What Can You Do if Your Doctor Will Not Complete Your Disability Claim Forms?

If you suffer from a severe illness or have an injury that interferes with your ability to work, you may need disability benefits. Whether you are applying for short-term disability (STD), long-term disability (LTD), or individual disability insurance (IDI) benefits, it is critical that your doctor(s) complete specific paperwork to support your claim. In this article, we address the challenges when doctors are unwilling to complete disability claim forms and provide guidance on navigating this situation effectively.

Key Takeaways

• Doctors are not legally required to complete disability claim forms, including Attending Physician Statements (APS), but your claim will likely be denied without them.
• Common reasons doctors refuse to complete claim forms include time constraints, fear of legal involvement, and office policies prohibiting them from doing so.
• For ERISA-governed claims (which include most employer-sponsored plans), if you end up in litigation, it is highly unlikely that your doctors will be called to testify since most cases are decided on the written record compiled by the insurance company or administrator during the claim and appeal process.
• If your doctor refuses to complete the required claim forms, you have options. You can schedule an in-office appointment to discuss the forms with your doctor, ask another treating provider such as a physician’s assistant (PA) or nurse practitioner (NP), seek a second opinion from a specialist willing to complete the paperwork, or undergo an independent evaluation.
• That said, it is important to avoid switching doctors too frequently, as insurers may view that as “doctor shopping” and question your claim.

What Type of Paperwork Is Required When You Apply for Disability Insurance Benefits?

When you file a claim for STD, LTD, or IDI benefits, there will be certain forms that the insurer and/or plan administrator will require you to complete. You will need to fill out forms regarding your work history, daily activities, medical condition, and treatment regimen. There will also be a form that your doctor must complete, which is typically called an Attending Physician’s Statement (APS). In that form, the insurer will ask your doctor certain questions about your diagnoses, treatment, and specific restrictions and limitations. These forms are essential for your disability insurance benefits claim, and are often some of the most critical evidence you can present to support your claim.

After your insurer approves your initial claim, you and your doctor(s) will typically be asked to complete updated claim forms every 6 to 12 months. Your doctors must be willing to fill out the initial claim paperwork and provide periodic updates when requested by your disability insurer or plan administrator. Otherwise, the insurer may delay or even deny your benefit payments.

If you are treated by multiple doctors or specialists, you must ensure that the right one completes the forms. Depending on your condition, you may want multiple specialists to complete the forms. This gives the insurance company or plan administrator a holistic view of your medical condition and resulting limitations. For example, if you have both a mental health and medical condition, a mental health practitioner and your primary care doctor or other treating specialist(s) should each complete the forms.

Why Do Doctors Refuse to Complete Disability Paperwork?

Understanding why your doctor may be reluctant to complete disability forms can help you address their concerns and find a path forward. Here are the most common reasons doctors decline:

Time constraints and lack of compensation

Attending Physician Statements can be lengthy and detailed. Doctors do not get paid by insurance companies for the time they spend completing disability paperwork, and many already feel overwhelmed by administrative demands.

Concern about legal involvement

Some physicians worry that completing disability paperwork could expose them to legal proceedings or require them to testify in court. However, that concern is often unfounded. Most employer-sponsored disability plans are governed by the Employee Retirement Income Security Act (ERISA). For ERISA claims, courts typically decide cases based solely on the insurer or administrator’s claim file. This means your doctor is highly unlikely to be called to testify even if your claim ends up in court, rendering the fear of courtroom involvement irrelevant.

Belief that the condition is not severe enough

Your doctor may not believe your medical condition meets the threshold for disability, even if you are experiencing significant functional limitations. This often happens with subjective symptoms like chronic pain or fatigue. It can also occur when the doctor does not understand how insurers evaluate claims or define disability.

Office policy

Some medical practices have blanket policies against completing disability paperwork, regardless of an individual patient’s circumstances.

Feeling unqualified to assess work restrictions

Physicians are trained to diagnose and treat medical conditions, not to evaluate work capacity. Some doctors feel uncomfortable making determinations about whether a patient can perform specific job duties, or physical or cognitive functions.

Unfamiliarity with the disability process

Many doctors are simply unfamiliar with disability claim procedures and the specific information insurers need. They may be uncertain about what to include or be concerned about including incorrect information.

Is Your Doctor Required to Complete Your Disability Claim Forms?

