Insurance co. orders "functional capacity test"

Discussion in 'Fibromyalgia Main Forum' started by ljf, Apr 11, 2007.

  1. ljf

    ljf New Member

    Hi. My disability insurance company (which has been covering me for 2 years) requested an "independent medical evaluation" which I went to last Monday, and now they want me to go for a "functional capacity test," a four hour test to measure aerobic capacity (on a treadmill), how fast and how much you can lift, and other things. Obviously, for CFS patients, this is a waste of time, and a difficult task. I want to call up my insurance company and tell them this, but I'm not sure what to say or how to handle this, or if I should get my doctor to call. Any advice?
  2. mezombie

    mezombie Member

    You're right, this test is a waste of time, difficult, and will probably make you sicker.

    My advice would be to check with your doctor and see if he won't write them a letter pointing out that this testing is medically contraindicated because it will actually only further debiliate you. This may stop your LTD company from proceeding, because if you do the test and get sicker, there will be a written statement from your doctor saying he advised against doing this.

    If this doesn't work, start checking around for other places that do the same testing but are aware of the limitations of people with CFS/FM. There are some here and there that will not only carefully document your responses to the test, but will also have you come back in a day or two. It's then that the effects of the "post-exertional fatigue" will show up.

    And if you can't find such a facility and are forced to go to the one chosen by your LTD company, see if you can bring someone with you and videotape the entire process. It's hard to argue with a videotape!

    I'm so sorry you have to go through this. Hang in there!
  3. roge

    roge Member

    ya , pretty much a usless test for FM and CFS.

    mezombie couldnt have said it any better and I have nothing to add, she said it all. excellent advice!

    worth repeating though , if you do have to do this, make a good effort as one of the main reasons insurers make claimants do these and other tests (neuropysch) is because there are parts of these tests which can determine if one is faking and that is what they want, cause if they have proof of this, then they can say you are a malinger and gives them good reason to cut you off or not approve you.

    good luck

  4. TXFMmom

    TXFMmom New Member

    Take the test.

    They have to pay for it, and yes, you will probably be tired by it for several days, but it is administered, or at least mine was, by a physical therapist, and the insurance companies give it great value, as the therapists know what to look for, to be if you are a malingerer.

    Believe me, you will have legitimate physical responses which will back up what you say, and they are not considered "subjective."

    I had one, and it put me over the top, where my private insurer and SSD approved and shut up.

    One thing, if possible, demand that you be permitted to ask your own physicians for recommendations as to where to have it and which practitioner to use. Don't just go to the one the insurance demands, as they may be on the insurance company's payroll.

    My Neurologist suggested the one I used.
  5. obrnlc

    obrnlc New Member

    hi ljf, there is a doctor who is very published and respected (harvard) and i can't get his name thru the fog, but has done alot of research and studies on why the standard FCT is NOT APPLICABLE for fm/csf patients.
    when i remember, i'll post again.

    however, they want an excuse to get rid of you, so be prepared for battle--videotape and have a witness, if you can't take the above advice to get your own doc to give you an excuse.

    i got invoices after the fact (didn't video, felt it would be rude--what an idiot!) and found that docs were paid over $800 for an eval that they would chg. $200 for the standard uninsured pt, so bought and pd for by insur. co.

    other studies have shown that an eval. THE DAY AFTER is appropriate, but they want to fail you, and will lie thru their teeth.

    i am going to research this doc--will post again--these dis. co. make me so angry!!
    take care--L
  6. obrnlc

    obrnlc New Member

    hi again,
    it is Dr. richard Podell, google his name and click on the link for fibro. disability, it may give you a legal "leg to hobble on" as he is an expert in this field.
    trust NO ONE from these companies and do not speak to anyone on the phone, get everything in writing.
    if you are able to be excused from this, be sure to get it certified and in writing, or they will deny you and say you just didn't show up.
    good luck--L
  7. Lichu3

    Lichu3 New Member

    This is advice from CFIDS Association of America disability packet.

    I agree with other posters: the exam probably isn't done out of good faith to really find out your abilities or to sift out malingerers. I think LTD companies would use anything to try to deny you your benefits.

    Unless you are severely disabled (probably to the degree where one is bedridden constantly or can only stand/walk a couple minutes), studies show that FCE exams done on only one day show little difference between normal and people with CFS. It's the days after that matter - the post-exertional malaise.

    Besides the great advice given above by roge, mezombie, and obrnlc, consider calling your LTD lawyer if you had one previously to ask their advice - they might be able to block, delay, or modify the exam. Also consider making an appointment with your MD after the exam if possible to document the aftermath of the exam.
    [This Message was Edited on 04/11/2007]
  8. Fmandy

    Fmandy New Member

    Is this test a requirement that you had to agree to in order to get the insurance coverage? Sorry if I missed the answer somewhere along the way.

