File your disability insurance claim disability insurance claim and note the “attending physician statement” or “APS.” The APS is a form designed by the insurance company that your doctor needs to complete in order for you to receive benefits. The form usually asks the doctor to list a diagnosis or diagnoses, prognosis, and functional limitations. Without a completed APS, the insurance company lacks proof of disability; and even with a completed APS, insurance companies also typically ask for additional records and test results.

Problems to file Your Disability Insurance Claim

File your disability insurance claim and what happens next? Is that the end of the dialogue with your doctor? Absolutely not. Here are some of the issues that may come which will necessitate a conversation with your doctor:

1. Ongoing Proof of Disability

Most medical conditions change over time and the insurance company will likely request regular medical updates. Make sure your doctor is aware that ongoing documentation may be needed. Try to obtain copies of the doctor’s progress notes after each visit – while most patients have access to a “patient portal” to retrieve information about their care and treatment, the progress notes are usually not accessible to the patient without a specific request. The progress notes are where the physician documents findings during an exam. For some conditions such as rheumatoid arthritis, multiple sclerosis or Parkinson’s disease, the progress notes also contain standardized measures of disease activity and/or functional limitations. Being able to provide the insurance company with that documentation may head off the need to take up your doctor’s valuable time to complete yet another report.

If reports are requested, though, you should have a discussion with your doctor about how the paperwork burden can be minimized. Filling in some of the information in advance or asking the doctor’s nurse or physician’s assistant complete the bulk of the report might be more efficient than giving the doctor a completely blank form to complete. Another way to assist the treating physician is to schedule an appointment for the express purpose of filling out the APS form while you are in the office with the doctor rather than leaving the form with the doctor to be filled out and when the doctor has time.

2. Dealing With the Insurance Company

During the course of the claim, a doctor working on behalf of the insurance company may try to reach out to your doctor to conduct a “peer to peer” call. Do not let that occasion turn into an ambush of your doctor. Tell your physician that he or she may receive such a call, but that you understand treating patients in the office is the doctor’s priority, and your doctor may not be able to accept a call when it comes in. The doctor should be told to be especially wary about talking to the disability insurance company’s doctor without having your chart accessible. Warn your doctor that the call may be intimidating – a message may be left stating the doctor needs to respond by the end of the day or their opinion will not be considered. Ask your doctor to instruct his or her staff to respond to such a message stating that the doctor is busy and may need to return the call at a more convenient time. If that occurs, ask your doctor to document both incoming calls of this type as well as responses to the insurance company’s physician. If a report later appears accusing the treating physician of refusing to speak with the insurance company’s doctor, that documentation can rebut false or misleading claims of calls having been placed to the doctor’s office or claims that the attending physician refused to speak with the insurance company’s doctor.

Your doctor should also be told that he or she has the right to be furnished with documentation of any comments or opinions given during a peer-to-peer call so that errors, mis-transcriptions, or mischaracterizations can be corrected. Best of all would be for the treating physician to request that any questions be submitted in writing to allow the doctor to respond at a convenient time. There may be a charge for the time your doctor needs to spend talking to the insurance company’s physician. The insurance company should have the responsibility to pay, but if the insurance company refuses, the patient may need to compensate their doctor for time spent responding to the insurance company’s doctors.

3. Dealing With Your Disability Lawyer

There may also be a need for the treating doctor to provide a report or an opinion to your disability insurance lawyer. You are far more likely to get the doctor’s cooperation if you first ask the physician whether he or she would be willing to speak to your lawyer; and if so, ask when the doctor might be available and what charges are anticipated. Explain to the doctor that the call should last no longer than 5-10 minutes and that the lawyer will be very respectful of the doctor’s time and may help with any transcription of their conversation and preparation of a draft report, although the report needs to be 100% the doctor’s opinion, not the lawyer’s or the patient’s.

4. General Do’s and Don’ts About Keeping Your Doctor Informed After Filing Your Disability Insurance Claim

Never try to put words into a doctor’s mouth. Even if the doctor is not willing to say or write what you want the doctor to express, you should not try to force the doctor to say something that is not consistent with his or her opinion. It is possible that you may need to get a second opinion from a different physician. However, “doctor shopping” is viewed warily by disability insurance companies.

Relatedly, never ask the treating physician to say you are “disabled.” The meaning of that term is dictated by the terms of your policy and the doctor is not trained in vocational analysis. What the doctor can do is offer a diagnosis and describe how the symptoms and findings relating to that diagnosis affect your physical abilities, cognitive functioning, or even the ability to stay on task when symptoms such as pain and fatigue, or even the side effects of prescribed medications may keep you off-task. Doctors are usually uncomfortable offering an opinion regarding how long you can sit or stand and may recommend a functional capacity evaluation. Note that such testing is not suited to every medical condition that cause “non-exertional” impairments, which would include seeing, hearing, speaking, and breathing, as well as factors such as pain.

Remember that your doctor is there to treat your condition, not to prove disability; and that you are not your physician’s only patient. The goal is to be able to elicit the information you need with the least amount of bother and inconvenience to the doctor, and that you need to respect the doctor’s limited available time.

Related Articles

Understanding Government and Church Plan Exceptions to ERISA

Understanding Government and Church Plan Exceptions to ERISA

The Employee Retirement Income Security Act (ERISA) is a landmark piece of legislation enacted in 1974 to safeguard the interests of employees who participate in retirement and health benefit plans offered by their employers. ERISA sets standards for these plans, ensuring transparency, fiduciary responsibility, and fairness in their administration. […]

ERISA 2023 Year in Review

ERISA 2023 Year in Review

Introduction The Employee Retirement Income Security Act of 1974 (ERISA) [1] directly impacts the lives of most Americans, yet few are familiar with ERISA despite its governance of pensions and retirement plans, along with other employer provided fringe benefits such...