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FUNCTIONAL EMPLOYMENT TESTING
How To Hire and Maintain and Safe and Healthy Workforce
By Terry Lawson, PT, CAE
Physical Therapist and Ergonomist
Integrated Injury Management
In this current economic downturn,
businesses are highly motivated to
reduce costs, especially high-cost
items
such
as
workers’
compensation, recruitment, and
temporary help. Many employers
from public agencies and national
employers to the smaller-size
businesses
are
turning
to
functional employment testing and
finding significant benefits in
decreased costs and improved
safety.
Despite recent reforms in many
state
workers’
compensation
systems, businesses continue to
experience frustration because of
their inability to manage their workplace injuries.
Despite more
careful hiring practices, they still
are hiring workers with serious preexisting medical conditions or
those who cannot actually perform
the physical demands of their
essential job tasks.
They
recognize that this leads to high
costs, but they feel incapable to do
anything about it.
These employers are not alone.
The Bureau of Labor Statistics
indicates that the costs of workinjuries and conditions is the
second most costly health problem
in America, estimated to be over
200 billion dollars per year, right
behind cancer costs and just
ahead of heart disease costs. This
is a serious and widespread
problem.
In addition, The Work Comp
Advisor magazine recently stated
that one-third of carpal tunnel
cases occur within the first year of
employment, and 15% of carpal
tunnel complaints occur within the
first three months of employment.
For those who are not familiar with
“carpal tunnel syndrome,” it is a
slow-onset inflammatory condition
typically caused by repetitive
motion such as computer input or
repetitive assembly-type work.
This would indicate that a
significant percentage of these
complaints stem from those who
had this condition BEFORE they
came to work for this employer. In
other words, the employer hired
them with this condition!
To add to this frustration,
employers are legally limit in their
ability ask questions that might
reveal
these
pre-existing
conditions or inabilities to safely
perform the job.
What many
employers don’t know is that both
federal and state* regulations allow
for careful evaluation of these
potential problems. With properly
prepared policies and procedures,
employers can remedy these
situations and take a more
proactive role in limiting their workinjury problems.
accepted and legally defensible
tests
and
procedures
are
performed assessing:






Medical History
Cardiovascular
Musculoskeletal
General Fitness
Strength
Job-Specific Ability
Based on these tests a report is
prepared for the employer with a
recommendation of “Capable” or
“Not Capable.”
Not capable
recommendations include specific
explanation of the problem areas.
This allows the employer to then
legally, withdraw the offer of
employment
based
specific,
current, and objective limitations
as required by law.
On average, businesses that are
utilizing Functional Employment
Testing are realizing savings of
50% of their previous year’s costs,
hundreds of thousands, even
millions of dollars saved in their
first year; a truly amazing statistic,
but one borne-out over thousands
15% of carpal tunnel complaints occur within the
first three months of employment….In other
words; the employer hired them with this
condition!
FUNCTIONAL EMPLOYMENT
TESTING is a process where
health
care
providers
can
accurately
and
efficiently
determine a “contingently hired”
applicant’s safe ability to perform
their job. A series of medically
of employers and hundreds of
thousands of functional tests,
without losses from legal claims.
POST-EMPLOYMENT TESTING
is also very helpful in controlling
the costs or temporary disability,
medical
treatment,
and
motivational issues that often arise
in workers’ compensation cases.
A medical provider, properly
informed about the actual job-task
requirements as well as the
previous medical history of an
injured worker is likely to provide
much more effective care and
appropriate early return-to-work
recommendations. In addition, the
objective measurements of an
injured worker’s progress towards
attaining the level of physical
ability necessary to return to work
is far more effective than the more
typical situation where the doctor
will ask the injured-work whether
they think they are ready to returnto-work or suggest that maybe,
“they should try it and see how it
goes.”
These
vague
determinations on return-to-work
readiness are not only costly when
the injured worker is not highly
motivated to return, but they can
be dangerous to those who might
be overly motivated to return,
despite lacking ability, and finally,
unless the injured workers ability is
actually tested, no one really
knows for sure: Not the treating
doctor, the injured worker, the
employer, or the payer. That’s the
value
of
post-employment
Functional Employment Testing.
There is another utility of
Functional Employment Testing
growing in importance as we
began to experience the aging
phenomenon or the “graying of
America” as it is sometimes called.
Many employers are experiencing
increased problems with an aging
workforce where many, although
more experienced, are not able to
keep up physically.
Inevitably,
there is going to be an intersection
of their declining ability and the
physical demand of their job, which
will likely result in an injury, and
unfortunately, statistic show these
injuries are often more profound
and costly.
