I can’t tell you how many times, when I’ve recommended a Functional Capacity Evaluation (FCE) or a Return-to-Work Physical Abilities Test, the question is raised:
“What if the test results disagree with the physician’s recommendations/restrictions?”
“What happens if the physician has already released the person to return to work and the test shows restrictions?”
What if the doctor’s restrictions are different from the test results?”
At which point I usually ask: “What testing has the doctor done on which to base his/her decision?
To which the response is usually: “None.” OR “Well, the doctor just goes off of his opinion.” OR “Well we can’t go against the physician’s opinion.”
Which confirms my point exactly – How can physicians make return to work decisions or decisions without testing?
The ability to work is not correlated with a diagnosis, lab tests, x-rays, or MRIs.
The only objective measure of an individual’s ability to perform physical work is a test of that person’s functional physical abilities.
A federal court decision from Georgia Madison v. Greater Georgia Life Insurance Co., 2016 WL 8648862 (N.D. Ga. Dec. 21, 2016) confirms this perspective.
In the case of Madison v. Greater Georgia Life Insurance Co., Ricky Madison underwent surgery to repair torn cartilage in his left knee. After surgery, Madison’s disability payments were discontinued even though he continued to have pain and difficulty walking. The ongoing issues were chalked up to a chronic defect in the joint.
A review of Madison’s file by an orthopedic surgeon supported the denial of Madison’s benefits. However, as part of the review, Madison underwent an FCE which indicated that his functional ability did not meet the requirements of his job.
Madison appealed the termination of benefits, and a second review was done by another orthopedic surgeon, who came to the same conclusion as the previous surgeon.
Here’s where the value of the FCE comes into play. The court determined that the decision of Greater Georgia to terminate benefits, based on physician opinion, was wrong. The previous reviews of Madison’s case by orthopedic surgeons did not take into consideration the FCE findings - which provided evidence that Madison could not meet the job requirements.
The court found that the FCE measured Madison’s physical abilities in relation to his job requirements whereas a surgeon can only evaluate whether an individual has an injury and whether surgical intervention could aid recovery.
Furthermore, according to this decision, the incorporation of sincerity of effort measures as part of the testing enhanced the functional evaluation’s objectivity and thus its evidentiary value.
The court found that FCEs do provide a reliable, objective assessment of an individual’s work-related function level and that the FCE is a reliable and objective method of gauging the extent one can complete work-related tasks. Read more about this disability case.
Have you ever disagreed with a return-to-work decision on one of your patients but felt powerless to influence the decision? What if you had done a return-to-work test/Mini FCE as part of your standard discharge evaluation? Could that have made a difference?
Sometimes the wrong decision is made from ignorance. No one knows the job demands. No one knows the patient’s abilities. By performing a brief mini-FCE/RTW Test as part of your discharge evaluation and comparing the results to the patient’s job requirements, you’ll be able to clearly and objectively show whether the patient is ready to return to work.
If you include a consistency of effort test in the mix, you’ll also be providing some extra support for the patient’s level of effort – good or bad.
Help your patients get a fair shake and help physicians make the right return to work decision.