Leveraging Functional Ability Evaluations to Reduce Claim Disputes

Understanding Functional Ability Evaluations

Functional Ability Evaluations (FAEs) are comprehensive assessments designed to measure an individual's physical capabilities in relation to the demands of their job. Unlike general medical examinations, FAEs focus on specific tasks and movements that are critical to the employee's role. These evaluations include tests for strength, endurance, flexibility, and other job-specific functions.

The Role of FAEs in Reducing Claim Disputes

1. Objective Evidence: One of the primary benefits of FAEs is the objective data they provide. By using standardized tests and protocols, FAEs offer unbiased, quantifiable evidence of an individual's functional abilities. This objectivity is crucial in resolving disputes where conflicting opinions about an employee's capacity to work may arise.
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3. Clear Communication: FAEs facilitate clear communication between all parties involved in a claim – the employee, employer, healthcare providers, and insurance companies. The detailed reports generated from these evaluations provide a common ground for understanding the employee's capabilities and limitations, reducing misunderstandings and misinterpretations.
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5. Informed Decision-Making: With the comprehensive data provided by FAEs, employers and insurers can make informed decisions regarding work modifications, return-to-work plans, and claim settlements. This reduces the likelihood of disputes arising from decisions based on incomplete or inaccurate information.
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7. Consistency in Assessments: FAEs ensure consistency in the evaluation process, as they are based on standardized protocols. This consistency helps in maintaining fairness and transparency in the assessment, making it easier to resolve disputes that may arise from perceived discrepancies in evaluation methods.

Implementing FAEs in the Workplace

1. Early Intervention: Conducting FAEs early in the recovery process can prevent disputes before they escalate. Early assessments provide a baseline of the employee's capabilities, allowing for timely adjustments to their recovery and return-to-work plans.
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3. Regular Re-evaluations: Regular FAEs throughout the recovery period help monitor progress and make necessary adjustments to work duties and accommodations. This ongoing evaluation ensures that the return-to-work plan remains aligned with the employee's current capabilities, reducing the risk of disputes due to changes in their condition.
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5. Collaboration with Healthcare Providers: Collaboration between FAE specialists and treating healthcare providers ensures a holistic approach to the employee's recovery. By integrating medical treatment with functional assessments, any discrepancies between the medical prognosis and functional capabilities can be addressed promptly.
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7. Training for Employers and Employees: Educating both employers and employees about the purpose and process of FAEs can enhance their acceptance and cooperation. Understanding the benefits of FAEs in providing objective data and facilitating a safe return to work fosters a collaborative environment that reduces the likelihood of disputes.
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Case Study: Reducing Disputes through FAEs 

Consider the case of Sarah, an administrative assistant who developed chronic wrist pain due to repetitive strain. Her initial claim was met with skepticism from her employer, leading to a dispute over the extent of her injury and her ability to perform her job.

NYRC’s assessor conducted an FAE to assess Sarah's functional abilities. The evaluation revealed significant limitations in her wrist movements, substantiated by clear, quantifiable data.

With the FAE report, Sarah's employer recognized the need for ergonomic adjustments and a modified work schedule. The objective evidence provided by the FAE resolved the dispute, leading to an amicable agreement on Sarah's work modifications and a clear path for her gradual return to full duties.

This case underscores the power of FAEs in providing the necessary clarity to resolve claim disputes effectively.

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Functional Ability Evaluations are a vital tool in reducing claim disputes related to workplace injuries. By providing objective, quantifiable data on an individual's functional capabilities, FAEs facilitate clear communication, informed decision-making, and consistent assessments.

At NYRC, we have seen firsthand how early and regular FAEs can prevent disputes, foster collaboration, and support successful return-to-work outcomes. Implementing FAEs as part of a comprehensive injury management strategy not only benefits the employee and employer but also contributes to a more efficient and fair claims process.