FIT FOR DUTY TESTING is an
effective
tool
when
used
appropriately in limiting the effects
of aging or other physical decline
in the workforce. When there is
objective evidence that a worker is
not able to keep up with production
requirements of the job, or that
there are signs or symptoms of a
problem that may be unsafe to
themselves or coworkers, a fit for
duty test may be utilized. Federal
regulations are clear on how the
process and the results of these
tests should be handled. Various
states have different specific
requirements, but generally there
is no restriction on an employer’s
attempt to maintain a safe and
productive workplace as long as
the test and the criteria are based
on “business necessity”, i.e. the
actually requirements of the job.
should be prepared to provide
accurate statistics of tests and that
data can be used to project (shortterm) and to determine actual
levels
or
injury
prevention,
improved injury management, and
the resulting savings (long-term).
The most important aspect of fit for
duty testing is what is done with
the results.
Federal and state
regulations protect workers from
discrimination and unfair treatment
by their employers.
Most
jurisdictions require that anyone
identified as “Not Capable” of
continuing to work in their present
job most be provided with
alternative work within their safe
ability if it is available.
An
“interactive process” is typically
required where the employer and
the affected employee work
together
(with
or
without
representation) to determine if and
where there is safe work within the
company.
If you do not have a current
Functional Employment testing
program, please complete the
following:
It is possible to legally and
effectively manage work-place
injuries and conditions utilizing
functional employment testing.
Businesses should consider such
a program when searching for
opportunities to cut costs and
provide and better workplace.
1. Annual Workers’ Compensation
Insurance Premium Costs: _____
2. Annual
Costs:
Actual
Work-Injury
2a. Direct:(Medical,TTD)________
2b. Indirect:(Replacement, Recruitment, Lost Productivity)_________
2c.TotalDirect/IndirectCosts:_____
(2a + 2b)
3. Annual Lost Time Accidents:___
SUMMARY
4. Annual Total Injuries:_________
Some businesses, when learning
about Functional Employment
Testing
fear
the
seemingly
complicated legal issues or the
potential costs of such a program.
What the statistics and experience
of hundreds of businesses show is
that a reasonable and “common
sense” approach is fully legal and
financially
sound.
Some
employers chose to “dive in headfirst” and implement a fully
comprehensive
program
as
discussed
above.
Others,
somewhat more cautiously prefer
to start small, targeting their most
costly areas or jobs.
In either case, the final step of the
program implementation should be
carefully
documentation
and
review of the results. Providers of
functional employment testing
5. Average Total Employees:____
6. Expected Hires Per Year:_____
7. Involved Job Classes:________
(number of jobs with high injury
rate)
The above data you provide will
assist us in projecting a costbenefit ratio of your first year of
Functional Employment Testing.
Functional Employment Testing Overview
Post-Offer Test:($75-175) Pre-employment tests given after a contingent-offer of employment. They include
comprehensive tests of safety, strength, and ability to perform the most difficult physical demands of the job
essential functions. Comprehensive musculo-skeletal baseline data is gathered to document any pre-existing
limitations for post-injury uses such as apportionment. A recommendation of "Capable", "Not Capable", or
“Not Capable for Medical Risk” is given. If "Not Capable" the contingent offer of employment is withdrawn.
Lateral Transfer Test:($175) Existing employees who are being considered for transfer to another job for the
same employer can be tested for their safe ability to perform the most difficult physical demands of the new
job.
Return-to-Work Test:($175) Existing employees who have been continuously absent from work for
occupational or non-occupational injury, condition, or health issue can be tested to ensure their safe ability to
perform the physical demands of their job.
Fit-for-Duty Test:($175) Existing employees who have observed limitations in completing their job tasks or
who display objective signs that they are unsafe to continue performing their job can legally be singled-out
and tested to determine they or their fellow workers are at risk.
Post-Injury Test:($175) Existing employees who are injured can be tested after their injury to determine the
extent of their injury. It is also important to determine their “sincerity of effort” to help identify fraud and to
ensure their full rehabilitation cooperation. When possible, this data can be compared to their post-offer test
to determining the employer's apportioned responsibility. The data can also be useful to determine actual
functional ability to perform work tasks, significantly improving a "transitional duty" program.
Functional Capacity Evaluation (FCE):($850-1500) Comprehensive functional tests that include interactive
patient tests and measurements of current functional status in comparison to job requirements. Includes
scientific methods of determining "sincerity of effort" to identify fraud or lack of cooperation. FCE is also very
useful to determine final “residual capability” upon reaching maximum medical improvement. This
objectively measured data is very useful in the “interactive process” required by ADA, CA FEHA and related
regulations.
