When you file your claim for short-term disability or long-term disability benefits, the insurance carrier will likely send you an Attending Physician Statement (APS) form for your treating medical provider to complete.
While an APS looks simple, how an APS is completed can make or break your case. Here are eight things you should know about an APS.
An APS is one of the primary ways an insurance company obtains information about the severity of your medical condition and your treatment history. The APS typically contains a series of questions for a treating medical provider to complete.
The length and details of the form vary by carrier. Typically, an APS includes places to indicate diagnoses, currently prescribed medication, and the length and extent of your treatment relationship with your treating medical provider.
Ideally, an APS would be completed by a practicing physician with an M.D., D.O., or Ph.D. While an insurance company won’t outright reject a medical opinion provided by a non-physician provider, such as a nurse practitioner, licensed clinical social worker, or licensed physical therapist, they typically weigh medical opinions of physicians more heavily.
However, if the medical provider who best knows your condition is a non-physician provider, it may be better to have that provider give their opinion and have their opinion co-signed by a physician. Of course, it’s best to discuss this decision with an experienced disability insurance lawyer.
Based on our experience, we find that treating medical providers are more receptive to completing an APS when you discuss the form with them at a scheduled in-person appointment. That way, you’re available to answer any questions your physician may have about the form and gauge whether you believe they’ll support your disability claim.
It also gives your doctor the opportunity to carefully review the form. You’re more likely to get a timely response from your doctor if you make your request at an appointment instead of leaving the form with an office manager or with the doctor in passing.
If the carrier has already sent the request to complete the APS to your doctor, we still encourage you to speak with your doctor about whether they’re willing to complete the APS and, if so, whether the form is completed accurately.
The conversation you have with your doctor is helpful in that it allows you to answer any question the doctor may have, and it helps ensure that the APS is completed promptly. If the doctor has already sent the APS directly to the insurance company, you should 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 contact 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 claim. If you receive the APS from your physician and have any questions about 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.
An APS for a disability benefits claim will generally include questions asked about your ability to perform certain exertional tasks, such as prolonged sitting, standing, lifting, carrying, pushing, pulling, bending, crouching, and kneeling. The intention behind these questions is to determine whether the limitations noted by your doctor preclude you from working either your full job or any job (depending on the definition of disability in your policy).
For example, if a physician indicates that you are able to sit frequently, the insurance company may conclude that you’re able to perform sedentary work and deny your claim.
Doctors may be reluctant to comment on the extent of your limitations because most doctors don’t evaluate their patients regarding their ability to work. Some doctors defer providing an opinion until a Functional Capacity Evaluation is done to assess your physical deficits. Others don’t want to get involved in the process at all.
The likelihood of a doctor saying “no” to your request is all the more reason for you to initiate a conversation with your doctor ahead of time to see if they would be willing to support your disability claim. If an APS isn’t definitive in giving an opinion regarding your inability to work, your benefits may be denied or terminated.
You may need to obtain an 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.
Strategizing with an experienced disability benefits lawyer is imperative if you find yourself in such a tricky situation.
If you’re receiving long-term disability 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 the Attending Physician Statement forms you provide present the strongest, most accurate information and help ensure you get and continue to receive the benefits and protections you deserve.
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.
