One of the most commonly requested documents by disability insurance carriers is an Attending Physician Statement (“APS”). Attending Physician Statement forms are provided by your insurance company to be completed by your doctor(s).
The medical information your doctor provides on the Attending Physician Statement could make or break your claim. If you submit an incomplete form, or it does not fully support your claim, benefits can be denied or terminated. You or your attorney should review any claim forms before they are submitted to your insurance carrier.
What Is an Attending Physician Statement?
An Attending Physician Statement is an important document in the world of insurance claims and disability assessments. It is a detailed questionnaire to be completed by the doctor or healthcare provider who takes care of a patient. It includes information about the insured’s medical history, current medical issues, treatment plan, and future prognosis. This information is used to determine if you qualify for long term disability benefits.
Why Do Insurance Companies Need an Attending Physician Statement?
Insurance companies and evaluators ask for Attending Physician Statements to understand the patient’s medical situation accurately. Requiring an APS serves multiple purposes, including:
- Assessing Claims: Insurance companies request an APS to determine if a claim is valid. These statements help the insurer understand the claimant’s medical condition and decide how much coverage or benefits they should receive.
- Providing Medical Evidence: APSs are essential when evaluating disability claims. They offer an objective assessment of the person’s impairments, how well they can function, and their ability to do everyday activities. This information helps decide if the person is eligible for disability benefits.
- Verifying Treatment: Attending physician statements confirm the medical treatment the patient has received. Insurance companies need this information to make sure the doctors treating you meet the terms and conditions of the policy.
- Understanding Prognosis: APSs provide insights into what the future holds for the patient’s health. This information is crucial for assessing long-term disability claims or determining if the person needs ongoing medical treatment.
When Will My Insurance Company Ask For an Attending Physician Statement?
Your insurance company will request an Attending Physician Statement throughout your disability insurance claim.
Most commonly, your insurer will request an APS when you apply for benefits. This claim form is critical to your claim. An incomplete or insufficient APS could be cause for a claim denial.
If you are approved or “put on claim”, your insurance carrier will still occasionally review your claim. Most insurance companies need an APS form when a claim is under review as well. You need to make sure your APS forms support continued approval of your claim if you want to keep your benefits.
How Do I Know If The Statement Completed By My Doctor Is Enough?
You must review the APS completed by your doctor very carefully. Just one mistake is all it takes for an insurer to deny or terminate your benefits.
Here are a couple of things to look out for when reviewing a completed APS:
- The APS form was completed by the right doctor. Many claimants receive treatment from multiple doctors, but not all of the treatment is related to a disabling condition. APS forms should only be completed by a doctor treating your disabling condition.
- Your doctor answered every question on the Attending Physician Statement. Any unanswered questions could cause the insurance company to take a closer look at your claim.
- Your doctor supports your claim that you are unable to work. They should specifically state how your condition prevents you from performing your job duties.
- Make sure the information provided is accurate. Even medical professionals make mistakes sometimes. Review the completed form to ensure your diagnosis, symptoms, and restrictions are reported correctly. If not, don’t be afraid to ask your doctor to correct the information before submitting the form.
- Consistency is key to continued benefits. After your claim is approved, it will still be up for review. if you have to submit a new APS, make sure your diagnosis, symptoms, and restrictions are consistent. If your doctor leaves off a symptom or restriction, the insurer may assume it no longer applies to you.
- If you need more space than the form provides, ask for a supplemental statement. Many of these forms are only 1 to 2 pages long. Your doctor may be limited to checking a box, or answering a question on just a few short lines. If your doctor is willing to make an additional statement, you can attach it to and submit it with the APS.
- If you receive treatment for your disabling condition(s) from multiple doctors, they should all complete an APS. One doctor may not be able to accurately report all of your symptoms and limitations. For example, let’s say you suffer from a spine disorder and a cardiac impairment. An orthopedic doctor will not be able to comment on your cardiac symptoms and the resulting limitations.
How Does a Long Term Disability Attorney Help with Attending Physician Statements?
It is not always easy to tell what information is needed to support your claim. Due to your disabling conditions, you may not have the cognitive ability to thoroughly review your APS. Maybe your doctor is hesitant to fill out an APS in support of your claim. This is where a long term disability lawyer can help with your claim.
At Ortiz Law Firm, we regularly help our clients with Attending Physician Statements. We will educate your doctors on the importance of these forms and can answer any questions. We will review the completed forms to ensure the information is accurate and consistent with the other evidence in your file. If there is any information that needs to be corrected, we can help you communicate this with your doctor.
If you are filing a claim or trying to keep your disability claim in the approved category, we can help. Call Ortiz Law Firm at (888) 321-8131 for a free strategy session with our long term disability attorney.