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20.9 Incapacity for work and Functional Capacity Evaluations

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A 'functional capacity evaluation' (FCE) is a battery of structured, calibrated tests to determine the client's residual physical ability. The client's ability to stand, walk, lift, carry etc. is measured objectively. Strength, endurance, manipulative ability and a range of other physical performance measures are also tested through a graduated series of activities. These tests relate to one another and some contain in-built checks to detect if and when the client is 'malingering' during the testing or attempting to manipulate the results.

FCEs are a useful medical assessment tool for establishing whether or not a client's injury prevents activities associated with 'suitable employment'. However the FCE measures only a general bodily capacity and this relates only by inference to the demands of a particular type of employment. Nor of course are the physical capabilities measured by an FCE the only matters to be settled in determining incapacity for employment or able-to-earn issues. For instance an FCE can not on its own determine whether a particular job represents 'suitable employment' under the wider meaning encompassed by S4(1) and S19(4) of the SRCA.

Nevertheless, FCEs may be relied upon to settle disputes as to whether a particular bodily impairment is capable of preventing participation in particular duties, or to estimate the hours per week for which the client could physically cope with the work. The FCE is a useful tool for objective analysis of alleged physical problems with particular tasks arising during the return to work or 'deeming able to earn' process. However the result of an FCE can not easily forecast whether a specific form of employment is suitable, nor identify vocational options and it is therefore better employed on an 'as required' problem-solving basis once the return to work strategy has been identified and is in progress.

The actual testing for an FCE is usually administered by a specially trained and qualified occupational therapist, on referral from a medical specialist. On conclusion of the testing the therapist produces tabulated test results with an analysis, observations and conclusions. For medico-legal purposes the specialist, (who must of course also examine the client), will need to analyse the FCE results in the light of his/her own observations of the client and endorse, refute or develop the testing therapist's conclusions.

It is strongly recommended that delegates who initiate an FCE by an Occupational Therapist do so only through a supervision of a specialist Occupational Physician because this is the medical specialty best qualified to comment on an FCE.