When you apply for long-term disability benefits, your insurance company may very well require you to participate in a Functional Capacity Examination (“FCE”), which includes a Transferable Skills Analysis (TSA). The TSA is an evaluation that is usually performed by a doctor, nurse or physical therapist. While the overall purpose of the FCE is to determine whether your disability prevents you from performing the essential duties of your current occupation, the entire point of the TSA exam is determine whether you are able to perform in other, less physically demanding occupations. Naturally, these less demanding occupations would pay just enough money to make you ineligible for long term disability payments.
Please note that the person doing the TSA is being paid by the Insurance Company to do this evaluation and therefore he or she might well be somewhat slanted in favor of the Company when coming to the decision as to whether you are able to transfer your skills to another job. Obviously, you have to understand the importance of the TSA when you walk in the door of the office performing it. Note that everything you do, say or write down is part of the analysis and will be used as proof that you are able to work at other occupations. So, make certain that the person doing the test has all of the correct information about your disability, so that there is no room to say that you can do work that in fact you are not capable of performing. You will no doubt be given a Questionnaire to fill out. Be careful as to what you write down as it can and will be used against you. Do not assume that the questions are simply obtaining some background information. Every question is there for a purpose and that purpose is to help prove that you are capable of some other type of employment that will make you ineligible for Disability Payments.
The person doing the FCE and TSA will perform some type of physical examination to measure your levels of strength, flexibility and pain — or lack thereof. So, if you are in pain when moving in certain ways, do not try to get through it to prove how tough your are. If moving your arms, legs, back, etc gives you pain, this is the time to say that you are in pain — even though you don’t usually like to complain about it.
You also may be asked to lift different amounts of weight over your head or just to carry weight while walking. If you can do this easily, then say so. But if this is difficult for you to do so, be sure to make the examiner aware of that.
You probably will be asked how far you can walk without discomfort and whether you can easily sit down and stand back up. If you have radiating back and leg pain, these simple movements may in fact be difficult and/or very painful for you. If so, again, tell the examiner about your limitations immediately so that there is an accurate description of your situation.
Clearly, you have to understand the purpose of the TSA in order to protect yourself from having an incorrect picture of your disability transmitted to the insurance company. If you are entitled to long-term disability benefits, make certain that you do not inadvertently undermine your own case.
Finally, the insurance company will know the exact date and time of your exam. When it comes time for your exam, you should expect that you will be followed and filmed when you leave your house, arrive and depart the exam location, and return to your home. You can also expect to be followed and filmed for two days following the exam. So while you might usually be successful in putting up a good appearance for short periods of time, your efforts may give the appearance that you are not disabled.
This informational blog post was brought to you by Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.
