When filing or appealing a long-term disability (LTD) claim governed by ERISA, claimants often encounter a variety of evaluative tools used by insurance companies. These tools are used by the insurance companies like Lincoln, New York Life, Unum, and others, to try and establish that the claimant is not disabled or that the prescribing physician’s restrictions and limitations are not valid or that the claimant has the skills and ability to perform other jobs with their residual functional restrictions and limitations.
Three of the most commonly referenced are the Transferable Skills Analysis (TSA), the Functional Capacity Evaluation (FCE), and the vocational assessment. While these terms are sometimes used interchangeably, each serves a distinct function in the LTD claims process—and understanding the differences is crucial to protecting your rights.
What Is a Functional Capacity Evaluation (FCE)?
An FCE is a clinical assessment of your physical and functional abilities. Typically conducted by a physical or occupational therapist, an FCE measures a claimant’s capacity to perform specific work-related tasks, such as lifting, standing, sitting, pushing, and pulling.
In the context of an ERISA-governed LTD claim, insurance companies often rely on FCEs to determine whether a claimant is physically capable of performing the essential duties of their own occupation or any occupation, depending on the policy’s definition of disability.
Key Points:
- Objective data about physical limitations
- Often used to dispute or support medical evidence
- Can be challenged if methodology is flawed or inconsistent with treating physician opinions
What Is a Transferable Skills Analysis (TSA)?
A Transferable Skills Analysis is a vocational tool used to determine what other types of work you may be capable of performing, based on your prior work history, education, and functional limitations.
TSAs are usually conducted by vocational consultants retained by the insurance company. They often rely on databases such as the Dictionary of Occupational Titles (DOT) and may use results from FCEs to suggest that you are capable of “sedentary” or “light duty” work, even if such positions are rare or unrealistic in the current labor market.
Key Points:
- Focuses on what jobs you could theoretically perform, not whether you can realistically get or sustain them
- Often biased in favor of denial, particularly if based on incomplete or outdated medical data OR vocational information like the Dictionary of Occupational Titles
- Should be scrutinized for accuracy and assumptions and compared to the language of the policy to make sure the conclusions reached are in fact usable.
What Is a Vocational Assessment?
A vocational assessment is a comprehensive analysis of your ability to work, taking into account your:
- Medical condition and limitations
- Functional capacity (from FCE or medical records)
- Work history, education, and skills
- Labor market conditions
True vocational assessment is holistic and often more favorable to the claimant when conducted by a neutral or claimant-retained expert. This analysis is not just a snap shot of a moment in time of what claimant’s physical and professional abilities are, as is the case with an FCE and a TSA, but rather focuses on the claimant’s ability to perform the material aspects of a job 8 hours a day, five days a week, week after week.
Key Points:
- Combines medical, functional, and vocational data
- Looks at the long-term implications of doing and repeating job functions
- considers the actual employability in the open labor market, including:
- availability of appropriate jobs
- hire ability of a candidate
- risks of reinjury
- much more
- Can rebut biased insurer reports
- Valuable evidence in LTD appeals and litigation
Why These Evaluations Matter in ERISA LTD Claims
Under ERISA, insurance companies are not only allowed but required to evaluate your ability to work. However, how they do this and whose evaluation they rely on can significantly impact the outcome of your claim.
Insurers may:
- Use an FCE to argue you are physically capable of “light duty” work
- Use a TSA to claim you can do other work even if it’s not realistic
- Ignore or minimize findings from your treating physicians or independent vocational assessments
That’s why it’s essential to review these evaluations critically, ensure they are based on accurate data, and be prepared to provide your own expert reports if needed.
How an ERISA Disability Lawyer Can Help
If your long-term disability benefits have been denied or terminated based on an FCE, TSA, or vocational assessment, legal guidance is crucial. At DoDisabilityLaw.com, we specialize in ERISA long-term disability claims and understand how to challenge unfair or flawed evaluations used to deny benefits.
We work with medical and vocational experts to ensure your limitations are fully understood and your claim is fairly reviewed.
If you’ve been denied LTD benefits due to a Transferable Skills Analysis or Functional Capacity Evaluation, contact us today. We offer free consultations and are ready to help you fight for the benefits you deserve.