The Attending Physician Statement (APS) plays an instrumental role in your short term or long term disability insurance claim. It serves as a comprehensive record from your doctor detailing your medical history, current health condition, restrictions and limitations, date of disability, and your prognosis for the future. This statement, filled out by your attending physician, provides the disability insurance company with vital data to assess the validity of your disability claim. The APS can influence the decision-making process significantly, making it crucial to ensure it is accurately and thoroughly completed. Contact a long term disability attorney at The Maddox Firm for help completing an APS.
Why Does a Disability Insurance Company Request an APS?
A disability insurance company relies heavily on Attending Physician Statements (APS) when conducting the initial review of your disability insurance claim. Disability insurance companies also request attending physician statements from time to time throughout the lifetime of a disability insurance claim. The frequency of these requests depends on the nature of your disability, the strength of the evidence in support of your disability, and the standard of disability in your policy, among other factors.
Attending physician statements provide insurance companies with a deep insight into your medical situation. Insurance companies use this information to discern the legitimacy of your claim, the severity of your health condition, and its impact on your ability to work. The disability insurance company uses the information contained in the APS to decide on the validity of your short term or long term disability claim.
The APS helps to paint a clear picture of your health condition from a medical perspective. This is crucial since disability claims are often complex, with various factors coming into play. The insurance company needs a comprehensive understanding of your health condition to make an informed decision. It enables them to evaluate if your disability aligns with the policy's definition of disability, further determining whether you qualify for benefits. Therefore, the APS is not merely a formality, but is an essential element in the insurance claim process.
When Does a Disability Insurance Company Request an APS?
An attending physician statement is typically requested by a disability insurance company at the outset of a disability claim, but its frequency can vary depending on the specifics of your situation.
The initial APS establishes the baseline for your health condition and disability. However, it is not a one-time request.
The insurance company may request updated APS forms periodically throughout your claim process. This allows them to track the progression of your condition, gauge your response to treatment, and assess your ongoing eligibility for benefits. It’s common for an APS to be requested annually, but in some cases—such as if your condition is expected to change significantly or rapidly—it may be requested more frequently. This underlines the importance of keeping regular appointments with your attending physician and retaining thorough medical records.
What Information Should be Included in the APS?
The APS should contain detailed information about your medical history, diagnosis, treatment plan, current health status, and prognosis. It should also include any relevant diagnostic tests, lab results, and medical records to support your claim. If you have had recent testing or lab results, make sure the APS refers to those tests/results, and include a copy of them with the form.
Additionally, the attending physician should provide a statement outlining how your injury or illness prevents you from performing your job duties, and if there are any chances of recovery in the future.
Attending physician statements can sometimes be quite brief, usually 1-2 pages. They typically only include a small amount of space to provide relevant information. This limitation on space can make it difficult to provide the full context needed to understand your restrictions and limitations, diagnoses, medical history, and prognosis. If the answer to one or more questions requires more space than is provided, do not be limited by the form. Instead, write “see attached” and provide a separate document with the full answer. The more accurate context your physician can provide, the better chance your claim will have of being approved.
How Can You Ensure the APS is Accurately Completed?
To ensure the APS is correctly filled out, you must communicate openly and honestly with your attending physician. Make sure they have all the necessary information and documentation to accurately complete the statement. Make sure your attending physician has all of your test results and medical records of your other physicians. Every time you meet with your physician, make sure to describe all of your symptoms and how they prevent you from performing the duties of your work, your activities of daily living, or any other changes caused by your symptoms. Do not forget to include descriptions of side effects of medications you may be experiencing. Your doctor does not know about your symptoms unless you describe them.
Remember, your physician's main role is your health care, not your disability claim. Therefore, it's important to ensure they understand the specific information needed for your APS and how it impacts your claim. If there are any changes in your condition, ensure they're updated promptly. Lastly, maintaining a respectful and professional relationship with your physician can contribute significantly to the success of your claim.
It is also essential to review the APS before submission, checking for any discrepancies or missing information. If possible, seek advice from a disability insurance lawyer who can assist with reviewing and verifying the accuracy of your APS. Reviewing an attending physician statement for accuracy and completeness is a crucial step in the process. Start by double-checking that all the necessary sections are filled out, including your medical history, current health status, and prognosis. Each of these sections should contain specific details and be supported by relevant diagnostic tests, lab results, and medical records.
Next, verify the diagnosis and treatment sections. These should be consistent with your medical records and reflect the exact nature of your illness or injury. Check that the description of how your condition impacts your ability to perform your job duties aligns with your experience.
Examine the prognosis section carefully. This section should accurately project your chances of recovery and the expected timeline, if applicable. If your prognosis is uncertain or recovery is not expected, this should be clearly stated. If the question asks for a specific date, you must have your physician enter a date even if it is an estimated date in the future. If possible do not use words like “never” or “indefinitely.” Answers such as these will usually cause the disability insurance company to spend extra time investigating the accuracy of this and other answers in the APS. Providing an estimated date, even if it is a few months into the future, will make the disability insurance company’s review easier.
Finally, have a candid conversation with your attending physician about the APS, ensuring they truly understand the impact of your condition on your ability to work. If possible, consult a long term disability insurance lawyer to review the APS. They can help identify any potential issues and ensure that your claim is well-supported and accurately presented. Remember, the objective is to provide the most accurate representation of your disability to the insurance company, so take the time to review your APS thoroughly.
How Can The Maddox Firm Help Me With My Attending Physician Statement?
The Maddox Firm has helped hundreds of clients navigate the short and/or long term disability claims process to successfully secure their benefits. Our experienced team can provide valuable assistance and support completing an attending physician statement.
Here’s how The Maddox Firm can help:
Policy Examination: A long term disability attorney at The Maddox Firm will review your disability insurance policy thoroughly to understand the specific terms, definitions, and provisions that apply to your claim. We can explain your rights and obligations under your disability insurance policy, ensuring that you understand what you are required to do during the claims process, including cooperating with interviews and examinations. A careful review of your policy enables us to provide you with precise guidance to you and your doctors to help prepare an attending physician statement.
APS Preparation: The Maddox Firm can help prepare a draft attending physician statement based on your doctor’s records that will give your doctor a head start in preparing the final statement for submission.
Advocating for Your Interests: The Maddox Firm will help prepare you for appointments with your physician so you can get the most of out of your doctor’s limited time. We can help educate your request additional information about the purpose of the interview and the questions your representative intends to ask before it occurs. During the interview, The Maddox Firm can be present to make sure you don’t inadvertently provide information that could harm your claim. Our attendance helps ensure that your insurance company follows the law and treats you fairly.
Appeals and Litigation: If your claim is denied or terminated, The Maddox Firm can assist with the appeals process, including gathering additional evidence, preparing a strong case, and, if necessary, filing a lawsuit against your insurance company to fight for your benefits.
Peace of Mind: Having a long term disability lawyer by your side can provide peace of mind during a potentially stressful process. You can rely on their expertise to navigate complex legal and insurance matters, including the completion of an APS.
The Maddox Firm can provide guidance from the outset to help you understand your rights, obligations, and how best to protect your interests in the event of an interview with your insurance company. Our knowledgeable team will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact a long term disability attorney to help you file your claim, appeal, or litigation the right way.