Necessity of Functional Capacity Evaluation? (California)

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Necessity of Functional Capacity Evaluation? (California)

Postby 1wayout on Mon Aug 14, 2017 1:29 pm

Applicant was injured while working for the employer as a retail sales clerk. After he became P&S, he secured a job with another company as a warehouseman, doing somewhat arduous work. The injury is to the applicant's back and it is largely resolved with only minor impairment.

Applicant's counsel is now demanding a Functional Capacity evaluation, presumably to override what the Orthopedic PQME's determinations. Orthopedic PQME said he's be willing to look at a FCE, but did not give reasons why it would be necessary.

Is the defense required to provide the applicant with an FCE? What are the bases for an FCE?
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Re: Necessity of Functional Capacity Evaluation? (California)

Postby 50Cal20 on Mon Aug 14, 2017 7:34 pm

Like any other medical test, it requires a doctor's request, not a lawyer's. It also requires and RFA and an explanation of why the test is necessary. Then it has to be run through UR for approval before anything is done.
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Re: Necessity of Functional Capacity Evaluation? (California)

Postby jpod on Tue Aug 15, 2017 6:52 am

While I am not arguing for either side it seems to me the counter argument is the FCE is not treatment but rather it might be Medical-legal.

If its not treatment I don't think UR is the right place to resolve the necessity for the test. I think the PQME should be asked if the PQME thinks the test is necessary for the PQME to form his/her opinion.
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Re: Necessity of Functional Capacity Evaluation? (California)

Postby vampireinthenight on Tue Aug 15, 2017 9:34 am

Agree with jpod. Until the QME says it is necessary, then... it's not necessary and shouldn't be compelled. How would the AMA Guides rating be affected by a FCE?
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Re: Necessity of Functional Capacity Evaluation? (California)

Postby 1wayout on Tue Aug 15, 2017 9:43 am

Thanks for the replies. I think the FCE will be the potential basis for an Almaraz/Guzman analysis. Who sets the appointment with the FCE company? I.e., can app atty insist on his personally selected FCE testing/assessment company to do the evaluation?
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Re: Necessity of Functional Capacity Evaluation? (California)

Postby LawAdvocate on Tue Aug 15, 2017 2:44 pm

FCEs require prior authorization number 1.

Number 2 - MTUS requires a FAILED return to work effort prior to an FCE being medically reasonable and necessary.

So unless the PQME can establish the medical necessity of it, no way.
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