By Molly Friedman, (301) 563-6685
An Attending Physician Statement form (APS) is one of the main ways that an insurance company obtains information about your medical status. An APS may be requested by insurance companies when you apply for short-term disability (STD) benefits, long-term disability (LTD) benefits, or a life insurance waiver of premium. The APS is a way for the insurance company to obtain a targeted summary of your medical condition directly from the treating source for informational purposes.
An Attending Physician Statement is typically a form provided by the insurance company with a series of questions for a physician to fill out. The length and details of the form vary by carrier. Some carriers call these forms different names, like Functional Report, but Attending Physician Statement is the most common title. There are several basic pieces of medical information that a doctor needs to include when filling out an APS. The APS will require information about your medical condition, including diagnoses and currently prescribed medication. The APS also requests information to establish the length and extent of your treatment relationship with the physician completing the form.
An Attending Physician Statement should be completed by a practicing physician with a doctoral degree, if possible. An insurance company may discount an APS completed by a non-physician treating professional, such as a nurse practitioner, licensed clinical social worker, or licensed physical therapist.
The process is most likely to go smoothly if you work with your physician, providing them with any information that may help them complete the form. When requesting your physician complete an APS, we’ve found it to be helpful to make an in-person appointment. That way, you are available to any questions that your physician may have about the form. It also provides the opportunity to carefully review the form.
Although the carrier may send the request to complete the APS to the physician, we encourage our clients to speak with their physician about completing the APS and review the document prior to submission to the insurance company. This not only allows you to answer any questions the physician may have, but it also helps facilitate the process and ensure the forms are completed and returned as requested. Even if the physician sends the APS directly to the insurance company, always request a copy for your records.
It’s important to remember that doctors are often extremely busy, and completing your documentation correctly takes time and energy. You may need to reach out to the physician’s office multiple times to check the status of the APS. Once you have the APS, check it very carefully to review for accuracy. Busy doctors may make errors, which could impact your coverage and benefits. If you receive the APS from your physician and have any questions regarding the answers, it’s important to reach out and clarify. It’s essential that the APS is consistent with what is included in the physician’s medical records and any previous APS that doctor may have completed.
Special Considerations for Disability Benefits Attending Physician Statements
In addition to information regarding your treatment, diagnoses, and symptoms, an APS for a disability benefits claim will generally include questions regarding your ability to perform specific actions. These questions may ask the physician to indicate how long, if, at all, you are able to sit, stand, bend, crouch, or kneel. The intention behind these questions is to measure critical vocational activities that determine functional capacities and make conclusions on your ability to work. For example, if a physician indicates that you are able to sit frequently, the insurance company may conclude that you are able to perform sedentary work and deny your claim. These questions are particularly tricky. Some of the questions may not apply to your limitations and may not have been measured by your physician. Additionally, many physicians have expressed a reluctance to answer these questions and offer conclusions regarding their patients’ ability to work. However, it’s imperative that these questions be answered as thoroughly and accurately as possible. If an APS is not supportive of your inability to work, your benefits may be denied or terminated.
You may need to obtain APS from multiple physicians as part of your disability benefits claim. Assuming the form is completed supportively, the strongest APS forms come from doctors who specialize in the area of your disability and have the longest treatment relationship with you.
If you are receiving LTD benefits, a carrier will likely periodically request that your physicians complete updated Attending Physician Statements. The frequency of these requests may depend on the carrier or the nature of your disability. Be prepared for these requests, and continue to maintain consistent treatment with your treating physicians to continue to build a strong medical record and receive necessary care.
While they may appear simple on the surface, an APS can have serious consequences. An experienced attorney can help you work with your doctor and insurance company to ensure that the Attending Physician Statement forms you provide present the strongest, most accurate information and help ensure you obtain and continue to receive the benefits and protections you deserve.
Contact Molly Friedman at (301) 563-6685.
About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone, and are there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at andalmanflynn.com or call 301.563.6685