What is a Functional Capacity Evaluation?

If you have been injured in a car accident and your accident benefits (auto) insurer has been paying you an Income Replacement Benefit (“IRB”) because you cannot work, the insurer may, from time to time, assess your entitlement to continued IRBs. This includes sending you to one or more assessments conducted by a health professional. One of the assessments that insurers like to do is called a Functional Capacity Evaluation (“FCE”).  

As the name implies, FCE’s are intended to measure a person’s ability to function in various activities, positions and tasks.  Typically, the results are extrapolated to determine if a person can return to their pre-accident occupation, or, whether they can return to some form of work.  Insurers like FCE’s because the testing is considered an objective measurement of your abilities.

Who Performs FCE’s?

Usually, an FCE is performed by a kinesiologist or a registered Occupational Therapist.

What IS an FCE?

Generally, there are 3 components to an FCE that you should be aware of.

  1. Physical testing includes the ability to perform certain activities. Activities that are measured include: sitting, walking, standing, kneeling, pushing/pulling, lifting and other bodily movements that we do throughout the day and which we may do during a typical workday.  During each of these activities, the assessor will observe while you perform these movements and will note your activity tolerance (such as the length of time you can perform the activity),  the maximum amount of weight you can lift/push/pull/carry, and, whether you had to make any adjustments or modifications while doing each activity.

    The physical testing will also measure factors such as your balance, range of motion (particularly in the injured areas), co-ordination, and ability to perform repetitive movements.

    If the insurer wants to assess whether you can return to a certain job, then the results of these physical tests are compared to the physical demands of that job.

  2. A “functional pain” assessment will also be conducted as part of the FCE – essentially, an evaluation of the person’s pain levels while they are performing the activities. These pain assessments vary from assessor to assessor, but typically involve some form of self-reporting by the injured person.
  3. A critical aspect of the FCE includes screening procedures to identify whether you put forth maximum effort (i.e. did you terminate the activity prematurely) and whether the different components of the testing were consistent (i.e. were your subject reports of pain consistent with your performance on all the physical tests). The assessor wants to make sure that the results of the FCE are a reliable indicator of your ability to work.

How Reliable is an FCE?

Most FCE’s are completed in one day, and usually in less than 7 hours.  They are often conducted as part of a multi-disciplinary assessment that may also include an assessment by a physician and/or a psychologist, depending on the nature of your injury.

An FCE may not be a reliable indicator of your ability to work.  The most obvious reason is that it is simply a brief snaphot in time and does not mimic an actual workday or workweek.  For example, a workday involves morning grooming, travel to the workplace, attending at the workplace, travel home, and then engaging in regular home activities after work.  It is much more than 7.5 hours.  Also, an individual may be capable of performing some residual work but as the week progresses, their symptoms increase, they make more use of medication and their after-work hours are spent resting and rehabilitating.  In the same vein, a person may feel fine during a 3-hour FCE, but may experience significant discomfort in the hours and days afterwards; further, they may not have the physical capacity to repeat the FCE the following day.

For individuals who have sustained head trauma and suffer from cognitive impairments, an FCE should include a cognitive screen during the course of testing.  Cognitive screens assess memory, attention, and multi-tasking, amongst other things.  However, not all assessors are qualified to conduct cognitive screens and they are often omitted from such testing.  Some insurers supplement the FCE with neuropsychological testing by a qualified neuropsychologist; this is useful, but, the cognitive screen during the course of the FCE can also be a useful tool to measure cognitive impairments while performing physical activities.

What should I do if my insurance company asks me to attend an FCE?

As long as the insurer follows the procedures under the Statutory Accident Benefits Schedule, you do have to attend the FCE.  Your lawyer will advise you if there are circumstances that allow you to refuse to attend.

During the FCE, you should put forth your best effort, but, refrain for doing any activity that causes you harm or which you have been advised by your medical team not to do.  For example, if you have a shoulder injury and  your doctor has told you NOT to lift more than 10 lbs, do not agree to lift more than that during the FCE.

During and after the FCE, make note of how you feel – your pain levels and any other discomfort you may have.  Make note of how you feel the next day, and advise your lawyer.  If you do not have a lawyer, then contact the insurance company and assessor and let them know that you are experiencing discomfort as a result of the FCE.

If as a result of the FCE the insurance company terminates your IRBs, then you should have a discussion with your lawyer about your options.  S/he may suggest further evaluations and/or an application to the License Appeal Tribunal to dispute the termination of your benefits.

Written by

Najma Rashid is a partner at Howard Yegendorf & Associates. Her practice is devoted exclusively to personal injury litigation, including motor vehicle accident claims, SABS disputes before the License Appeal Tribunal, and LTD claims. She was a director on the OTLA Board of Directors for 4 years, and was the Chair of the Long-Term Disability Section in 2020/21.

In addition to OTLA, Najma is a member of the Advocates Society, as well as a supporter of organizations such as REACH Canada, Probono Ontario, the Ontario Brain Injury Association and the Canadian Paraplegic Association.