The open and active phase of an L&I claim or self-insured employer claim when the work injury claimant receives medical treatment. In legal terms, we refer to this phase as when the worker is actively receiving necessary and proper treatment for conditions that relate to the claim. related conditions. This phase begins to wind down as the work injury claimant reaches Maximum Medical Improvement (MMI) or Medical Fixity. Maximum medical improvement does not mean that the worker returns to the same level of physical health prior to the work injury or disease. In essence, it means that medical providers gave the injured worker all the treatment they can. In other words, the worker received all available diagnostic, curative or rehabilitative treatment. Beyond that, any further treatment will be palliative only.
Physical capacity evaluation and functional capacity evaluation
Once the work injury claimant reaches medical fixity, we need to assess their overall level of function. The evaluation is critical to determine their permanent abilities following the workplace injury. Occasionally, the attending provider can deliver a reasonably accurate assessment. However, in most cases, the provider needs additional tests and data. Here, as part of this step, we recommend performing a Physical Capacity Evaluation (PCE) or Functional Capacity Evaluation (FCE). This evaluation tool can help us understand the work injury claimant’s ability to return to work. It can also help guide doctor recommendations regarding further treatment that may be necessary.
A qualified and licensed physical or occupational therapist perform the physical or functional evaluation. The Department of Labor and Industries (L&I) requires the therapist to compile all evaluation in a report. Furthermore, the report must contain 6 important elements:
(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, L&I also requires therapists to complete an FCE summary form.
Best practices and recommendations
For reference, L&I has several resources on their website regarding PCE and FCE for evaluators and vocational counselors. However, these resources are also very useful for work injury claimants. For example, L&I has a list of definitions that can help you understand the activities to perform during an evaluation. Furthermore, L&I has an informational sheet regarding FCE evaluator standards.
The sheet also provides useful information that can help set expectations. Finally, once the PCE or FCE report is complete, the attending physician must also receive it. In turn, the attending physician will provide feedback concerning the findings and their accuracy. Therefore, it’s always good for the work injury claimant to meet with the attending provider and review the PCE or FCE report and its recommendations.
Additional resources: The Physical Capacities Evaluation form on the L&I website