Independent Medical Evaluation

An independent medical examination (IME) occurs when a doctor who has not previously been involved in a patient’s care examines the patient.

IMEs may be conducted to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue; whether a worker has reached maximum benefit from treatment; and whether any permanent impairment remains after treatment. An IME may be conducted at the behest of an employer or an insurance carrier to obtain an independent opinion of the clinical status of the individual. Workers' compensation insurance carriers and self-insured employers have a legal right to this request. Should the doctor performing the IME conclude that a patient’s medical condition is not work-related, the insurer may deny the claim and refuse payment.

Functional Capacity Evaluation

What Is the FCE?

A Functional Capacity Evaluation (FCE) is an all-encompassing term to describe the physical assessment of an individual's ability to perform work- related activity. It can also be known as a Functional Capacity Assessment (FCA), Physical Capacity Assessment or Evaluation (PCA or PCE), or Work Capacity Assessment or Evaluation (WCA or WCE). A well-designed FCE should be comprehensive in terms of encompassing the physical demands of work as defined by the U.S. Department of Labor in the Dictionary of Occupational Titles (DOT), have standardized instructions and operational definitions, be practical regarding space and length of time for administration, be objective in minimizing examiner bias, and, most importantly, be reliable and valid. An FCE must also be administered with care for the patient's safety and well-being, with due diligence to minimize the chance for injury during the course of the evaluation.

What Are the Purposes and Applications of the FCE?

The FCE may be used to determine:

  • Goals for rehabilitation or readiness for discharge
  • Return to work status (including full duty, modified/transitional duty)
  • Case settlement
  • Disability status
  • Ability to meet job demands as part of a hiring process(for preemployment/post-offer testing)

What Are the Components of an FCE?

A FCE usually consists of:

  • Medical record review
  • Musculoskeletal screening
  • Physical ability testing

Physical testing may include graded strength activities such as lifting, carrying, pushing and pulling; position tolerance activities such as standing, sitting, and stooping; and mobility activities such as walking, crawling, and climbing. An FCE may also include information about an individual's dexterity, coordination, balance, endurance, and other job specific testing. The FCE report includes an overall level of work, a summary of physical abilities that is usually couched in the language used by the DOT, information about consistency of effort, job match information, and recommendations, if requested.

FCEs are done on a one-to-one basis and may range in length from 4 to 6 hours. An FCE may take place over two consecutive days.

Who Is Qualified to Perform an FCE?

The occupational therapy practitioner has the unique combination of skills and abilities necessary to assess the physiological, psychophysical, and biomechanical function of the individual engaged in occupation. Occupational therapy practitioners also have the observational skills, training, and experience to perform complex task analysis and assessment of environmental factors affecting work performance. Physical therapists, exercise physiologists, athletic trainers, and those in other disciplines may also perform FCEs. Advanced certification in FCE is available from many vendors.

Who Pays for the FCE?

  • Worker's compensation insurance plans
  • Self-insured plans
  • Individual insurance plans
  • State and/or local agencies
  • Managed care plans
  • Private pay

Rates can and do change based on geography. Precertification of the service and verification of the state fee schedule is advised.

Who Can Refer/Recommend the FCE?

  • Physicians
  • Case managers
  • Other therapists
  • Insurance carriers
  • Employers/human resource personnel/risk managers
  • Attorneys