The attending physician’s statement (APS) is one of many methods insurance companies use to determine whether you are disabled or not. On the surface, it seems fair: The APS is prepared by the doctor who is treating you. It often is very thorough, containing extensive information about your medical history and how your disabling condition came to be. Unfortunately, insurance companies often manipulate information from your doctor in a way that works in their favor and leads to your benefits being cut off.
How Insurance Companies Manipulate the APS
Does your doctor truly understand the work you do? It is possible, but in reality, your doctor’s job is to treat your medical condition. Your doctor is not charting your medical information for litigation. He or she is jotting down what was important so there is an accurate history. How much bending, lifting, pushing and pulling you do during the day or how long you stand, walk and sit are not things you generally go over with your doctor — but you should. Your insurance company will be asking questions about these issues.
Does your doctor know how the insurance company defines disability? He or she may have a general idea, but because every insurance company, every policy, can have a different definition, this is not something your doctor can possibly know for certain. Again, that will not stop the insurance company from asking questions about whether you are disabled or not.
At DarrasLaw, America’s top disability firm, our lawyers understand the tactics insurance companies use to manipulate the attending physician’s statement. With more than 100 years of experience, we know how to overcome these tactics.
Considerations for Your APS
Each disability insurance carrier has its own attending physician statement (APS) forms and questions that your doctor must fill out certifying your disability and your inability to do your occupation.
The questions often refer to your:
- Diagnosis
- Symptoms of your condition
- Your treatment plan
- Whether you can perform certain actions, particularly the important duties of your occupation
The first three might be fairly straightforward for your doctor to complete, as they will have diagnosed your condition based on your symptoms and designed your medical treatment plan. However, questions regarding your specific abilities – or disabilities – can be trickier.
The questions might ask whether you can stand, sit, walk, kneel, crouch, bend, or engage in other activities that are necessary for your vocation, and for how long you can do the activities. The insurance company will use the answers to these questions to determine whether you have the functionality to perform the essential duties of your occupation, so any misstatements or understatements by your physician can impact or undermine your claim.
For instance, if your physician answers that you cannot stand or walk for a long time, but you can sit, the insurance company might determine that you can perform sedentary tasks. Depending on your policy terms, this might disqualify you from your monthly disability benefits.
Your physician cannot always answer these questions accurately because he or she is not with you during your daily life and activities. They only see you when you are at an appointment, which may not give them the whole picture of your condition. You will want to make an in-person appointment to be there to answer any questions your physician may have regarding your daily activities and abilities. Remind your doctor about your pain; what triggers it; whether medications have caused side effects like difficulty focusing and concentrating; whether it is difficult to get to sleep, stay asleep and wake up refreshed from sleep; whether fatigue has caused you to nap during the day.
Obtaining Attending Physician Statements From Multiple Doctors
Some disability insurance carriers ask the insured to obtain these statements from different physicians to file a complete claim. You might have a general physician that tends to your overall health and helps manage your condition in certain ways, as well as specialists that focus on your type of condition and disability. If possible, you want to provide statements from all your doctors with whom you have a long treatment relationship and who fully understand your disability and how it prevents you from returning to work.
Periodic APS Requests
Once you file an APS with your disability claim and begin receiving monthly benefits, you might think you are finished with the process and can move on with your life post-career. However, your insurance company will often request updated attending physician statements periodically, depending on the policy terms and the nature of your particular disability.
Continue seeing your doctors consistently, and bring your list of complaints, problems, side effects and difficulties so they know about your ongoing condition. This way, they will have updated medical records and may fill out an updated APS that accurately reflects your disabilities and your inability to work.
While an APS might not seem like a complex part of your disability claim, submitting one with the wrong or incomplete information can jeopardize or be fatal to your claim. You should discuss this part of the process with your disability attorney who can help give pointers on how to obtain the most accurate APS possible. It should properly illustrate the nature of your disability and the limitations that impact your inability to return to work in your occupation or any occupation by which you are trained, educated or suited.
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