Functional Capacity Evaluation Technology Evolves to Fight Fraud

Functional capacity evaluations have long been used by employers and insurers to determine the severity of an individual's injuries, assign a disability rating, and develop restrictions to ensure an injured employee's speedy return to the workplace. However, one expert said new technology may take the process even further and help root out a persistent problem in workers' compensation -- fraud.

Traditionally, functional capacity evaluations consist of a review of an individual's medical records, a physical ability test, and other screenings performed by physicians, occupational therapy practitioners, and other medical specialists to gauge a person's ability to perform the essential elements of his job. This may include a series of exercises to grade the injured worker's ability to lift, push, carry, sit, walk and climb, as well as determining the person's coordination, balance, endurance and dexterity.

Dr. Bradley A. Marcus, head of the Medical Rehabilitation & Kinematics Lab in San Diego, said that while traditional functional capacity evaluations have been the cornerstone in determining disability, they are limited in the data that they provide, especially when it comes to spotting fraudulent claims. These tests, he said, are flawed because they are unable to consistently ascertain real injury from symptom magnification, and lack the objective and reproducible data that is crucial when using the information as evidence in court. In addition, patients may also be trained to fool the examiner and the tests, providing inaccurate data.

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Bradley, who is certified by the American Board of Medical Specialties in the field of physical medicine and rehabilitation, said to limit the billions of dollars spent annually on fraudulent claims, a more accurate and objective picture of the performance of the injured worker was needed. The kinematic functional capacity evaluation, he said, provides the solution to that long-standing problem.

Latest technology. A kinematic functional capacity evaluation, according to Bradley, is a non-invasive, computer-based evaluation designed to create an objective report of a person's current functional abilities. The state-of-the-art method utilizes motion capture cameras and kinetic force plate technology to accurately measure and analyze an individual's motion and strength capabilities, as well as the ability to return to work safely.

"By using this technology, it is almost impossible to fool someone," said Bradley, who operates the only facility on the West Coast equipped with the technology to perform the tests. "The reason for that is the high-speed cameras, which can allow us to digitize frame-by-frame to show sudden changes in acceleration or movement that can't be picked up by the human eye. We combine that with electromyography devices, which measure the electrical activity of the muscles, and the use of force places, which will indicate whether muscles are firing to create a force pushing into the ground."

Using the technology, patients are no longer able to trick examiners when asked to perform a routine lift or other task.

"We all know Newton's laws of motion that states that for every action, there is an equal and opposite reaction," Bradley said. "Well, using the kinematic functional capacity evaluation technology, if I ask a patient to lift something from the ground and they are groaning and showing signs of struggle but no force is going into the ground, it means they are faking it. You will know that something is going on if the technology is not registering that they are giving you that effort."

The test isn't only helpful in spotting fraud, Bradley said, it will also pinpoint injured employees who may have a higher threshold for pain and are pushing themselves more than what is suitable for their conditions.

"Sometimes you'll have an injured worker who isn't complaining about his condition and just wants to get back to work," he said. "However, our test will show that he has limitations in his ability to flex, lift, bend, etc. From the employer's standpoint, they want to do what is best for the patient. They want to be able to accurately know that if an employee says his knee is fine, that he is able to go back to the job safely, without risk of further injury. They realize that returning someone too soon to the job will eventually cost more in the long run."

A typical kinematic functional test lasts about an hour and a half, depending on the person's injuries. Bradley said the findings, which are generated in a report as soon as five days after the test, are beneficial for all parties involved.

"Overall, this test provides the most fair outcome," he said. "Everyone can say they are in pain, but pain is subjective, and there isn't a great way to measure it. We take that out of the equation and only look, objectively, how someone can perform."

Read more at the WorkersComp Forum homepage.

August 9, 2010

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