An Attending Physician Statement (APS) plays a critical role when you’re filing a disability insurance claim for benefits. The APS provides detailed information to insurance companies about your medical condition and how it impacts your ability to work.

When you file a long-term disability claim, it’s your responsibility to prove your medical condition meets your insurance policy’s definition of disability. Strong medical records like the APS can go a long way in supporting your case and ensuring you receive the benefits you deserve.

In this article, we’ll discuss what an APS is, how it can support your long-term disability claim, and what you can do to get the most out of it.

What we’ll cover:

What is an Attending Physician Statement?

An Attending Physician Statement (APS) is a detailed medical report prepared by a patient’s primary or attending physician, typically in the form of a questionnaire. It provides comprehensive information to insurance companies about a patient’s health condition, medical history, and ongoing treatment plan.

Insurance companies often request an APS during the application process to better understand the patient’s medical condition and make informed decisions about a claim. An insurance company may also occasionally request an APS after it has approved a claim as part of its ongoing assessment of a patient’s health status.

An APS will typically include:

  • Diagnosis and medical history
  • Symptoms and severity
  • Functional limitations (what you can and can’t do)
  • Treatment plan and prognosis
  • Physician’s opinion on how the medical condition impacts your ability to work

Why is the APS important?

The APS helps to bridge the gap between insurance companies and healthcare providers, ensuring everyone involved has a comprehensive understanding of a patient’s health condition and medical history.

When you file a long-term disability claim for disability benefits, your insurance provider needs to assess the medical necessity of your claim and the severity of your medical condition. Insurance companies rely heavily on the Attending Physician Statement when determining whether to approve or deny a claim.

A well-prepared APS with clear and professional medical information can significantly boost your chances of a successful claim outcome, and under no circumstances can you win your claim without a supportive APS on file.

Attending Physician Statements and LTD claims

A supportive Attending Physician Statement can be a powerful tool in your pursuit of long-term disability benefits. Below are some ways an APS can help support your claim.

It provides validation from healthcare providers

Your insurance company isn’t going to just take your word for it. An insurance underwriter will be looking for clear evidence that your medical condition is real, serious, and meets your policy’s definition of disability. An APS from your attending physician quantifies your work restrictions and limitations and provides supporting evidence in professional, medical terms.

It links your medical condition to your inability to work

Your physician can explain in an APS how your illness or injury prevents you from performing your job duties. This is critical because one of the most common reasons disability claims are denied is the failure to prove a disability prevents you from working.

It shows continuity and credibility

A detailed APS helps prove that your disability is verified by a physician, and you’re not exaggerating. It shows you’ve been under consistent care, following a treatment plan, and that your doctor supports your need to stop working.

It may help avoid delays or denials

A strong APS can prevent insurance companies from requesting additional information, sending you to Independent Medical Exams (IMEs), Functional Capacity Evaluations (FCEs), or denying your claim due to “insufficient evidence.”

It strengthens your appeal if needed

If your insurance company denies your claim, a supportive APS becomes an essential part of your appeal. It demonstrates that a qualified medical professional believes your condition truly prevents you from working.

Read also: How to Appeal a Long-Term Disability Denial

How to make the most of the APS

Choose the right doctor: Your attending physician should be familiar with your medical history and specialize in the specific condition they are treating you for. When being treated for a chronic disabling condition, it’s not uncommon to receive care from multiple specialists. You have the option to get an APS from each of your attending physicians.

Keep personal records: Maintain personal health records, including a journal chronicling your health journey, and share your records with your attending physician. Keeping up-to-date records can ensure your Attending Physician Statement is complete and accurate.

Communicate openly: Be sure to maintain open communication with your physician about your symptoms and any changes in your condition, especially if your condition worsens. Make sure to explain to your doctor how the symptoms of your conditions affect your ability to work as that is the key issue for the insurance company.

Understand your policy requirements: Refer to your policy documents to understand what information the insurance company requires and how your policy defines disability. Understanding your policy’s requirements can help you determine what information to provide to your physician for the APS.

Be honest and detailed: Share as much detailed information as possible with your physician to ensure they understand your limitations and can accurately describe them in the APS.

Ensure the APS is complete and accurate: An APS must be fully completed with correct information. Any errors or omissions can lead to incorrect decisions by insurance companies and a denied claim. Ask your doctor to make sure the information they report in the APS is precise and up-to-date.

How we help with Attending Physician Statements

The Attending Physician Statement is a critical part of your long-term disability claim as it can help to validate your condition and its impact on your ability to work.

For the best results, it’s important to ensure that any APS you submit with your claim is complete, accurate, and up-to-date. We can review your APS statement to ensure it meets expectations and does not raise any red flags for the insurance company, which can lead to further, more detailed investigation and even claim denials.

We understand the challenges of navigating the complex application process while also dealing with chronic health issues. Remember, you don’t have to manage the process alone. Help is available.

Roy Law Group specializes in disability insurance law and ERISA. We’re dedicated to managing all of the details of filing a claim or appeal so you can focus on taking care of yourself.

Contact us today for free advice on your long-term disability claim or appeal.