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 of doctors not completing disability claim forms and provide guidance on navigating this situation effectively.
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 needs to be completed by your doctor, 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 the most critical evidence you can present to support your claim.
If your initial claim is approved, you and your doctor(s) will also typically be asked to complete updated claim forms every 6-12 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, your benefit payments may be delayed or even denied.
If you treat with multiple doctors or specialists, it is crucial that you have the right one complete the forms. Depending on your condition, you may even want to have the forms completed by multiple specialists to ensure that the insurance company and/or plan administrator has a holistic view of your medical condition and resulting limitations. For example, if you suffer from a mental health condition and a medical condition, you should have the forms completed by a mental health practitioner, as well as your treating primary care doctor or other specialist(s).
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. While your doctor(s) must provide you with a complete set of your medical records, they are not required to fill out specific paperwork for your disability insurance benefits claim. On the other hand, if your insurance company or plan administrator requires you to complete certain forms, it is your responsibility to make sure they are completed in full and on time.
What Should You Do if Your Doctor Will Not Complete Your Disability Paperwork?
If your doctor does not complete the claim forms required for your STD, LTD, or IDI benefits claim, you have options. 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 you make an appointment with your doctor, and they still refuse to complete the claim forms, you may want to ask their physician’s assistant or nurse practitioner to do so.
Alternatively, you may need to add another doctor to your treatment team who is willing to complete the paperwork. As you interview new doctors, you should let them know you are pursuing disability insurance benefits and ask if they are amenable to completing paperwork when requested by your insurance company or plan administrator. It is essential that you have at least one treating provider with the appropriate specialty to treat your condition who is willing to fill out claim forms and communicate with the insurance company. Otherwise, your disability benefits may be denied or terminated for failing to supply the documentation needed to support your claim. On the other hand, you do not switch doctors too frequently, so the insurer does not think you are “doctor shopping” to find a doctor who will render a particular opinion about your disability.
You may also consider undergoing an independent evaluation to assess your restrictions and limitations objectively. That may include a functional capacity evaluation (FCE), which is typically conducted by a physical therapist to measure your physical functionality, including how much weight you can lift and how long you can sit, stand, and walk; a neurocognitive evaluation, which is usually administered by a neuropsychologist to measure your cognitive abilities, including your memory, processing speed, and executive functions; or a psychological evaluation, which is normally performed by a psychologist to assess your mental state and symptomology. Which evaluation best suits your claim depends on the nature of your disability and your occupational demands.
How Can an Attorney Assist in Having Your Disability Paperwork Completed?
You do not want your claim for disability insurance benefits to be denied or terminated simply because your doctors are unwilling to complete the required disability claim paperwork. If you are having trouble getting your doctors to complete the forms required by your disability insurance company or plan, experienced disability benefits attorneys like those at DeBofsky Law, Ltd. 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, Ltd. are here to advise you and your doctors through every step of the claim process.