Best Practices for Filing a Long Term Disability Claim – Attending Physician’s Statement

Jan 11, 2015

One of the most challenging aspects of the LTD claim submission is the proper completion of the Attending Physician’s Statement (APS).

A doctor’s primary focus is patient care. Many of them are extremely busy and find it challenging to dedicate sufficient time completing paperwork. Some physicians view completion of the APS as necessary, but tedious. Others view it as an extension of care that they provide for their patient.

Considering the above, it’s not unusual to see a wide range in the quality of information provided on an APS. The information can range from one word answers and sparse detail to a full explanation of all of the relevant medical information, along with copies of supporting documentation in advocacy of their patient’s claim.

The challenge with this is that the case manager who will be reviewing the claim may not have sufficient detail to complete their review, in which case a lengthy journey of waiting for information, following up, and gathering the missing pieces takes place. This can range from a few extra weeks to a few extra months. That can make a very significant difference to the plan member who is reliant on their LTD benefit payments.

To help ensure that your plan member’s APS is fully completed, we highly suggest that you, as the plan sponsor, attach a very brief, but specific memo directed to the doctor indicating the situation, and in the interest of the plan member/patient, request that the physician provide the insurer as much detail as reasonably possible, along with copies of relevant chart notes and specialist consultation reports. This can help prevent delays in the assessment of the claim and may help ensure that the patient receives their LTD benefits on a timely basis.

By requesting the information this way, it alleviates the need for the patient or plan member to ask the doctor to provide more specific detail, which can be an awkward or difficult conversation for most patients to have with their doctors.

Your benefits consultant may have a template that you can use for such an occasion, so you may be able to rely on them for assistance. I sincerely hope that this four part series on filing an LTD claim has been helpful and informative.

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