Hi, I’m Nick Ortiz. I’m a board certified disability attorney. Today I’m here to talk to you about attending physician statements which are also called medical source statements or physical capacity evaluations.
The real thing that I want to get into detail with you today is the fact that the attending physician statements that are provided to you by insurance company are complete garbage. They’re virtually useless and that’s another reason why you might consider hiring an attorney is to help you create a custom form that I’m about to go into a little bit more detail that will help you in proving your case. The first thing that I did was I requested online, I downloaded a copy of UNUM, which is probably the biggest disability insurance company out there, their attending physician statement. I’m gonna go over a little bit about some of the questions that they ask and why it’s virtually useless.
On the first page, they ask for the diagnoses, so they ask the doctor to identify their primary diagnosis, the secondary diagnosis, if you’ve been hospitalized, so those things, they’re important to identify what your medical conditions are, your diagnoses, but they don’t really get into too much detail about what your resulting limitations are. However, on page two, they do have section B, functional capacity and where they ask whether you have any physical restrictions and/or limitations on the physical side and whether you have any behavioral health restrictions and/or limitations with respect to mental health impairments. I’ll read to you what they’re asking the doctor, and I’ll show you why it’s insufficient.
It says, “if your patient has current physical restrictions “and/or physical limitations, list below. “Please be specific and understand that a reply of “no work” or “totally disabled” will not enable us to evaluate your patient’s claim for benefits and may result “in us having to contact you for clarification.” And they give about an inch for your doctor to write down what your limitations are. That really doesn’t do your doctor any good. They’re not gonna know what to say and it’s really not gonna help your claim if your doctor doesn’t specifically identify what your limitations are. So you can see why this doesn’t really help your case or help you to make the proper decision in your case to approve your claim for benefits.
What we do in each and every one of our cases is we create a hyper custom form, depending on your individual condition and I’ll show you why we believe that our forms are much more specific and can provide a lot more assistance to the insurance company in deciding your case. I’ve printed off two. One was a couple pages from our cardiac arrhythmia medical source statement that we use, and the other is from our lumbar spine medical source statement. This is two pages out of our forms typically are between four and five pages long. But I’ll read to you some of the questions so you can see how ours is a lot different.
We already know what the diagnosis is and we do ask at the very beginning of ours what is the diagnosis, but then we get in to more specific questions like, “if your patient has episodes “of arrhythmia, please identify your patient’s symptoms.” And we have check boxes for them to check whether you have chest pain, weakness, shortness of breath, syncope, palpitations, edema, lightheadedness, chronic fatigue, nausea, dizziness. All they have to do is go and check the appropriate box that they think applies to your case with respect to your symptoms. We ask how often the symptoms occur or the episodes occur. We ask for clinical findings to support those symptoms, and then we get into more detail, more specific details about how this condition may impair you. So we get into detail about how long can you sit before you need to take a break? How long can you stand? How far can you walk? Do you have any restrictions in pushing and pulling and lifting and carrying weight, bending, stooping, crouching, crawling.
We get into all these details where all they have to do is circle the appropriate answer or check the appropriate box, but the idea is to identify with great specificity what your specific impairments are because that goes to show why it is you can’t do work activity, and that, at the end of the day, is what the insurance company needs in order to make a decision in your favor. If you think about it, you can almost see why they’re gonna give you just enough information to show that they’ve requested the information from the insurance company, but do they really want all the detail that we’re gonna provide them in our form? Not really because at the end of the day, it’s our opinion that the insurance companies don’t really want to pay benefits. They wanna show that they’re doing just enough to try to request information, but at the same time, they don’t want all this detail because that may go to further support your case and really prove up your case.
We need to provide that to them, so we’ve created custom forms for virtually, not every kind, but for most conditions, we have a custom form. We have custom forms for fibromyalgia, lupus, back pain, neck pain, back and neck pain. We have them for cardiac or heart problems, pulmonary or breathing problems, nephrology, kidney problems. We have them for joint pain, we have them specifically for problems with just the legs, just the arms. We have really forms for a wide variety. We probably have about 100 custom forms for individual conditions that we use and even though we have the base, we further customize them for each of our individual clients.
We really do believe that this type of form is extremely important in proving up your case to show not only what your diagnoses are, that’s important, but we need to bridge the gap to what is your resulting level of limitation and we need to make it easy on the doctor to where they can just check the appropriate box, circle the appropriate answer and not try to come up with their own description of what your limitations are, generically. That is one of the big things that hiring an experiences attorney like us can assist you with in your case is to help you build a better case that will help you maximize your opportunity and win your case.
If you would like to work with us, and we encourage you to give us a call at 308-7833 for a free phone consultation. Otherwise, if you’re not quite ready to talk, but you want some additional information, then I encourage you to download a free copy of the book that I wrote called The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim that you can claim at www.freeltdbook.com. We look forward to hearing from you, have a great day.