Functional Capacity Evaluation?

S31

Hi everyone
I wonder if anyone has any experience of a Functional Capacity Evaluation? I have been asked to attend one of these evaluations over a period of 2 consecutive days by my employers Permanent Health Insurers. My employer offers a core benefit of Permanent Health Insurance as part of our standard contracts.
I have been out of work for just over a year following a serious accident (including but not limited to multiple spinal fractures) and have been diagnosed with Complex Regional Pain Syndrome. I have attended with a number of specialists and consultants up to now. My employers HR department made a claim against their PHI insurers after a period of 6 months had passed. Reports were submitted from my specialist however their Occupational Therapist felt I was fit to work. All of this took a number of months for them to organise. I appealed their decision and supplied further addendum reports from my specialist and GP. I have now been asked to attend one of these 2 day evaluations as part of their review of my appeal. Im beginning to feel that regardless of what I supply, which has been everything requested of me, the insurers intend to continue to place further obstacles in the way as some sort of attempt to avoid paying out my wages (which is 2/3 under their policy). Can I add that this process has been ongoing since January and has really begun to take its toll on me, mentally, as I have really been struggling to pay my bills and mortgage. I havent found that the HR department has been much help to me and it is quite difficult to get them to respond to any queries or give me updates during the process. Some of the appointments I have attended for these insurers have been almost 4 hour round trips from my home and I am unable to drive long distances or sit for too long, of which they are aware. Yet they continue to arrange appointments for me with companies that are miles away. I suppose I have outlined a few issues here but if anyone has had similar experiences or has attended a Functional Capacity Evaluation I would be glad to hear how things went.

I hope I have posted in the correct section of boards - if not please feel free to move

Thank you.

Misguided1

Hi

I haven't been through anything similar but can tell you that the process of being accepted/rejected onto a PHI scheme is very difficult. Like any insurance policy, the insurers will do anything possible to avoid paying out. I have seen people with back injuries rejected form PHI applications because of an opinion they they will recover and will be able to return to work.

HR have little influence or information on the process as this is entirely driven by the insurance company. They are not privy to any of the medical information or the basis on which the assessments are made. They have no say in where your appointments are or with whom. They are merely the conduit between you and the PHI company.

I suspect the assessment will try to establish under what conditions you are fit to return to work. So whether the company can make any accommodation (orthopedic chair for example) to allow you to return.

Are you hoping to return to work or stay on leave on medical grounds?

Glass fused light

Will you be able to return to work at all or are you looking at a long term payout and then going back? This will make a difference.
How long should the company pay to cover your sick leave without the PHI.
At this stage I would be looking at requesting a meeting with your HR people and have an honest discussion on your future with the company and if and how the insurance policy will provide value for the company. If nothing else it will remind the staff member that you are more than a voice on the phone and that some day they may need to avail of the policy. Also find out if they have had previous claims and how quickly they progressed. Is It just covering sick periods or did the contract cover permanent incapacity? It's their contract and if one of the employment benefits was that you get PHI payout it's up to them to enforce the contract. You need to establish if it's you or the company which should be submitting a formal complaint with the view of making a complaint to the Ombudsman and taking legal action. An OT can 'feel' that you can return to work but are the insurance co willing to go up in court with an OT against a specialist doctor?
If you are not getting paid at all and are suffering additional cost to attend then this should be discussed with HR and see if either the company or the PHI pay for this.