Is Settlement in Work Comp Determined by FCE in NC?

In Personal Injury by Greensboro Attorney

Is Settlement in Work Comp Determined by FCE in NC?

Workers’ compensation claims rarely move in a straight line. When an injured employee is working through pain, medical appointments, and time off the job, there can be questions about how the eventual settlement gets calculated. Many people ask about the factors that decide the value of their case. In North Carolina, one term comes up again and again: the FCE, or Functional Capacity Evaluation.

Let’s unravel how much power the FCE truly holds over the outcome and settlement of a workers’ compensation claim in North Carolina—and what other forces shape the negotiation process.

The Role of the FCE: Fact and Fiction

Many believe the FCE stands as the single deciding factor for workers’ comp settlements. This is a common misconception. While the FCE plays a meaningful part, the reality is a bit more layered.

A Functional Capacity Evaluation is a series of tests performed by physical or occupational therapists. These tests measure what tasks an injured worker can reliably and safely perform. Things like lifting, carrying, pushing, pulling, walking, sitting, and standing are all assessed. It’s objective, or at least tries to be, taking some of the guesswork out of judging how someone’s injury limits their daily life or work potential.

But a settlement doesn’t simply flow from a checklist of FCE results in the context of workers’ compensation; it also involves considerations of work compensation arrangements.

What the FCE Helps Determine

  • Work Capacity: Can the employee return to their old job, or can they only perform less demanding work?
  • Permanent Restrictions: Are there limits that will never improve—such as lifting ceilings, or time on one’s feet?
  • Impairment Rating Guidance: The FCE can inform the physician’s “permanent partial disability” (PPD) rating. This number reflects the percentage loss of use to a body part or system.

FCEs are powerful tools, particularly when the treating doctor is asked to rate permanent impairment. But they are just one ingredient in a much larger recipe.

The True Settlement Calculus

Settlements in North Carolina workers’ compensation cases typically come down to a mix of factors, including: consideration of the injured worker’s future earning capacity,

  • The impairment rating assigned by the authorized treating physician
  • The medical evidence showing the degree of ongoing disability or functional loss
  • Lost wages and earning potential post-injury
  • Projected future medical needs
  • Any disputes about the cause or extent of injury

Attorneys, the insurance company, and the North Carolina Industrial Commission (NCIC) consider all these elements. An FCE may provide meaningful data, but it doesn’t issue a ruling or dollar value on the case by itself.

Understanding North Carolina’s Approach

Here, settlements often follow one of two main legal approaches: “ratings-based” recovery and “loss of wage earning capacity” (also called wage differential). The choice has significant impact on the payout.

Ratings-Based Recovery

If you have a permanent partial disability rating to a body part—for instance, 10% loss of use to a hand—you may be entitled to payment according to a statutory schedule. The law assigns a set number of weeks for each body part, multiplying this by the degree of impairment.

Table: Sample Statutory Schedule for Body Parts, NC

Body Part Weeks Multiplied by % Impairment
Arm 240
Leg 200
Hand 200
Foot 144
Eye 120
Thumb 75
Index finger 45
Great toe 35
Back (spine) Variable, very case-specific

This is where the functional capacity evaluation (FCE)’s findings often prove influential. However, the final rating is given by your treating doctor, who considers the FCE among other medical evidence. They might agree fully with the FCE, or they might not.

Loss of Wage Earning Capacity

Alternatively, if your injury affects your future earning capacity—meaning you can no longer return to your prior employment, or you must accept a lower-paying job leading to lost wages—you might pursue ongoing wage loss benefits. This is not strictly dictated by the FCE or the impairment rating. Instead, it’s about your demonstrated limitations and real-world employment prospects.

The Dance Between Medical Reports and Real Life

An FCE can look ironclad on paper. Maybe the numbers show you can lift 30 pounds occasionally, carry 15 pounds frequently, and stand for 4 out of 8 hours per day. But what matters is how this translates to the job market, and your unique employment situation.

A skilled workers’ comp attorney understands that while the functional capacity evaluation (FCE) is evidence in workers’ compensation cases, it isn’t destiny. They may use the FCE results to bolster your claim or to challenge restrictions if the evaluation doesn’t reflect your true capacity. Sometimes, more than one FCE is ordered—by different therapists, yielding different outcomes.

