Functional Capacity Evaluations: What Employers Can Expect

When an employee is injured, yes, it is that person’s back, neck, or perhaps hip that is affected. But the consequences of a work-related injury extend to other parties, including the insurance carrier, attorney, physician, adjuster, case manager…and of course, the employer.

And such injuries are on the rise.

In 2022, private industry employers reported 2.8 million nonfatal workplace injuries and illnesses, up 7.5% from 2021.

But concerned employers are not alone. There is a well-established barometer of employee wellness that is routinely used to assess a worker’s ability to perform his or her job tasks—the Functional Capacity Evaluation (FCE).

“An FCE is an objective and thorough assessment of an employee’s ability to safely return to work,” says Kelly McDonald, P.T., D.P.T., Regional Director of BenchMark Physical Therapy, one of Upstream Rehabilitation’s brands, in Charlotte, North Carolina, who has performed nearly 200 FCEs.

“An FCE is typically recommended if an employee has been out of work for more than three months or is two physical demand levels lower than they need to be to perform their work duties. As for timing, an FCE is usually done after the worker has already been through physical therapy (PT) and perhaps has undergone work conditioning—this tends to be around one year after the injury.”

What exactly is a Functional Capacity Evaluation (FCE)?

The FCE, typically a 4-hour evaluation that is administered by a physical or occupational therapist, involves a multitude of tests with work simulations. The results are utilized to provide recommendations regarding an employee’s ability to return to work, return to work with restrictions, or the need for accommodations in the workplace.

Dr. McDonald states, “FCEs assess the entire body, not just the injured area. This is a standardized test that is the same for all workers regardless of their job duties. Combined with the patient’s medical history, the FCE provides employers with a comprehensive, research-based recommendation as far as the worker’s abilities. At Upstream Rehabilitation, our primary goal is to allow people quick access to an FCE so there can be a timely resolution to the situation.”

A Functional Capacity Evaluation typically unfolds as follows: the therapist conducts a patient interview, reviews the medical records, and then does a physical screening. Common FCE test parameters include:

• Lifting
• Carrying
• Pushing & Pulling
• Sitting
• Standing
• Walking
• Balancing
• Reaching
• Stooping
• Kneeling
• Crouching
• Crawling
• Object Handling/Manipulation

During testing, the therapist assesses the worker’s coordination, flexibility, and postural abilities (all while recording heart rate for safety and for validation of physiologic exertion). This includes sustained and/or repeated observations of the ability to assume, maintain, and exit positions consistent with work including those defined by the Department of Labor or the Dictionary of Occupational Titles.

What tests are performed?

Sam Carlson, P.T., D.P.T., Clinical Director, at BenchMark Physical Therapy in Atlanta, Georgia has performed roughly 200 FCEs.

“An FCE includes a Static Strength Report which clarifies the average force an individual uses to lift, push, or pull in various common work postures. The average force is then compared to essential job demands and/or safe lifting recommendations based on research conducted for the National Institute for Occupational Safety and Health.”

“For a measure of whole-body strength, the FCE includes a Dynamic Lifting Capacity test, the results of which are correlated to the appropriate U.S. Department of Labor’s Physical Demand Characteristic work ability rating. At the end of each lifting and lowering cycle (weight level) the employee is asked to rate his or her perception of the weight on a scale of 1 to 9. A rating of 8 or 9 is taken as ‘excessive discomfort’ and terminates the test, i.e., the person has reached his or her psychophysical endpoint. Overall, an FCE may feature up to 45 tests that yield an objective, accurate picture of the employee’s ability and/or limitations.”

What can an employer expect?

“FCEs can be scheduled right after someone is referred for PT,” says Kelly McDonald. “One aspect of the assessment that employers find especially helpful is that we include images of the employee attempting to do various postures. If someone can’t assume XYZ position during the test, then we can show the employer that we eliminated the test because of safety concerns.”

The employer can expect reliable information on whether the employee put forth a consistent, good effort during testing and whether the person’s subjective reports are consistent with the objective test findings. Employers will also receive information on the frequency (Avoid, Seldom, Occasional, Frequent, or Constant) that is appropriate for activities that do not require lifting.

