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Glenn Pransky

Abstract

According to the AMA Guides to the Evaluation of Permanent Impairment, a functional capacity evaluation (FCE) measures an individual's physical abilities via a set of activities in a structured setting and provides objective data about the relationship between an impairment and maximal ability to perform work activities. A key distinction between FCEs and self-reported activities of daily living is that the former involve direct observation by professional evaluators. Numerous devices can quantify the physical function of a specific part of the musculoskeletal system but do not address the performance of whole body tasks in the workplace, and these devices have not been shown to predict accurately the ability to perform all but the simplest job tasks. Information about reliability has been proposed as a way to identify magnification and malingering, but variability due to pain and poor comprehension of instructions may cause variations in assessments. Structured work capacity evaluations involve a set of activities but likely underestimate the individual's ability to do jobs that involve complex or varying activities. Job simulations involve direct observation of an individual performing actual job tasks, require a skilled and experienced evaluator, and raise questions about expense, time, objectivity and validity of results, and interpretation of results in terms of the ability to perform specific jobs. To understand the barriers to return to work, examiners must supplement FCEs with information regarding workplace environment, accommodations, and demotivators.

in AMA Guides® Newsletter
Glenn Pransky
,
Radoslaw Wasiak
, and
Jay Himmelstein

Abstract

The US Social Security Disability Insurance (SSDI) system does not use the AMA Guides to the Evaluation of Permanent Impairment, but examinees who are evaluated for permanent impairment frequently also are receiving SSDI benefits. The latter are restricted to workers who have long-term impairments that are so severe they preclude any type of gainful compensable activity, and the impairment must be medically determinable and expected to last at least a year or result in death. Both SSDI and the Supplemental Security Income plan (primarily for workers who have insufficient past work contributions) require the examining physician to provide specific medical information such as the medical history, physical examination, laboratory findings, and impairment, often using standardized forms. Examiners should know that the observations of the treating physician have legal significance, especially in areas of controversy. Social Security may approve additional diagnostic testing in order to conclusively establish the extent and severity of an illness. Based on the patient's history and observations during the examination, physicians also are asked to report any impairments in daily functioning, but examiners are advised not to address work-relatedness and are discouraged from discussing ability to work, which is determined by the state disability agency. Infrequent follow-up reports may be requested because most accepted claims are reviewed on a periodic (yearly) basis.

in AMA Guides® Newsletter