Preparing Clients for a Functional Capacity Evaluation: A Lawyer’s Guide
In personal injury and disability cases, a Functional Capacity Evaluation (FCE) can be a pivotal moment. The results of an FCE – which assesses what a person can and cannot do physically – often influence settlement decisions, insurance payouts, or court judgments. As a lawyer, you want your client to approach an FCE prepared, informed, and ready to give their best, honest effort. But many clients have never heard of an FCE before being asked to attend one, and the unknown can be intimidating. This guide, from the perspective of an occupational therapist who frequently conducts FCEs for medical-legal purposes, will arm you with clear steps to help your clients navigate the FCE process. By preparing your client well, you not only help them reduce stress – you also ensure the evaluation paints an accurate picture that will ultimately support their case.
What is a Functional Capacity Evaluation (FCE)?
A Functional Capacity Evaluation is a comprehensive series of tests and observations that determine an individual’s functional abilities and limitations, usually related to work tasks. In an FCE, a trained evaluator (often an occupational therapist or physical therapist) will measure things like how much your client can lift, how long they can sit or stand, how far they can walk, how their pain responds to activity. The evaluation often takes several hours and may cover:
Physical Strength and Endurance Tests: Expect lifting, carrying, pushing, and pulling tasks. The evaluator might have your client lift weights from the floor to a table, carry objects over a distance, or push against a resistance to test strength. They’ll also time activities to see how fatigue sets in – e.g., walking on a treadmill or climbing stairs to evaluate endurance.
Range of Motion and Flexibility: The evaluator will likely measure joint movements – how far the client can bend, reach, or twist different body parts. Any stiffness or pain-limited range gets recorded.
Postural Tolerances: This means how long someone can tolerate basic postures – sitting, standing, crouching, kneeling. If your client can only stand for 10 minutes before needing to sit, for instance, that’s crucial data and will be recorded.
Dexterity and Coordination: Some tests might check fine motor skills, especially if the job in question involves hand use (typing, tool use). They may ask the client to pick up small objects, manipulate bolts and screws, or write with a pen to see if injuries (like nerve damage or pain) affect coordination.
Pain Response and Effort: Throughout the FCE, the evaluator observes signs of pain (wincing, guarding) and notes when the client has to stop due to discomfort. They are also subtly gauging the client’s effort – are they trying their hardest, or holding back, or perhaps exaggerating? Many FCEs include built-in consistency checks to see if the effort is genuine. For example, the client might be asked to perform a similar task twice; inconsistent results can indicate variable effort. Some FCE protocols even include a psychological or behavioral component to assess effort and sincerity.
Functional Simulations: If possible, the evaluator might simulate some of the client’s actual job tasks (or daily tasks if it’s a disability/home life evaluation). If the client is a delivery person, for instance, the evaluator may have them simulate carrying a load up and down a hallway. These simulations make the findings very relatable: instead of abstract numbers, it becomes clear that “this person can lift a 10kg box from floor to waist, but cannot climb a ladder while holding that weight.”
At the end, the evaluator compiles all this into a detailed report, summarizing what the client can do, cannot do, and recommendations on work capacity or accommodation. In essence, the FCE establishes a functional baseline grounded in objective testing.
Why Preparation Matters:
Although an FCE is meant to be an objective assessment, how your client approaches it can influence the results. The goal is not to “game” the test – honesty is paramount – but rather to ensure that the results truly reflect your client’s capabilities. Proper preparation can prevent simple mistakes or oversights that might skew the outcome. Here are a few reasons preparation is so important:
Reducing Anxiety for Better Performance: FCEs can be physically demanding and psychologically stressful (someone watching and judging your every move for hours). If a client is extremely anxious, they might not perform to their actual ability – for instance, hesitating out of fear of pain, or not communicating clearly when something hurts. By briefing them on what to expect, you remove the fear of the unknown. A client who isn’t surprised by the tasks can focus on doing them as well as they are truly able.
Ensuring Honest Effort (Without Overdoing): Some clients might think they need to push through pain or fatigue to “impress” the evaluator. In reality, overexerting and then collapsing or worsening their injury helps no one. Conversely, other clients might unconsciously hold back because they’re afraid pain will flare up. We need the Goldilocks effort – as much as they can do safely. Explaining this balance – “Give your full effort until you truly cannot continue, and communicate when it hurts” – will lead to a more accurate assessment.
Avoiding Red Flags of Symptom Exaggeration: FCE evaluators are trained to spot inconsistency. If a client isn’t prepared, they might inadvertently create red flags. For example, if they say on intake that their pain is always 9/10, yet they perform relatively strenuous tasks without visible distress, the evaluator might question credibility. By coaching clients to be accurate and factual (not understating or overstating their abilities), you help them present consistently.
