Today, I met with Rob Wolinsky, a physical therapist at the Kelly Hawkins Physical Therapy facility at Charleston and Valley View . Rob oversees approximately a dozen functional capacity evaluations (FCE’s) each week at the request of physicians and adjusters administering Nevada workers compensation claims. A FCE is an evaluation by an experienced therapist like Rob. The is asked to perform particular physical tasks while the evaluator gathers information about the worker’s ability to return to their pre-accident employment. Even when it is obvious to a treating doctor that the worker cannot return to his old occupation, the doctor may want a FCE so that a vocational counselor knows what kind of retraining program to develop.
I asked Rob about how he determines whether a FCE is valid or not. I was surprised to learn that about 30% of the evaluations he does each week are invalid. An injured worker must pass 70% of the validity criteria built into the test to have a valid test.
Validity criteria tells the evaluator whether the worker is honestly trying his best to do the various physical tasks required during the evaluation. Rob explained that the validity criteria used by Kelly Hawkins PT was developed over many years from several sources. He was confident that their validity criteria provides him with a fair and objective way to measure an injured worker’s true effort and physical work abilities.
Rob also stated that there might be valid reasons for a FCE to have inconclusive or invalid results. For example, he told me that if the FCE is done too soon following a major back surgery, the test might be invalid despite the injured worker’s consistent, and best efforts. In that particular case, Rob said that he phoned the doctor who had ordered the FCE just two months after the patient’s back fusion to tell him that the FCE should be done later. Rob also said that if an injured worker is disabled due to a separate non-industrial injury, or is unable to perform all tasks due to a pre-existing illness, the test may come back as invalid.
FCE test results are sent to the treating physician for a statement of permanent work restrictions. A physician is not obligated to follow the recommendations of the FCE evaluator. However, most physicians do rely on the FCE results. Problems occur when the job description provided to the FCE evaluator is not accurate, or when no job description is provided. In that case, the FCE evaluator uses the general physical job description from the U.S. Dept. of Labor for the most appropriate job title.
An invalid FCE can cause serious problems for an injured worker. The treating doctor , who reviews the invalid FCE report, may now believe that the patient is trying to fake a more serious injury. Most doctors release the patient full duty without any restrictions when they see invalid FCE results. Rob told me that sometimes a FCE will be invalid, but it is clear to him that the patient should have permanent restrictions. In those rare cases, Rob may phone the doctor to discuss the FCE results.
Again, clients with legitimate injuries may have invalid FCE results for various reasons. Those injured workers often have to appeal the termination of their benefits, and they must pay $800 or more for another FCE test until they get valid results for their doctor.