Functional Capacity Evaluation

Ormond Neuroscience undertake functional capacity evaluation (FCE) of clients who have lodged disability claims with their insurance companies.  A functional capacity evaluation is a detailed examination of the effect of illness or disease on someone’s functioning, particularly occupational functioning.

Obviously, a functional capacity evaluation is undertaken from the perspective of a particular discipline.  Given that the focus is on the person’s capacity to work, it follows that functional capacity evaluations are most commonly undertaken by occupational therapists.  Occupational therapy functional capacity evaluations provide a broad and general overview of the person’s functioning.

When the insurance company is dealing with a client with a brain-related problem, then the specialist opinion of a neuropsychologist is required and in such circumstances Ormond Neuroscience may be called upon.  We undertake detailed neuropsychological assessment into the effect of neurological or psychiatric illness on the client’s functioning.  Although the focus of a functional capacity evaluation is on the client’s capacity to do their job, we also consider basic activities of daily living, participation in community activities, and any other aspect of life that is relevant to the client’s functioning, in order to understand the big picture.

If you are a client who has been requested to undergo a neuropsychological examination and you would like to know more about what to expect on the day and what and who to bring along, then please click here.

 

Medical Boarding

The process of being granted medical disability is sometimes called medical boarding.  It begins when the client falls ill and is no longer able to work.  Providing they have the relevant insurance cover and are genuinely ill, then the client is usually granted temporary disability.  When two years have gone by and the client has still been unable to return to work, then the insurance company will consider permanent disability.  It is usually at that point that clients are referred to Ormond Neuroscience for functional capacity evaluation.

The insurance company will often get reports from a few different disciplines.  The occupational therapists’ reports provide the broad framework.  Specialists then provide reports that deal with specific problems related to the illness affecting the client.

 

Disability vs Functional Incapacity

Healthcare professionals make decisions regarding the degree of a client’s functional incapacity.  Insurance companies make decisions regarding the degree of a client’s disability.  Functional incapacity is a medical concept; disability is a legal concept.  The medical board at the insurance company make a legal decision regarding disability that considers both the information contained in the functional capacity evaluations and the fine print of the insurance policy that covers the client.  If the client is unhappy with the decision made by the insurance company, they are entitled to lodge a dispute with the insurance ombudsman.

 

Access to Information

Clients are legally entitled to see the report produced by Ormond Neuroscience, since it may impact on their capacity to exercise their legal rights.  Of course, insurance companies are legally entitled to make decisions without interference from the client.

Since the insurance company pays Ormond Neuroscience to produce the report, they are the owners of the report.  Requests to access the report produced by us should therefore be addressed to the insurance company.  Ormond Neuroscience grants permission to the insurance company to make the report available to the client.

 

Objectivity

Ormond Neuroscience are independent of the insurance company.  The reports that we provide are impartial and objective.  We favour neither insurance company nor client.  It makes no difference to the content of the report whether our fees are paid by the insurance company or by the client.