Why do insurers and benefit providers order functional evaluations?
Why do insurers and benefit providers order functional evaluations?
If you are a kinesiologist, physical therapist, occupational therapist, or clinic owner this is for you.
National return-to-work guidance recognizes that functional abilities evaluations may be requested not only by employers and workers’ compensation boards, but also by health insurance providers—positioning FAE/FCE as a common tool in insurance/benefits decision-making about return-to-work readiness and risk.
A concrete Long Term Disability (LTD) example is Alberta Blue Cross’s LTD claim guide, which states that once a Long Term Disability claim is received, a disability case manager is assigned to assess the claim, and that “in some cases” the claimant may be asked to undergo an independent medical exam or a functional evaluation, which Alberta Blue Cross covers financially.
In this LTD context, the decision purpose described is explicitly entitlement/assessment: the guide frames the review around medical information provided, how the condition impacts ability to do the job, and ability to carry out daily living activities, with IMEs/functional evaluations as potential additional information tools.
If you are planning to offer functional testing services, this is a core assessment type you need to understand and apply correctly.
We cover this in our upcoming in-person Functional Capacity Evaluation workshop in Calgary.
Details and registration:
https://lnkd.in/eM5YG4bB
Disclaimer:
This content is intended for informational and educational purposes only and is specific to Alberta, Canada. It does not constitute legal advice. Laws and their application may vary. You should consult a qualified legal professional or appropriate regulatory authority before implementing any fit-for-work or functional testing program.