Other Related Services
Functional Capacity Evaluation (FCE) “Forensic Evaluation”:($250/hr) Comprehensive forensic evaluation of
FCE files by certified and licensed FCE experts regarding the scientific integrity of a FCE method and report
and related file. Each FCE will be subjected to an intense evaluation based on scientific, peer-reviewed,
published research. A report regarding the findings will be prepared. Witness preparation and/or expert
testimony services can be provided.
Job Analysis/Ergonomics:($150/hr or $250/job) Functional employment testing requires objectively
measured job demands. During this evaluation, ergonomic issues can also be reviewed and adjusted when
necessary. Our physical therapist is trained and experienced in job analysis and is certified in ergonomics to
provide accurate and legally defensible functional testing and return to work criteria.
Work Conditioning:($75) Functional exercise in the clinical setting focused on the physical demands of the
essential functions of a specific job. This process is essential to prepare the injured worker to return to duty
as early as possible in transitional work and to progress to full duty.
Rehabilitation Case Management/Utilization Review:($150/hr) Physical therapists are uniquely qualified to
participate in the management of work injuries or conditions involving the musculoskeletal system. Adjusters
and nurse case managers are typically not sufficiently familiar with modalities, procedures, exercise
programs, and objective functional evaluations that constitute an effective and efficient work-injury
rehabilitation program. Physical therapy is also unique in that it is the most highly abused part of the workers’
compensation system. Payers are not responsible to pay for illegal physical therapy services. Our state
certified physical therapist expert can determine if physical therapy is being conducted legally.
How is Our Functional Capacity Evaluation (FCE) Different?
A FCE is a set of comprehensive medical and functional tests administered to individuals to
document current functional capabilities in comparison to their job requirements. It should
answer the questions: 1) What is the worker’s TRUE and OBJECTIVE ability? 2) How does
their ability compare to the functional demands of their job?
The IIM FCE is unique because first and foremost, it accurately determines if individuals are
giving their sincere effort. A comprehensive literature review of 27 studies over the last 20
years found that on average the best other FCE protocols could claim was a 70% accuracy
rate. That means they unfairly misclassify 30% of those tested. One study even showed
only 5-7% accuracy in determining maximal effort. Without the ability to accurately determine
sincerity of effort, a FCE is only minimally useful as there is no way to know if the FCE is a
true measure of the individual’s effort.
The IIM FCE uses the only Sincerity of Effort protocol based on uncontested rules of
physics and published peer-reviewed studies. These studies show 99.5%-accuracy in
determining sincerity of effort. Five more brand-new studies confirm the validity of the IIM
FCE process and debunk the methods of the other FCE protocols. For more information,
please ask us about our research.
Our FCE includes medically accepted and legally-defensible tests and takes about 2-4 hours
depending on case complexity. A summary and comprehensive report is provided with
specific information of the individual’s current functional ability. This report includes:
“Sincerity of effort” scores. Is the claimant telling the truth about their ability?
Medical history and current complaints
Accurate measurements using AMA-recommended tools for joint range of motion
and integrity, NIOSH recommended tests of strength and material handling, and EEOC
endorsed methods of determining job-specific capabilities
Daily and job-related functional ability based on direct observation and
measurement
“Summary of Results” and “Comprehensive FCE Report”
Our FCE can be useful:
Immediate post-injury when there are suspicions of untruthfulness. Our “Sincerity of
Effort” testing will accurately assess these problems
For developing return to work programs that are based on a worker’s actual
measured ability and as they are progressing toward full return to work.
With signs of poor progress or noncompliance in medical treatment or rehabilitation
At case closure when maximum medical improvement is apparent. Useful for
objectively measured ratings and return to alternative work (interactive process) is being
considered. Useful in providing objective data useful in refuting high impairment ratings
and other Almarez, Guzman, or Ogilvie-type legal issues.
Our goal is to schedule appointments promptly with reports within one week post-evaluation.
We have over 80 locations throughout the West from which to serve you.
Please call Terry Lawson, PT, CAE, for more details. We look forward to the opportunity to
assist you soon.
FCE@integratedcentral.com
800-515-4552
www.integratedcentral.com
“In the case of one school district, before utilizing WorkSTEPS, the experience mod of the district was
162%. At the present time their experience mod is 104%....three years ago we had a 32% reduction in our
frequency of claims. The year before last we had a 25% reduction and we’re estimating this year which
ended June 30, 2002 an 11% reduction. There figures indicate an excess of 50% reduction in frequency.
