by molly friedman, (301) 563-6685
an attending physician statement (aps) form is one of the main ways an insurance company obtains information about your medical condition. Insurance companies can apply for an APS when you apply for short-term disability (STD) benefits, long-term disability (LTD) benefits, or a life insurance premium waiver. the aps is a way for the insurance company to obtain a specific summary of your medical condition directly from the source of treatment for informational purposes.
An attending physician statement is usually a form provided by the insurance company with a series of questions for the physician to complete. the length and details of the form vary by carrier. Some companies call these forms different names, such as Functional Report, but Treating Physician’s Statement is the most common title. There are several basic pieces of medical information that a doctor must include when completing an APS. aps will require information about your medical condition, including diagnoses and currently prescribed medications. aps also requests information to establish the length and scope of your treatment relationship with the physician completing the form.
The attending physician’s statement should be completed by a practicing physician with a Ph.D., 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 more likely to go smoothly if you work with your doctor and provide any information that may help you complete the form. When having your doctor fill out an aps, we’ve found it helpful to schedule an in-person appointment. that way you are available for any questions your doctor may have about the form. it also provides an opportunity to review the form carefully.
Although the insurance company can send the request to complete the aps to the doctor, we encourage our clients to talk with their doctor about how to complete the aps and review the document before sending it to the insurance company. Not only does this allow you to answer any questions the doctor may have, it also helps streamline the process and ensure forms are completed and returned as requested. even if the doctor sends the aps directly to the insurance company, always ask for a copy for your records.
It’s important to remember that doctors are often extremely busy and completing your paperwork correctly takes time and energy. You may need to contact the doctor’s office several times to check the status of the aps. once you have the aps, go through them very carefully for accuracy. busy doctors can make mistakes, which could affect your coverage and benefits. if you receive the aps from your doctor and have any questions regarding the answers, it is important that you communicate and clarify. It is essential that the PSA is consistent with what is included in the physician’s medical records and any prior PSAs the physician has completed.
special considerations for disability benefits based on medical statements
In addition to information about your treatment, diagnosis, and symptoms, an application for disability benefits will typically include questions about your ability to perform specific actions. These questions may ask the doctor to indicate how long, if at all, you can sit, stand, bend, stoop, or kneel. The intent behind these questions is to measure critical vocational activities that determine functional capabilities and draw conclusions about your ability to work. For example, if a doctor indicates that she can sit frequently, the insurance company may conclude that she can do sedentary work and deny her claim. these questions are particularly tricky. some of the questions may not apply to your limitations and may not have been measured by your doctor. furthermore, many physicians have expressed a reluctance to answer these questions and offer conclusions about their patients’ ability to work. however, it is imperative that these questions be answered as completely and accurately as possible. If an aps does not support her inability to work, her benefits may be denied or terminated.
You may be required to obtain an AP from multiple doctors as part of your claim for disability benefits. Assuming the form is completed with support, 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’re receiving ltd benefits, an insurer may periodically request that your physicians complete updated treating physician statements. the frequency of these requests may depend on the company or the nature of your disability. be prepared for these requests and continue to maintain consistent treatment with your treating physicians to continue building a strong medical record and receive the care you need.
While they may seem simple on the surface, an aps can have serious consequences. An experienced attorney can help you work with your doctor and your insurance company to ensure that the treating physician declaration forms you provide present the strongest, most accurate information and help you obtain and continue to receive the benefits and protections that are available to you. deserves.
Contact Molly Friedman at (301) 563-6685.
about andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & flynn has built a distinguished reputation for legal excellence. The firm represents people seeking disability benefits across the country and practices family law in Maryland and the District of Columbia. The firm focuses on cases that impact the rights of all, and is available to clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and its attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. for more information about andalman & flynn, visit the website at andalmanflynn.com or call 301.563.6685.