Maximizing Useful Data: Simple practical prep (discussed below) like wearing the right clothing or taking medications appropriately can make sure nothing interferes with showing their true abilities. You don’t want something like stiff dress shoes or skipping a necessary inhaler dose to limit your client during the test.
Positive Impression and Cooperation: A well-prepared client arrives on time, with necessary paperwork, and understands the process. This often leads to a more cooperative interaction with the evaluator. While evaluators strive to be neutral, a client who is polite, engaged, and tries hard (thanks to feeling prepared) can create a subtle positive impression. At the very least, they won’t inadvertently irritate the evaluator by, say, not bringing their prescribed brace or coming late (which could subconsciously affect how the evaluator perceives them).
In short, preparation ensures that the FCE outcome is a true and fair reflection of the client’s functional status – which is exactly what you need to support the case.
Key Preparation Steps for Your Client:
As the attorney, you can guide your client through these practical steps in the days leading up to the FCE:
Educate Your Client on the FCE Process: Start by explaining in plain language what an FCE is (feel free to share the overview above). Let them know it’s typically a few hours long and involves physical activities. Knowledge is power – if they know what kinds of tasks might be asked (lifting weights, walking, etc.), it won’t catch them off guard. Emphasize that this is not a gym competition; it’s about finding their safe limits, so they should neither under-report nor push until they risk injury.
Review Relevant Medical History and Job Duties: Go over the key points of your client’s medical condition and, if applicable, their job description. Make sure the client can clearly communicate their essential symptoms and limitations. For example, if bending the right knee past 90° always causes sharp pain, they should mention that upfront and again if a task triggers it. If their job as a construction worker required lifting 50lbs routinely, they should convey that context to the evaluator. This ensures the evaluator has accurate background. (Sometimes, you as the lawyer can provide documentation of job demands ahead of time. If so, double-check it’s correct.
Encourage a Good Night’s Sleep and Regular Routine: Clients should treat the day before like the “night before an exam or big event.” Getting adequate sleep will help their concentration and endurance during testing. They should also eat a normal, light meal beforehand – not a huge heavy brunch that could cause discomfort, but also not skipping breakfast which might lead to fatigue or dizziness mid-test. Hydration is important too; just not so much that they need constant bathroom breaks.
Medication and Pain Management Strategy: This one can be tricky. Generally, clients should take their medications as prescribed, so they are in their typical condition during the FCE. However, if the client routinely takes as-needed painkillers, discuss a plan: taking a strong dose right before the FCE could mask pain and make them appear more capable than they are (and the evaluator will not know the pain they’d feel without medication. On the other hand, not taking something and then being in debilitating pain isn’t good either. If possible, consult with the client’s doctor on how to handle short-acting pain meds the day of the FCE. In any case, the client should inform the evaluator what medications they have taken that day, so context is clear.
Comfortable Clothing and Aids: Advise your client to wear loose, comfortable clothing and supportive footwear. If they have any braces, splints, hearing aids, glasses, or assistive devices they use, they must bring them to the FCE. Coming without their knee brace (because they “only use it when it’s bad” or forgot it) can skew results or even be seen as non-compliance. It’s best to dress as if they’re going to a light workout session, not a formal appointment.
Arrive Early and Composed: Stress the importance of punctuality. Arriving at least 15 minutes early is key. Rushing in late can raise their heart rate, increase anxiety, and possibly annoy the evaluator or even lead to rescheduling. By arriving early, they can use a restroom, get a drink of water, and start the evaluation calm. Also, evaluators sometimes observe clients in the waiting room (some have windows or informal checks). It shouldn’t be paranoid, just the client should be mindful that their professional behavior starts the moment they enter the facility.
Honesty is the Best Policy: Coach your client to be truthful about their pain and limits throughout the evaluation. If something hurts, they should say so and not push to the point of injury. Conversely, they should attempt every test to the best of their ability unless they believe it’s unsafe. One useful mindset: “Perform as if you want to safely show the very most you can do today, and be clear about what you can’t.” Evaluators appreciate candor. If a client can’t finish a task, encourage them to explain why: e.g., “I have to stop because my back pain is getting too severe and I’m worried I’ll fall if I continue.” That helps the evaluator record the precise limitation. Remind the client that it’s okay to say “no” if something is beyond their capacity – that in itself is valuable information.
