your case, it’s very important to get a realistic idea of what future medical care you will need. If you had a fusion or other hardware put in place, it’s likely that it will need to be replaced at some point. If you are taking pain relievers or need some treatment, you can still settle and be compensated for that.
The payments for this future care come in the form of a Medicare Set Aside which is an estimate as to what future treatment you will need. The insurance company will present a dollar amount to you. That is typically not negotiable but can be used as a way to drive up your settlement if you aren’t happy. In the alternative, if you take your case to arbitration, you will keep your medical rights open for life as it relates to your work injury.
Does this sound confusing? It can be. If you have any questions you can contact us any time to speak with a lawyer for free. Bottom line though is that nothing is more important than your health and just because a doctor says you are as good as you are going to get does not mean you can’t have any more medical care.