    If you did not agree to this test as a requirement, I would not do the test. You could endanger your health. What if you had a bad heart? Would they still demand the test? Is this discrimination among the disabled. Many questions are raised in my gourd by just the thoughts of having to take this test.

    I see this as an invasion of privacy and a blatant disregard of your physician's ability to determine your medical status.

    I have never heard of this. Provident LTD is being sued in courts all over America now because of their unethical thievery. Google Provident Unum if you want more info.

    The best LTD insurance is the kind you get on your on and not through an employer. It does cost more though. The policy should be gone over with an attorney or an expert before you take it out though.

    The insurance companies can bury really important information in the "small print". Here is an example, if you go stark raving mad, many LTD policies will only pay for a maximum of 2 years. Bummer!

    Good luck,

  9. butterfly8

    butterfly8 New Member

    My disability insurance co. required me to do a fct. They said that if I did not do it, they might not have sufficient info. to assess my condition, which could hold up future payments - obviously a threat. This was after they had already been paying me for over 4 years for total disability.

    I was compliant and did as much of the test as possible, dressed appropriately etc. Fortunately, I had a very compassionate assessor who let me rest several times during the test, which lasted well over 2 hours.

    The fact that I collapsed at one stage and had an asthma attack at another time obviously worked in my favour. I also think that the assessor was concerned re. liability if something worsened my condition during the test.

    Obviously, I was in bed for the next week. If you can, take someone with you- if for no other reason than to help you get home.

    Also, previous replies have mentioned info. re the unsuitability of such tests for cfs patients. If you can get a copy of this info. give it to the assessor when you meet him. Also, give him a full outline of your history and test results - this may not have been provided to him by the insurance co. which is often selective re. what information it provides in such circumstances.

    I also contacted in writing the assesssor company AND the insurance co. before my visit requiring such things as:
    a. what experience does this assessor co. have re. cfs. patients
    b.are they regularly used by the insurance co. for such assessments of cfs patients
    c.what publications have they put out re. the value of such fct

    I had been advised that, since I was being assessed by an organization about which I knew nothing, that I was entitled to such info. Surprisingly, both the insurance and assessor co. replied!!! and answered each question that I had listed. I think it put them on notice that I knew my rights.

    Anyhow, I failed the test - even though I did try - there is no point 'pretending": I did what I could . Since then, the insurance co. has been paying me (touch wood) I also obtained a copy of the assessor's report.

    Good luck.
  10. mezombie

    mezombie Member

    Here is the URL for a speech Dr. Podell gave on CFS/FMS and disability. Check out #5, which specifically refers to FCEs.

    If you want a printable copy, go to
    [This Message was Edited on 04/11/2007]
  11. TXFMmom

    TXFMmom New Member

    I did the two day test. I did not do well, obviously on the first day, but the second day, I was exhausted, sweating, pale, and my knees buckled and nearly passed out.

    The two day test can be better, for it shows that if they try the well, you did okay, it shows that in no way can any of us, once we reach a certain point do something and force our way through a one day exertion and not be totally, completely unable to function on a second day.

    Do we know anyone who will hire someone who might be able to manage part of or a day, and then have to take a day off?

    It is always safest to speak with legal advice and see that every possible protection is taken for your sake.
  12. blkkat

    blkkat New Member

    Ive done this . if you refuse, it makes it look like you are not doing your part. go in on half of your pain meds . i feel they need to see you at least in some pain that you have to deal w/ everyday!!! your not faking anything. you have pain. they can't feel what your feeling only how your acting and looking.

    be nice, but i would at least try w/ out saying ,oh i can't do that because ,in their eyes were faking it. go on the treadmill . but like what i did because, it really did hurt me , i said while doing the task in my head , because by know we can tell by what we do one day will hurt us at the next day. they don't see it that way though. when she tried to speed uo the tread mill to go faster i tried but in my head i knew i would pay for it later and for days.

    so while crying i put my feet on the sides of the treadmill. i said i HAD to lay down so i could cope w/ the pain. i only lifted nothing over 10 lbs. and made it known i was hurting a lot . really i feel they keep you there that long just to see if you can move a round or work w/ just a little bit of pain. which they feel is ok.

    plus have you gone to a shrink yet? if yes DON'T be shy tell them everthing, because they try anything to not paying you . from depression if you have it that effects your love life, or relationship of ALL kinds!!! if you suffer like i do ,then you need to let them really get what kind of pain your in. hope i didn't just ramble . good luck let us know please how it went ok. GOD BLESS -- BLKKAT

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