Consistency and Awareness: Advise the client to be mindful of consistency. This doesn’t mean they should fake anything – it means they should be aware if they have good moments and bad moments. For instance, if pain fluctuates, it’s fine that at one point they could do 5 reps and later only 3 reps – but they should perhaps mention, “my pain is increasing as I do more, that’s why I had to do less this round.” This kind of communication can pre-empt any appearance of inconsistency. Essentially, narrating their experience in an honest way keeps the evaluator in the loop of why their performance might change.
Mental Preparation for Possible Discomfort: Let them know it’s normal to feel tired or have some pain during and after the FCE – after all, it’s like a prolonged physical exam. The next day soreness doesn’t mean they did anything wrong. If something really hurts or feels unsafe during the test, they should voice it. Knowing that they have permission to stop or request a break can actually make them more confident in giving full effort (because they know they have an “out” if needed). Evaluators typically allow brief rest breaks or will pause if they see a client is in significant pain – it’s an assessment, not torture. But the client might need to speak up.
Review Paperwork and Bring ID/Documentation: This is a small but important point. Ensure the client has any required paperwork with them – sometimes there are pre-questionnaires or forms to bring, or simply having a list of their medications. Government-issued ID is often needed for any medical appointment check-in. These seem obvious, but in the stress of a big evaluation, a forgetful moment can cause hiccups.
By walking your client through these steps, you set them up for a smoother FCE experience. Some lawyers even provide a one-page tip sheet – you might consider doing that, summarizing the above points for your client to review the day before the FCE.
During and After the FCE – Additional Pointers:
While most of the preparation happens beforehand, here are a few things to remind your client about for the day of and immediately after:
During the FCE: Encourage them to focus and listen carefully to instructions. If they don’t understand what the evaluator is asking, it’s absolutely fine to ask for clarification or to say, “Can you demonstrate that for me?” Following instructions correctly is part of the test (e.g., lifting an object the way they’re asked to). They should also pace themselves – if the evaluator doesn’t specify a pace, it’s usually better to move steadily rather than rushing through something and exhausting themselves too quickly. And as discussed, they should keep communicating: if they feel lightheaded, if a certain motion caused a sharp pain, if they need a brief pause – speaking up is allowed and expected. The evaluator can only record what they observe or are told.
After the FCE (Debrief with Client): Once the FCE is over, it’s useful to debrief with your client as soon as possible (the same day or next day while it’s fresh). Ask them how they think it went. What was the hardest part? Did anything concern them? For instance, if the client says, “They stopped the test when I complained of chest pain,” that’s important info for you to know and watch for in the report. If the client felt the evaluator was dismissive of their pain or if the client realized they forgot to mention something crucial, you might be able to address that by, say, sending a follow-up note to the evaluator (or at least anticipating how to counter an unfavorable report). Also, encourage your client to note their pain levels later that day and the next. Sometimes clients significantly flare up after an FCE. Those post-FCE effects can be telling: if your client is bedridden for two days after, that reinforces that the evaluation pushed them to their limits. Such information might be worth communicating to whoever is using the FCE results, as long as it’s truthful.
Reviewing the FCE Report: When the FCE report comes in (usually sent to the referral source, e.g., the insurance company or your office), review it in detail. Cross-check it with what your client reported to you. If there are major discrepancies – “client showed no signs of pain” and your client insists they expressed pain – you may need to gather clarification or even consider a second opinion, depending on the stakes. In many cases, though, a well-prepared client’s FCE will align with expectations. Use the report’s findings to strengthen your case: the data about limitations can support your arguments about disability, needed accommodations, or extent of injury. If the report is more favorable than expected (perhaps showing more ability), then at least you know that objectively and can adjust strategy (for instance, focusing less on physical limitations and more on another aspect of damages).
Conclusion:
A Functional Capacity Evaluation can indeed make or break a personal injury or disability case. By taking the time to prepare your client, you help ensure the “make or break” goes in your favor. Remember, preparation isn’t about coaching someone to misrepresent themselves – it’s about empowering them to put their best foot forward and communicate their genuine limitations effectively. As an occupational therapist who has run many FCEs, I can’t overstate how apparent it is when a client is unprepared versus prepared. The former might show up in dress shoes, unsure what’s happening, and perform inconsistently. The latter comes in calmly, in sneakers, and works hard with steady, reliable results. The difference in outcomes can be significant for your case.
As a lawyer, your role extends beyond paperwork and arguments; it includes setting your client up for success in these evaluations. With the guidance in this Lawyer’s Guide to FCEs, you can confidently brief your clients for the road ahead. When the FCE day arrives, they’ll walk in informed and ready – and walk out with results that truly reflect their needs and bolster your fight for their rights. Contact us for more information.