Impairment Ratings and FCEs: Are They Interchangeable?

When a worker suffers a serious injury or illness, permanent impairment is often the result. Assessing the extent of that impairment is necessary to determine the compensation a worker receives due to a work-related injury. Assessing impairment is done by conducting an Impairment Rating, which determines the extent of impairment within the framework of a percentage-based evaluation system. As valuable as an Impairment Rating is for case settlement, it does not provide information regarding the worker's functional ability relative to work. In order to assess the worker's physical abilities to perform work, a functional assessment such as a Functional Capacity Evaluation (FCE) or a Return to Work (RTW) screen must be conducted. The two assessments are related but address different questions. Understanding which assessment you really need is critical. In some cases, it may be both.

About Impairment Ratings

Impairment evaluations are performed to gather information about the level of impairment a person has suffered due to injury or illness. The American Medical Association (AMA) defines impairment as a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder or disease.

According to AMA guidelines for the evaluation of impairment, which are the standards most commonly used for impairment ratings in workers' compensation injuries, impairment ratings should only be assigned to permanent impairments. A permanent impairment is defined as an impairment that has reached maximum medical improvement (MMI), is well stabilized, and is unlikely to change substantially over the next 12 months with or without medical treatment. In other words, an impairment is considered permanent when the worker has reached his or her best level of recovery and there is no expectation of further improvement, even with additional medical intervention.

Impairment ratings done in relation to compensation determinations in workers' compensation cases are generally performed by physicians or physical or occupational therapists who are trained or certified in the process of Impairment Rating. Musculoskeletal impairment is typically measured as the percentage of total body impairment lost and is either diagnosis-based or based on a demonstrable loss of range of motion. In some cases, pain, loss of sensation, or muscle weakness can also influence the impairment rating.

About Functional Capacity Evaluations (FCEs)

While an impairment rating can offer useful information in workers' compensation case settlements, it is not a strong predictor of work-related function. Establishing the ability of a previously injured worker to perform his or her job is the purpose of the Functional Capacity Evaluation. FCEs provide insight into the functional ability of the employee, while a Job Demands Analysis (JDA) quantifies the demands of the job. With these two assessments, the worker's abilities can be compared to the physical demands of the job to determine if return to work is feasible or if accommodations can be made. If accommodations are not possible for the original job, the employer can use the results of the JDA and FCE to help identify suitable alternative jobs into which the employee may be permanently placed. Knowing the employee's function and how it matches the job affects the individual and their coworkers and is an important step in safe and effective return to work planning, as well as preventing additional workplace injuries.

The employee job matching process allows employers to foresee potential conflicts and issues that might increase the individual's risk of re-injury or lead to a failed return to work attempt. Additionally, placing an impaired worker in a position they aren't capable of handling safely can place other employees at risk. Foreseeing these potential problems offers the opportunity to address them by modifying duties for greater suitability and safety.

So, back to the question posed in the title: are Impairment Ratings and FCE's interchangeable? The short answer is "no." Valuable, yes - but interchangeable? Clearly not. Knowing the difference is critical in the effective management of work-related injuries.