While many doctors are willing to complete these claim forms, some will not. The doctor’s decision may not have anything to do with you. It may be the doctor’s policy, or they may feel that the questions are outside their area of expertise. Your doctor(s) must provide a complete set of your medical records, when requested. However, no law requires them to fill out specific paperwork for your disability benefits claim. On the other hand, if your insurance company or plan administrator requires certain forms, you are responsible for submitting them completely and on time.

What Should You Do if Your Doctor Will Not Complete Your Disability Paperwork?

If your doctor will not complete the claim forms required for your STD, LTD, or IDI benefits claim, you have options.

Schedule an Appointment to Complete the Forms Together

It may be helpful to schedule an appointment with your doctor and bring the claim forms with you for completion during the appointment. That way, you can ensure the forms are completed in their entirety and answer any questions your doctor may have. If your doctor still refuses after an in-person visit, ask their physician’s assistant or nurse practitioner to complete the forms instead.

Alternatively, you may need to add another doctor or specialist to your treatment team who is willing to complete the paperwork. When interviewing new doctors, let them know you are pursuing a disability benefits claim and ask whether they will complete insurer-requested paperwork. It is essential that at least one of your treating providers with the appropriate medical specialty is willing to fill out claim forms and communicate with the insurance company, as needed. Otherwise, your disability benefits may be denied or terminated for failing to supply the documentation needed to support your claim.

Avoid Switching Doctors Too Frequently

A word of caution about changing doctors: While it is important to find a physician willing to complete paperwork for your disability carrier, you should avoid switching providers too frequently. Insurance companies scrutinize claim files for signs of “doctor shopping” or seeking multiple doctors until one provides a favorable opinion. If your insurer suspects doctor shopping, it may question the legitimacy of your disability and view your claim with increased skepticism. When you do change doctors, document legitimate reasons for doing so such as relocation, network changes, or the need for a specialist. You should also maintain consistent treatment to avoid gaps in care.

Consider an Independent Evaluation

You may also consider undergoing an independent evaluation to assess your restrictions and limitations objectively. Several types of independent evaluations may support your claim: A functional capacity evaluation (FCE) measures your physical functionality. A physical therapist typically conducts this type of evaluation, assessing things such as how much weight you can lift and how long you can sit, stand, and walk. A neurocognitive evaluation measures your cognitive abilities such as memory, processing speed, and executive functions. A neuropsychologist typically administers this assessment. A psychological evaluation assesses your mental state and symptomology. A psychologist normally performs this type of evaluation.

Related Article: How a Functional Capacity Evaluation Can Help Prove Your Disability

How Can an Attorney Assist in Having Your Disability Paperwork Completed?

You do not want your claim for disability benefits to be denied or terminated simply because your doctors are unwilling to complete the required paperwork. If your doctors refuse to complete the required forms, experienced disability benefits attorneys like those at DeBofsky Law can help. A skilled disability lawyer can counsel your doctors on why it is critical that they complete the disability paperwork and answer any questions they have. A disability attorney can also refer you for a third-party evaluation, if needed, that explicitly addresses your condition, resulting limitations, and occupational duties. The disability benefits attorneys at DeBofsky Law are here to advise you and your doctors through every step of the claim process.

Common Questions About Doctors and Disability Claim Forms

Can a doctor legally refuse to fill out disability forms?

Yes. Doctors must provide copies of your medical records upon request. However, no law obligates them to complete disability claim paperwork. That said, without a completed Attending Physician Statement (APS) or something from your treating provider(s), the insurer will likely deny your claim.

Will my doctor have to testify in court if they complete my disability forms?

For most employer-sponsored disability claims governed by ERISA, the answer is no. Courts typically decide ERISA disability cases based on the insurer’s or administrator’s claim file alone, without live testimony. This means your doctor is highly unlikely to be called to testify simply because they completed your disability paperwork.

Can someone other than my doctor complete the Attending Physician Statement?

Several provider types can usually complete an APS, depending on your policy and condition. These include a physician assistant (PA), nurse practitioner (NP), physical therapist, psychologist, or other qualified provider with direct knowledge of your treatment.

What should I do if my doctor believes I am not disabled?

If your doctor does not support your disability claim, have a frank conversation about your functional limitations. Explain how those limitations affect your ability to work. You might also seek a second opinion from a specialist or undergo an independent functional capacity evaluation (FCE) or neuropsychological evaluation. A disability attorney can help identify additional evidence to strengthen your claim.