We recognize and appreciate the benefits which your support and services have provided our JPA.” Wesley
B. Tarr, Administrator, California Risk Management Authority, Oakhurst, CA
“For over two year, I have utilized Terry’s organization to perform job analysis and functional preemployment and post-injury fit for duty testing, using the WorkSTEPS testing protocol. As a result of my
Plant’s positive experience with WorkSTEPS, the entire Motor Home and Travel Trailer Divisions have
adopted the WorkSTEPS program.” Brian Sheehe, General Manager, Fleetwood Motor Homes of CA,
Inc.
“Injury frequency was reduced from 32.4 in 1999 to 6.9 year to date in 2006 (Calendar). Loss prevention
and claims processes initiated in 1999, to lower exposure, have lead to reductions in Letters of Credit of
$10.1 Million. The cost of risk for our Texas injuries has been reduced from $2.2 million annually to
$631,000 annually.” William McMahon, ARM, RPA, National Risk Manager, Fleetwood Enterprises,
Inc. at the 2007 National Risk and Insurance Management Society (RIMS) Conference, New Orleans
“I’ve just completed the 2002-2003 Year End Report for our superintendent. The number of reportable
workers’ compensation claims was reduced from 112 for the previous year to 64 for our policy year-end
June 30, 2003. This is nearly a 50% reduction of reportable injuries in one year. Even better was the
reduction in the cost of claims. It went from $874,659 to $220,727, a 75% reduction!” Annette Lindley,
CSP, ALCM, Loss Control Specialist, Madera Unified School District
“It has been an amazing turnaround in our work injury experience. In our Las Vegas Nevada Office we
have seen a reduction in Workers’ Compensation Losses from over $140,000 per year to less the $4,000 for
the 1st year of WorkSTEPS. I would strongly recommend the WorkSTEPS program and your service to
any employer seeking to reduce their work injuries and the high associated costs.” Rick Caprario,
National Director Safety/Risk Management, Bergelectric, Corp.
“…we experienced a 71 percent reduction in the severity of our claims. In addition, we experienced at 40
percent reduction in the frequency of our claim. The above mentioned statistics translate into a tremendous
savings of several hundred thousand dollars.” Glenn MacIlroy, Safety Manager, Knight Transportation
“Pool California started using WorkSTEPS two years ago to help reduce Workers’ Compensation costs and
eliminate poor candidates from becoming part of our workforce. We were becoming frustrated because of
the many fraudulent claims we were having and no means to combat the claims. I’m happy to report that
last year we have reduced our claims costs by 33%. Gary Kaufman, Personnel/Safety Representative,
Pool California Energy Services, Inc.
“I have known Terry for approximately two year now, mainly as a physical therapist performing functional
capacity evaluation as pertaining to industrial injuries. He has completed over 50 functional capacity
evaluations at my request, and in each case I have been impressed by the thoroughness of his evaluation,
the promptness of formulating his typewritten reports, and his precise conclusions regarding the abilities of
an industrial worker in performing work activities. I can truly state that his functional capacity evaluations
have been an asset in formulating my Permanent and Stationary evaluations, and have been beneficial not
only for me as an orthopaedic surgeon, but also to the employees in performing their work duties safely,
and also the industrial carrier and the employer in reducing the liabilities in problematic cases.” Ghassan
S. Tooma, MD, Orthopaedic Surgeon, Corona, CA
Terry Lawson, PT, CAE
Terry Lawson is a physical therapist licensed in California and Hawaii. He is also a
certified ergonomist.
Terry has nearly 30 years of experience in a wide variety of practice settings. For the past 20
years he has been working with a special emphasis in work injury prevention and case
management.
Terry has pioneered functional employment testing in the west coast and Hawaii having performed
thousands of functional employment tests and functional capacity evaluations (FCE).
Mr. Lawson assists employers with implementation of functional employment testing programming
performing risk assessments, job categorization and analysis, ergonomic analysis, and functional
test design. His clients include public school districts, city and county governments, third-party
administrators, joint powers authorities, workers’ compensation and disability insurers, airlines,
utilities, transportation, waste management, manufacturing, and healthcare companies.
Mr. Lawson was recognized for his contributions to California and Texas workers’ compensation
reform through his executive summary “Function” which was entered into both states congressional
record.
He provides injury prevention and management seminars for organizations such as Professionals
in Workers’ Compensation, American Society of Safety Engineers, Public Agencies Risk Managers
Association, and the International Disability Management Employer Coalition.
His professional passion is using objective, research-based methods to PREVENT and minimize
workplace injuries, disability, fraud, abuse and the associated costs.