Labor and Industries (L&I)Workers compensation legal info

Maximum Medical Improvement (MMI) and Physical or Functional Capacities Evaluation (PCE or FCE) in Workers’ Compensation Claims

Workers' Compensation L&I Claim Maximum Medical Improvement

What happens when a workers’ compensation or L&I claim starts winding down? And what are the terms Maximum Medical Improvement (MMI) and Functional Capacities Evaluation (PCE or FCE) referring to?

 

As I outlined in prior posts, the open and active phase of a workers’ compensation claim is the phase where the claim is open and the injured worker is actively receiving necessary and proper treatment for claim related conditions. The open and active phase of a claim begins to wind down as the injured worker reaches what is often referred to as maximum medical improvement or medical fixity (MMI). MMI does not mean that the injured worker has been returned to the same level of physical health they had prior to the injury or disease. MMI means that the medical providers have given the injured worker all available diagnostic, curative or rehabilitative treatment available and that any further treatment will be palliative only. Once injured workers reaches MMI, it is important to assess their overall level of functioning to determine their permanent post injury or disease abilities.

 

In some cases, the attending provider can provide a reasonably accurate assessment of the injured workers permanent abilities. However, sometimes a provider would like additional data that can be used to assess an injured worker’s abilities, and a physical or functional capacities evaluation (PCE/FCE) can be a tremendously helpful tool for helping to better understand an injured worker’s ability to return to work. It can also help guide recommendations regarding the type or length of treatment that may still be needed.

 

The evaluation is performed by a qualified and licenses physical or occupational therapist. The Department of Labor and Industries (L&I) requires the findings of the evaluation to be put into a report containing six elements that include:

(1) Worker information;

(2) A musculoskeletal screening;

(3) Positional, material handling and non-material handling capacity testing;

(4) Cardiorespiratory endurance testing;

(5) Consistency and level of effort testing; and

(6) Musculoskeletal and psychosocial questionnaires.

Additionally, effective July 1, 2016, L&I started requiring PCE or FCE providers to complete a FCE Summary Form, summarizing the evaluation results.

 

L&I has several resources on their website regarding PCE and FCE that are designed for evaluators and vocational counselors. However, these resources can be equally informative for injured workers. For example, L&I has a list of FCE Definitions that can help injured workers better understand the activities they may be asked to perform during an evaluation. L&I also has an informational sheet regarding FCE Evaluator Standards, which also provides useful information that can help injured workers know what to expect from their evaluation. Finally, once a PCE/FCE report has been completed, the attending physician should be given an opportunity to review the complete evaluation report and provide feedback concerning the accuracy of the findings. For this reason, I think it is usually a good idea for the injured worker to meet with their attending provider to review the PCE/FCE report and recommendations.

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