Long-term disability (LTD) insurance is a critical aspect of safeguarding your family and financial future. Unfortunately, insurers are often focused more on profit than paying what someone deserves. This is made more difficult when a functional capacity evaluation clearly supports a claim, but this doesn’t mean the insurance company will make things easy. Individuals can improve their chances by knowing the role of functional capacity evaluations in LTD claims.

With this knowledge, those seeking disability benefits will be able to navigate the claims process more easily and thus have a better chance at securing fair compensation. And as it turns out, functional capacity evaluations play various roles in the LTD claims process.

Providing an Objective Assessment

Functional capacity evaluations (FCEs) are conducted by trained healthcare professionals. They conduct these evaluations using standardized protocols that ensure consistent and reliable findings. Put simply, these are objective assessments of a person’s ability to work.

This means there’s very little room for disagreements. The impartial results of these evaluations are not subject to an insurer’s or claimant’s interpretation. This objectivity adds a clear sense of credibility to the claimant’s case.

Clarifying Functional Limitations

Functional capacity evaluations don’t just determine whether a person is able to return to work. They also provide a clear picture of a person’s physical and cognitive abilities and limitations. This means there’s no guesswork necessary when determining what a claimant is capable of.

This information is critical for insurers to understand the specific restrictions and limitations that their policyholder faces when performing work activities. This information can guide decisions on eligibility and benefit amount.

Documenting a Disability’s Impact

The role of a functional capacity evaluation in LTD claims clearly relates to identifying disabilities and limitations. However, these assessments also document a disability’s impact on a claimant’s ability to perform essential job tasks.

By documenting the impact of a disability, FCEs can assess physical capabilities, functional limitations, pain and discomfort, consider specific job demands, and more. All this evidence will demonstrate how relevant injuries or conditions clearly affect a person’s ability to work.

Providing Supporting Medical Evidence

Functional capacity evaluations are more than just opinions. They’re determinations made by healthcare professionals. As such, they serve as supporting medical evidence that shows insurers that workers truly are as limited as they claim.
FCEs are far from the only consideration when it comes to LTD benefits claims. Policy terms and conditions, former medical records, and other documentation play a significant role as well. However, the role of FCEs as medical evidence in LTD claims may be the most important.

Rehabilitation Planning

The role of functional capacity evaluations in long-term disability claims frequently revolves around securing fair compensation. However, these evaluations can also guide rehabilitation efforts. After all, these in-depth evaluations provide medical evidence of disability. This is critical for understanding a person’s limitations.

With this knowledge, the claimant can seek appropriate therapy and treatment to improve their functional capacity or mitigate the impact of their disability. While these evaluations may seem like a nuisance that’s in the way of securing benefits, it’s important to remember that these are medical professionals — not insurance adjusters — performing them..

Reduction of Fraud

While many of the roles that functional capacity evaluations play in LTD claims are beneficial for claimants, they can also serve important functions for insurers. Perhaps the most significant is the ability to reduce payouts on fraudulent claims.

It’s an unfortunate fact, but rates of insurance fraud have skyrocketed in recent years. And while many people legitimately need LTD benefits, there are also those hoping to take advantage of the system. By providing a consistent, reliable, and objective assessment, FCEs help reduce fraud.

Determining Eligibility and Appropriate Benefits

Perhaps the most important role functional capacity evaluations play in the LTD claims process is determining eligibility and appropriate benefits. An evaluation that shows a person is unable to perform their job or another job they’re qualified for will serve as evidence that disability benefits are needed.

In addition to eligibility, the findings of this evaluation can have a significant effect on the level of benefits provided to the claimant. Insurers are more likely to provide fair compensation when the evidence shows your claims of disability are supported by the facts. Unfortunately, insurers sometimes still make things difficult.

This is why having a long-term disability attorney on your side is important. At Chad Brown Law, PLLC, we’ll fight to secure every bit of compensation you deserve. Contact us today at (336) 962-5373 to schedule your free consultation.