Long Term Disability Insurance claimants are required under the terms of their policies to comply with all reasonable requests by their own insurance carrier. The Employee Retirement Income Securities Act, commonly referred to as ERISA applies to most disability insurance policies. The result is that ERISA gives the disabled claimant very little room to argue that the insurance company’s requests are “unreasonable” under the terms of the policy. Therefore, claimants are frequently required to undergo difficult Functional Capacity Exams (FCE) to continue their claim for benefits.
Functional Capacity Exam
A Functional Capacity Exam (“FCE”) is a series of physical tests given to determine a claimant’s RFC. These are standardized tests given by a physical therapist over about a 3-4 hour period in a gym like setting. The claimant will walk on a treadmill, lift and carry cardboard boxes and go through several series of different postures, like squatting and crawling. The physical therapist will observe and analyze the claimant’s physical abilities to sit, stand, walk and lift and carry. These tests are designed to surmise the claimant’s maximum RFC in the work environment. However, 3-4 hours of activity can’t really reflect how well a claimant would do 8 hours a day, day after day, week after week.
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Disability Insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy. Their ability to force a disabled person to endure an FCE is just one of them.
Other insurance companies with a large share of the disability market include The Hartford, Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
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If you have questions, ask disability attorney, Marc Whitehead by visiting disabilitydenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.
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