Amanda Nix, O.T.R./L., C.F.E. is an occupational therapist at BenchMark Physical Therapy in Gainesville, Georgia who has performed approximately 150 FCEs.

Detailing one area of evaluation, Nix states, “If an employee reports lifting 60 times a day, then that is considered ‘frequent.’ We put that job demand in the computer and based on the time the person took to do it, the software provides objective information as to whether the employee has a deficit.”

Practical benefits

The information provided by an FCE is critical for worker’s compensation claims because it provides unbiased, objective information about the nature and severity of a patient’s injuries or illnesses. Additionally, they can help prevent re-injury or additional workplace injuries, as well as resolve disputes about the severity of injuries in worker’s compensation claims. They can also help determine whether an employee is qualified for worker’s compensation, Social Security, or other benefits; FCEs may also help prevent insurance fraud.

Tips for employers

When referring someone for an FCE, it is important that the express purpose be communicated to the therapist. Another vital part of the picture is the employee’s medical records, which may include operative notes, recent diagnostic test reports, physician records, and occupational and physical therapy records.

Selecting a qualified provider to perform the FCE is crucial. The provider should be experienced in performing these types of evaluations and have a good understanding of what the job entails; ideally, employers should ensure that the provider who is certified to perform FCEs.

“I have found that employees are often unclear about why they are coming to see me,” says Dr. Carlson. “Ideally, employers and/or physicians will educate employees about why they are being referred for an FCE and what it might entail—including what will happen with the final report. Having this educational piece completed up front means that we can get someone evaluated and back to work in an expedited fashion.”

“It is important to understand that an FCE is a standardized test. Sometimes employers want uber-specific information, for example, saying, “I need to know if my employee can operate this particular piece of machinery”—but the FCE doesn’t work that way. We are using static and dynamic work postures as defined by the Occupational Safety and Health Administration.”

“The FCE is quite a utilitarian tool,” adds Dr. Carlson. “Beyond the above-mentioned uses, it can also help reverse engineer what we are seeing in an FCE to prevent employees from getting hurt in the future. On top of that, this is a ‘portable’ assessment, i.e., we can take the equipment with us and perform the evaluation onsite if necessary.”

Amanda Nix adds, “It is very helpful when employers send details about the job demands along with the employee. Although I can work with what the employee tells me, it is not always a full representation of the extent of their job-related deficits.”

Whether ordered by the insurance carrier, employer, attorney, doctor, adjuster, or case manager, FCEs serve as guardrails for all stakeholders and can provide clarity during a time of uncertainty.

Upstream Rehabilitation, the nation’s largest dedicated outpatient physical and occupational therapy provider, employs the latest evidence-based medical model to perform Functional Capacity Assessments.

Contact our team to learn more about how Upstream Rehabilitation can help your organization with Functional Capacity Evaluations. To find an Upstream Rehabilitation location near you, please visit https://urpt.com/find-a-location/

1. “Employer-Reported Workplace Injury and Illness, 2018.” Www.bls.gov, www.bls.gov/news.release/osh.nr0.htm.
2. “The Importance of Functional Capacity Evaluations (FCE).” Www.occmedpartners.com, www.occmedpartners.com/blog/the-importance-of-functional-capacity-evaluations-fce#:~:text=FCEs%20are%20often%20administered%20as. Accessed 13 Feb. 2024.
3. Allison, Steve, et al. Current Concepts in Functional Capacity Evaluation: A Best Practices Guideline CURRENT CONCEPTS in FUNCTIONAL CAPACITY EVALUATION: A Best Practices Guideline Intent and Scope. www.orthopt.org/uploads/content_files/files/2018%20Current%20Concepts%20in%20OH%20PT-FCE%2006-20-18%20FINAL.pdf.
4. “Requesting a Functional Capacity Evaluation: Who Needs One.” Https://Worksafept.com/, worksafept.com/when-to-get-a-functional-capacity-evaluation-who-needs-an-fce/#:~:text=Tips%20for%20employers%20who%20are%20considering%20requesting%20an%20FCE. Accessed 13 Feb. 2024.