Unum abused its discretion by disregarding results of a functional capacity evaluation (FCE) of a disabled registered nurse

Can a Functional Capacity Evaluation be Useful to determine if a Claimant with Fibromyalgia is disabled?

It is very common for an insurance company to deny disability benefits to individuals suffering from Fibromyalgia. This happens more often than not due to the inability to provide the insurance company with objective proof of the disability, as none exists. There are no known objective tests for fibromyalgia at this point in time.

The diagnosis is made solely by the subjective complaints of the patient and by ruling out all other possibilities. Claimants become frustrated with their disability insurance carriers when they ask to provide objective proof of their condition, but none can be provided. However, a functional capacity evaluation (FCE) can be performed on claimants with fibromyalgia to help provide objective proof that they are suffering from pain and fatigue and unable to perform their occupation or any gainful occupation. If an FCE shows that the claimant is disabled and unable to work, the insurance company must take this into consideration.

In the case of Warner v. Unum Life Ins. Co., a Court in the Northern District of Illinois ruled that Unum acted arbitrarily and capriciously by completely disregarding the results of an FCE that limited the Plaintiff, an R.N. to sedentary work capacity. Unum ignored the FCE results and relied on its physician’s opinion that merely performed a paper review of her records and stated that she was not disabled. Unum claimed that the reason it would not consider the FCE report was that “the FCE recorded functional limitations caused by impairments that could not be seen or measured with objective medical tests… even though the resulting limitations were documented.” The Court disagreed with Unum’s decision, noting that in the Seventh Circuit, precedent “forbids the denial of benefits based on this sole ground if indeed there are no applicable objective tests to perform.”

Since Unum failed to consider the FCE, the Court in Warner entered judgment for the Plaintiff, awarding past due benefits to her and remanding her claim back to Unum to determine if she was able to work in any gainful occupation (as this had never been considered).

If you are suffering from Fibromyalgia and have been denied disability benefits by your insurance carrier, or think you may be, it may be beneficial to undergo an FCE with the proper specialist. The results of the FCE may help demonstrate that you are unable to perform the duties of your occupation or any gainful occupation. To determine whether this may be appropriate for your claim, please contact the law firm of Dell & Schaefer and ask to consult with one of our disability attorneys.

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