The Importance of Understanding the Referral Question with a FCE Referral


A very common question we receive from our customers is "what type of FCE should I do for my client"?

When a FCE referral comes to your clinic, it's critical that the evaluator understands the purpose of the FCE, and where the referral is coming from, prior to interviewing the client and administering functional testing. Why is this important?

This is important to ensure that the evaluator provides the referral source with the information they need to create a client-focused report that answers the questions that the referral source needs addressed.

The first things the FCE examiner needs to determine when that referral come in is:

1. Who is requesting the FCE and who is paying for it?

Once this has been determined the examiner then needs to ascertain what the referral question is.

2. Who are the referral sources that may refer a client to your clinic?

Functional capacity evaluations referral sources include:

  • Physicians
  • Insurance Adjuster (work comp or long- term disability)
  • Nurse case manager (work comp)
  • Vocational Counselor (work comp)
  • Employer (self-insured employers)
  • Attorneys (defense or plaintiff)

A functional capacity evaluation could be recommended by the referral source for a number of reasons depending on the circumstances of the client including:

  • Making return to work decisions, and/or work placement decisions.
  • Case closure. Includes work placement decisions or determining permanent partial disability (impairment rating).
  • Determining disability or residual physical capabilities.

Physician Referrals

FCE referrals can be directed by the treating physician or an IME physician in a work comp case for clients with a work comp injury or chronic pain issues to assist the physician in decision making. A physician referral for an FCE can also be made to make disability decisions based on the client's residual physical abilities.

Attorney Referrals

An attorney can request an FCE in a workers compensation case or in disability cases. If the attorney referral is a workers compensation case, the attorney may represent the plaintiff (injured worker), or the defendant (employer). Plaintiff attorneys typically refer to obtain your expert opinion on the severity and prognosis of the injury and underlying pain issues on the client’s occupational and ADL impairments. Defense attorneys typically refer for your expert opinion on the validity and reliability of the client’s pain condition, and the degree of occupational impairment.

Once you have determined the referral source, and the purpose of the functional capacity evaluation in answering the referral question, this will guide you in planning the type of FCE to perform, and the functional tolerances to prioritize during your assessment of the client.

Types of Functional Capacity Evaluations

Job Specific FCE (Workers Compensation Case)

  • Determine whether the client can return to a specific job. If not, what restrictions/accommodations can be made. This can include if rehab recommendations are appropriate such as a work hardening or work conditioning program.

Baseline FCE (General Capabilities FCE): Criteria includes:

  • Workers' compensation case that was referred from a vocational rehab professional to determine transferable skills for a different job.
  • Work comp case with no job to return to, may need the Baseline FCE to determine modified duty with current employer and permanent work restrictions, and/or determine the impairment rating.
  • Work Comp case to provide baseline data to establish a rehab plan (work hardening/work conditioning program) for clients with traumatic or complex injuries.
  • Long Term disability claim that is paid through a LTD insurance policy (may have to be performed at recurring intervals to update previous FCE findings).

Physical Residual Functional Capacity Assessment

  • General Capabilities assessment specifically for determining disability benefits for Social Security Disability (SSDI).
  • Typically, this is a cash based service, however may receive the referral from a disability assessment network such as Impact Medical, Inc.

Keep in mind that there are typically several stake holders behind the scenes with every Functional Capacity Evaluation referral, and there may be multiple referral questions that need to be answered. So, it is critical for evaluators to contact the referral source, prior to testing, to get those questions answered.

Please don't hesitate to reach out to us here at OccuPro if you have questions regarding the functional capacity evaluation referrals you receive. We would be happy to discuss the case with you and guide you to the most appropriate plan of action, in addressing the referral sources needs.

We also offer multiple Functional Capacity Evaluation training courses if you have interest in providing this fun and often challenging clinical service.

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