How to increase the quality and value of attending physician’s statements

Why a physician’s statement is vital to a disability determination

The attending physician’s opinion of their patient’s functional capacity can be one of the most critical elements of any disability review. The attending physician’s statement (APS) is used to help establish the claimant’s functional capacity, among other methods, which is a key factor in determining if an individual is disabled under the terms of their disability insurance policy.

Ideally, this form is completed thoroughly, containing extensive information about medical history, the progression of the individual’s disability condition(s), and the individual’s current functional capacity. Further, the APS can serve in providing information when there are gaps in the medical records, which can be especially important during a pandemic, when medical records may be limited.

A claimant depends on an accurate, complete, and timely assessment provided by their physician(s) to substantiate their claim for disability benefits. However, often physicians do not provide sufficient information when completing the APS. 

Reasons the APS may not be completed thoroughly

We conducted a study in 2020 to better understand this common problem.

We asked a random selection of 100 physicians and health providers how well they understood what details insurers were looking for when making a disability determination. More than three-quarters of respondents acknowledged that they do not have a strong understanding of what is valuable in these forms.

How well physicians understand what insurers need.

 

When asked about what tools or education might be valuable to them to better convey their patient’s conditions and limitations to an insurer, many said a cover sheet, video, or other multimedia content offering guidance would be helpful. 

Tools for physicians

 

When asked if there was additional input that would be valuable, the majority of physicians felt the definition of disability would be an important piece of information to have.

Valuable information for physicians

 

While many physicians have a baseline understanding of what is required of them when completing an APS, most would value more guidance and resources from insurers. 

Guidance for an attending physician 

When physicians are asked to complete an APS, they should focus on compiling the following information first:

A physician should also consider the following questions:

Setting expectations with attending physicians

It may be helpful for physicians to understand what happens after they complete the APS and why the form is such a crucial aspect of a disability determination.

Receiving a thoroughly completed APS lends credibility and validity to the patient’s quest for disability benefits.

The information provided on the form allows the insurer – and any medical peer reviewer – to compare the information in an attending physician’s assessment to the medical records in the patient’s file, and the patient’s self-assessment of their own capacity.

Should clarification be needed, an attending physician should be prepared to answer follow up questions in a more detailed written questionnaire, or even a phone call from a peer reviewer. The APS can serve as a starting point in this conversation and allows for a much greater understanding of the patient’s functional status. 

Additionally, an attending physician should expect that they may need to complete more than one APS if their patient continues to receive care. Multiple completed forms over a range of time helps to identify improvement or regression in the patient’s condition.

Input from a physician can be vital to the expeditious and effective management of a claim, but it is also critical to keep in mind that physicians are not claim experts and may value guidance on the purpose and use of attending physician’s statements.

 

 

Bobbie Ahern, RN