Does a Functional Capacity Exam Determine Your Disability Benefits?
Unfortunately a recent Appellate court answered this question yes. Every disability case is distinguishable so for every case that says an FCE is reliable evidence of disability, there is another case that will say it is not reliable. Additionally, it is rare that an FCE on its own is enough to support a disability denial. Functional Capacity Examinations (FCE) requested by disability insurance companies are frequently used by disability insurance companies in an effort to deny disability benefits. There is no consistent law which states that if an FCE determines a person can work, then the claimant must not be disabled. To learn more about FCE exams and what to expect you should watch our video discussing FCE exams.
Lets take a look at a recent disability denial that was reversed by the district court, but then overturned in favor of the insurance company by the Appellate court. This disability insurance case against Union Security Insurance Company (“Union”), also known as ASSURANT, sheds light on how a court can view a Functional Capacity Exams.
Disability Attorney Sues Union Security Insurance Co. (ASSURANT)
When he was thirty-five years old, Charles Green began working as a light industrial warehouse worker for Andersen Distribution, Inc (“Andersen”). As an eligible employee, Green participated in Andersen’s LTD-benefits disability plan insured by Union. In February of 2001, Green stopped working citing physical pain as preventing him from being able to work. Under his policy, during the first 24-months of disability, a claimant must be prevented from performing at least one of the material duties of his “regular occupation” to qualify for benefits. After the 24-month period, a claimant qualifies if his disability prevents him from performing at least one material duties of “any occupation.”
After applying for benefits, Green was awarded LTD benefits under the “regular occupation” of the policy for 24-months. However, after 24 months, Green was denied LTD benefits after Union determined Green did not meet the Policy’s “any occupation” definition of disability.
Green subsequently brought an action against Union in the United States District Court for the Western District of Missouri challenging Union’s decision. The District Court issued judgment in favor of Green and Union Security appealed the decision.
District Court improperly concluded FCE was of “limited value”
When reviewing Union’s decision, the District Court reviewed the record containing records of an FCE and video surveillance conducted by Union of Green’s activities. The district court had discounted the FCE which was conducted over a period of two days and which concluded that Green was capable of working in a full-time sedentary job, contrary to Green’s assertions.
The Court of Appeals disagreed with the lower court and concluded that the district court improperly discounted the FCE explaining that “it is true an FCE can only provide a ‘snapshot’ of a claimant’s functional capacities, but this does not render the FCE of ‘limited value.'” Rather, the court concluded that an FCE provides objective clinical evidence regarding how a claimant’s condition affects his ability to work.
Assurant Relies on FCE exam and Video Surveillance to Deny Disability Benefits
This case is unusual as it is not often that an Appellate court will reverse a lower court finding in favor of a disability claimant. Additionally, this case is not great for disability claimants as it can allow insurance companies to try to rely on unreliable FCE exams. If a claimant has an FCE set by an insurance company, then must be aware of the type of testing that will be administered and they must be prepared. The case against Assurant is distinguishable as the Assurant also conducted video surveillance of the claimant for two days. The combination of the video surveillance and the FCE was something that made the Appellate court overrule the decision of the lower court. Due to the unfavorable arbitrary and capricious standard of review in ERISA governed cases, the appellate court found that ASSURANT did not act unreasonably.
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Lincoln Financial
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It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
Lincoln Financial
Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
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MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
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I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
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Disability Benefit Tips
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Can a disability insurance company rely on a Functional Capacity Exam ("FCE") to deny long-term disability benefits?
Unfortunately a recent Appellate court answered this question yes. Every disability case is distinguishable so for every case that says an FCE is reliable evidence of disability, there is another case that will say it is not reliable. Additionally, it is rare that an FCE on its own is enough to support a disability denial. Functional Capacity Examinations (FCE) requested by disability insurance companies are f... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
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At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
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Showing 8 of 375 Dell Disability Cases
Assurant overturned its previous denial of long term disability benefits for Maine Sales Consultant
Our client, Ms. C, formerly worked as a Sales Consultant for an international manufacturer of dental materials. In July 2013 a number of medical issues, including the debilitating effects of chemotherapy treatment as well as recurrent breast cancer forced Ms. C to stop working and submit her claim for disability benefits first under her employer’s short-term disability (STD) policy and then continuing under ... Read More >
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
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Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
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Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
The claimant is a 58-year-old former MRI Technologist for Fairview Health Services who has long suffered from the debilitating effects of her chronic medical conditions. She has a history of neck pain as well as right arm pain and numbness dating back to 2005 with a reoccurrence of severe symptomatology in 2013. MRI of her cervical spine performed in August of ... Read More >
Engineer With Depression Wins Prudential LTD Appeal
The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >
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5 Ways We Help Get Your Benefits Paid
Get Your Disability Application Approved
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
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If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
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Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
How can I contact you?
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.