Functional capacity evaluations are a type of independent medical examination that insurers often require of those receiving income-replacement benefits.
When you’re injured in an Ontario automobile accident, Ontario law and your auto insurance policy entitle you to receive certain statutory accident benefits regardless of fault. If, as a result of your accident, you are unable to return to work for a period, those benefits include income-replacement benefits.
However, in some circumstances, your insurer can require you to undergo an independent medical examination to verify your continued eligibility for benefits. These examinations may involve any of several different types of evaluations, one of which is known as a functional capacity evaluation (FCE).
Functional capacity evaluations are intended to objectively test your ability to do certain routine tasks. The results are then used by your insurance company to determine whether you are still entitled to receive income-replacement benefits.
To help you understand what you can expect if your insurer asks you to undergo an FCE, we’ve compiled some basic information about your statutory rights regarding such requests and what you can expect from the evaluation itself.
Article at a Glance
- If you’re receiving ongoing statutory accident benefits, your insurer can periodically require that you provide updated information or undergo an independent medical examination to prove your continued eligibility.
- Functional capacity evaluations are a type of independent medical examination that insurers often require of those receiving income-replacement benefits.
- Although functional capacity evaluations are meant to be objective, standardized tests, they are not the final word on your entitlement to statutory accident benefits.
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Background: When Can Your Insurer Require an Independent Medical Examination?
When you’re receiving certain types of statutory accident benefits, your insurer is entitled to periodically review your ongoing eligibility for those benefits. For example, if you’re receiving income-replacement benefits or non-earner benefits, your insurance company can:
- Request that you submit a new disability certificate within 15 days; or
- Require that you undergo an independent medical examination, either in person or by submitting information and medical records to the professional chosen by the insurance company; or
- Do both of the above.
If you refuse to comply with the insurance company’s request, the insurance company can stop paying your benefits until you do so.
Of course, the insurance company’s right to require either of these things (and, accordingly, its right to stop paying your benefits) is limited by the Statutory Accident Benefits Schedule (SABS). Specifically:
- The insurance company cannot make such requests more often that is “reasonably necessary”; and
- If the insurer notifies you of the need for an independent medical examination, it must tell you the medical and other reasons for the examination.
In addition, the insurance company is required to give you at least five business days’ advance notice if you will have to attend the medical examination in person. If your insurer makes a request that is not in compliance with these SABS rules, then you can challenge its subsequent denial of benefits.
Given the relative complexity of these requirements and the need to protect yourself against an insurer’s unreasonable demands, you should consult an experienced Ontario accident benefits lawyer if you have any questions or concerns about your insurance company’s conduct in this regard.
Where Do Functional Capacity Evaluations Fit In?
Functional capacity evaluations are a type of independent medical examination that your insurance company may require you to undergo. The evaluation is designed to test your ability to do routine tasks (like those you may be required to do at work) to objectively determine whether you can return to work or not.
Accordingly, during an FCE, you may be asked to perform tasks that test the following:
- Your ability to stand, sit, or kneel;
- Your capability to walk;
- Your capacity to lift and carry objects;
- Your pushing-and-pulling power;
- Your grip strength;
- Your range of motion and flexibility;
- Your balance; and
- Other functional capacities.
While observing you in performing these tasks, the person conducting the FCE will ask you about your pain level. He or she will use this subjective information to supplement the objective data collected from his or her observations.
Are Functional Capacity Evaluations the Final Word on Your Ability to Work?
No. In fact, as a standardized examination in an artificial setting, the results of functional capacity evaluations can be misleading. For example, an FCE may only last a few hours. But just because you can perform certain tasks for purposes of a one-off evaluation doesn’t mean you would be able to repeatedly perform those tasks, day-in and day-out, at work.
In addition, you may experience pain or fatigue as a result of undergoing the FCE that does not manifest until after you complete it. If you have to spend days recovering after undergoing an FCE, then your performance during the FCE is not a good indicator for how well you would do on the job.
Fortunately, if your insurance company terminates your benefits on the basis of an FCE, your lawyer can help you challenge that decision if you believe the FCE’s findings are faulty. Your lawyer may provide further, contrary evidence to your insurer to persuade it to reinstate your benefits. Alternatively, your lawyer can help you challenge your loss of benefits before the Licence Appeal Tribunal and Ontario courts.
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Contact an Experienced Accident Benefits Lawyer Today
As the above discussion makes clear, you have legal rights when dealing with your auto insurance company—rights that insurance companies aren’t always keen to respect. To help protect your rights to continue receiving statutory accident benefits, including income-replacement benefits, you should work with an experienced Ontario personal injury lawyer.
Preszler Law Firm is a personal injury firm in Ontario with decades of experience helping injured Ontarians navigate the complexities of the province’s accident benefits system. Our lawyers work diligently to review your insurer’s conduct and hold it to its legal obligations under your insurance policy.
Contact Preszler Law Firm today for a free consultation about your case.
Call or text 1-877-573-3563 or complete a Free Case Evaluation form
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