One of the most common forms requested by long term disability insurers is a form statement from your doctor, called an Attending Physician Statement (“APS”). Whether you’re initially applying for long term disability benefits, or even after your claim is approved, it is highly likely your insurance company will require your doctor to provide an APS to receive benefits.
Your doctor's responses on the APS are critical to the outcome of your long term disability claim and your ongoing receipt of benefits. An incomplete and unsupportive APS form can easily result in benefit denial or termination. Below, you'll learn more about APS forms and how to ensure they will help your claim. As with all forms relating to your long term disability claim, careful review is key.
What is an Attending Physician Statement?
An Attending Physician Statement (APS) is a form questionnaire from the insurance company that your treating doctor must complete. The purpose of the APS is for your doctor to certify your inability to work. Typically, the APS will request details from your doctor on the following:
- Your doctor’s history of treating your condition;
- Your diagnosis and symptoms;
- Your prescribed medications;
- Your treatment plan;
- Whether or not you are disabled from performing your job duties;
- The date on which you became disabled;
- The expected timeframe you can recover and return to work;
- Your work restrictions due to your condition.
The APS is one of the most critical pieces of evidence for your disability insurance claim. If the APS is not sufficiently supportive, your insurance company may use it as grounds to deny or terminate your benefits – regardless of your other evidence.
When does my insurance company ask for an Attending Physician Statement?
Your insurance company may ask for an APS at multiple stages of your long term disability claim.
Most initial LTD applications will include an APS for your treating physician to complete. The initial APS submitted will be a critical part of your application. If your doctor’s APS is not sufficiently supportive of your disability, it may be cause for your insurance company to deny your claim.
Once your LTD claim is approved, your insurance company will ask for periodic updates on your condition. With each of these update requests, your insurance company will likely request a new APS form from your doctor.
The extent of these requested updates depends on the nature of your disability and other factors. It is possible for your insurance company to request an updated APS from your doctor as often as every couple of months. This means it is vital to understand what your insurance company will look for in the APS to continue approval of your claim.
How do I know if my doctor’s Attending Physician Statement is supportive enough?
Once your doctor has completed the Attending Physician Statement, you should review it carefully before submitting it to your insurance company. One mistake may be enough for your insurance company to deny or terminate your claim.
Here are a few tips for handling and reviewing an APS:
- Have the appropriate doctor complete the APS. You may have multiple doctors treating you for different medical issues, not all relating to your disability. It is important that the doctor treating your disabling condition is the one completing the APS. For example, if you suffer from Multiple Sclerosis, it is likely your neurologist would be the most appropriate doctor to complete the form. They will have the best insight into your condition and how it impacts your ability to work.
- Multiple doctors can complete the APS. Many disabling conditions are complex and treated by multiple providers. One doctor may not be able to account for all of your symptoms and work restrictions. If you have more than one doctor treating your disabling condition, and they are supportive of your disability claim, provide them a blank copy of the APS. The more supportive APS forms you can provide your insurance company, the stronger your disability claim will be.
- The APS should reflect your inability to work. Insurance companies will look to the completed APS to see if your doctor believes you are unable to work due to your disabling condition. A supportive APS should affirm you as disabled from your job duties and elaborate on the ways your condition prevents you from working. Any ambiguity as to your ability to work from your doctor can be weaponized by your insurance company to deny or terminate your claim.
- All questions must be answered. Your doctor should complete all questions on the form. Any missed questions may raise red flags with your insurance company.
- Consider asking your doctor for a supplemental statement. Due to space and the questions asked, an APS can be limiting. Ask your doctor if they are willing to provide a supplemental statement or narrative letter to explain the full scope of your diagnosis, disabling symptoms, and how your condition prevents you from performing your job duties. This can be attached to the APS and submitted to your insurance company in support of your claim.
- Review the APS for accuracy. It is important for the APS to be accurate in regards to questions of your date of disability, treatment history, and diagnosis and symptoms. Any objective testing your doctor has performed should be accounted for. Doctors are often very busy, and it is not uncommon for them to rush through these forms. Be sure to look over the APS carefully for any mistakes. A wrong date of disability, missing treatment dates, or a lack of objective testing listed could all impact your insurance company’s decision on your claim.
- The APS should be consistent. If your claim is beyond the initial approval stage, your insurance company may require an APS to be completed on a routine basis. Your doctor’s report on your diagnosis, symptoms, and work restrictions should be consistent with previous APS forms, unless your condition has improved and you plan to return to work. Any differences on the forms will be questioned by your insurance company. For example, if your doctor mistakenly does not account for a symptom that was listed on a previous APS, your insurance company may assume you no longer suffer from that symptom. When asking your doctor to complete a new APS form, you may want to provide a copy of the last APS they completed for their reference.
How can a long term disability attorney help with Attending Physician Statements?
It can be difficult to know what your insurance company is looking for in an Attending Physician Statement. You may also not have the physical or cognitive capacity to review an APS properly. This is where a long term disability attorney can help.
At Riemer Hess, we routinely handle all aspects involved with the completion of Attending Physician Statements for our clients. We will communicate with your doctors to provide the forms and answer any questions for them about what is needed. Once the APS is completed by your doctor, we review the form for accuracy and consistency – making sure your diagnosis, symptoms, and work restrictions are correctly reflected. If any revisions to the form are needed, we coordinate with your doctor to implement the necessary corrections.
If you are applying for disability insurance benefits or need assistance maintaining your approved benefits, our New York long term disability lawyers can help. Call Riemer Hess LLC at (212) 297-0700 for a consultation on your disability case.