Is Settlement in Work Comp Determined by FCE in NC?

Workers’ comp cases rarely follow one script. Below are a few typical situations where an FCE and your settlement may interact, and how is settlement in work comp determined by FCE:

  • The FCE finds minimal restrictions: The insurance company may argue for a lower impairment rating and a smaller settlement. Your attorney may review the accuracy of the test and whether it considered the full medical picture.
  • The FCE finds significant restrictions: This often supports a higher impairment rating, a greater statutory settlement, and possibly a transition to wage loss benefits.
  • Conflicting medical opinions: Sometimes, the treating physician disagrees with the FCE’s limitations. The dispute may get resolved by more medical evidence, or by medical depositions.
  • Vocational rehabilitation: If you can’t return to your job but could work somewhere else, you might be steered into vocational retraining. The FCE shapes what jobs will be pursued.

What Else Can Affect the Size of Settlement?

Several factors outside the FCE report play into the final negotiation, often beginning with a thorough consultation with your legal representative.

  • Future Medical Treatment: Will you need continuing care? Surgeries, pain management, injections, assistive devices?
  • Wage History: North Carolina uses your “average weekly wage” to calculate benefits. This sets a ceiling on what you can recover.
  • Severity and Type of Injury: Catastrophic injuries sometimes result in ongoing lifetime benefits vs. lump-sum settlements for less extensive injuries.
  • Preexisting Conditions: Did your prior health or job history complicate the injury or recovery?
  • Legal Advocacy: The skill and diligence of your legal team often have a significant impact.

How a Workers’ Comp Lawyer Strategizes Around the FCE

Attorneys working on these cases have a toolkit for making the most out of an FCE, or contesting one that doesn’t reflect their client’s reality.

  1. Reviewing for Validity
    1. Was the test properly administered?
    2. Did the examiner account for pain, fatigue, or other real effects?
  2. Securing Second Opinions 2. Sometimes a second FCE or an independent medical examination (IME) is needed.
  3. Advocating for the Whole Story 3. Lawyers look past just numbers. They take into account subjective pain, pre-injury job requirements, and your ability to realistically re-enter the workforce.

The Workers’ Comp Settlement Timeline (in a Nutshell)

Understanding the sequence of major events helps clarify when the FCE comes into play:

  1. Injury Occurs: The worker reports the accident, starts medical care.
  2. Medical Treatment: Ongoing care until the worker reaches “maximum medical improvement” (MMI).
  3. FCE Ordered: Typically when the doctor feels further improvement is unlikely.
  4. Impairment Rating Assigned: The physician uses the FCE and all medical evidence.
  5. Settlement Talks Begin: Both parties start negotiating based on all evidence.
  6. Negotiation / Hearing: If parties can’t agree, a judge may step in.

It’s important to recognize that the FCE is usually just a milestone, not the finish line.

Real-World Tips for Injured Workers

  • Take the FCE seriously. Give your full effort, but don’t push beyond safe limits. Honesty is vital; under-stating or over-stating your limits can backfire.
  • Know what’s at stake. The findings will likely shape your doctor’s assessment, and therefore your settlement.
  • Stay in communication with your legal team. Share all symptoms, even those that seem unrelated, as they can impact the result.
  • Keep good records. Document your pain, limitations, and how your daily life is affected.

Mythbusting: “My Case Is All About the FCE”

It can be tempting to see the FCE as the ultimate gatekeeper to your workers’ comp settlement. While it undeniably influences the outcome, it shares the spotlight with a host of other factors: medical evidence, employment history, post-injury limitations, and the ability (or lack thereof) to earn a living going forward. Negotiations rarely hinge on a single test result.

In North Carolina, a well-prepared case draws from all available sources to build a persuasive picture. The goal: to get you the benefits you’re entitled to receive so you can move forward with confidence.

If you’re wrestling with a difficult workers’ compensation situation, or facing an upcoming FCE, qualified legal advisers are here to make sure your story is told thoroughly and your rights are protected every step of the way.