What to Do When Your Doctor Won’t Complete Disability Paperwork
Having medical support for your disability is often the most important part of any short-term and/or long-term disability insurance (STDI/LTDI) claim. In addition to medical records, your insurer will typically request that your doctor complete paperwork regarding your medical conditions and the ways in which those conditions impact your ability to do work-related activity. This paperwork is often referred to as an Attending Physician’s Statement (APS).
Some of the most common disability insurance companies make their APS forms available online:*
• Cigna (aka Life Insurance Company of North America)
• Standard Insurance Company
• Madison National Life Insurance Company
• Reliance Standard Life Insurance Company
*When filing a claim for benefits, it is important to ensure the form you are using is the most up-to-date version, and the version applicable to your claim.
Next, the insurer will use the complete APS to assess whether, based on the restrictions supported by your doctor, you can perform the material duties required by your own job, or any job for which you are reasonably qualified. Not having this form completed, or not completed in its entirety, could delay approval of your claim or even result in your claim being denied. In other words, having a doctor willing to advocate for you by completing disability paperwork can mean the difference between a swift disability benefit approval and a lengthy legal disability battle.
Despite the APS being central to your STDI/LTDI claim, doctors are not required to complete disability paperwork and sometimes a doctor declines to do so. If this happens, certain information and strategies may help you secure the necessary medical support for your disability claim.
Common Reasons Doctors Don’t Complete Disability Paperwork
If your doctor has declined to complete your disability paperwork, it can be helpful to first try to discern the reason (or reasons) behind their refusal. Knowing their motivation for declining your request can help you tailor your response. Here are a few reasons a doctor may decline to complete your paperwork:
• The doctor may not believe your medical condition is severe enough to cause disability.• The doctor may not want to get involved in a legal battle or be called to testify.
• The doctor may not have the time to complete extra paperwork.
• The doctor may not be willing to complete extra paperwork without compensation.
• The doctor may not feel qualified to support work-related restrictions and limitations.
• The doctor’s office may have a blanket policy against completing disability paperwork.
How to Get Your Doctor’s Cooperation
As a preliminary matter, don’t procrastinate. Doctors have busy schedules and the insurers typically impose strict deadlines by which you must return the APS. To that end, you should make a point of contacting your doctor right away if you know you will need them to complete paperwork. Additionally, it can be helpful to contact your doctor directly (rather than the office’s administrative staff) to explain the importance of the paperwork to your doctor.
The doctor may not believe your medical condition is severe enough to cause disability.
It can be deeply frustrating and discouraging to have a doctor doubt the seriousness of your medical condition, but try to refrain from getting angry. Instead, have a conversation with your doctor about the problems you are having and the ways in which they impact your ability to work. If you and your doctor still do not see eye to eye, you may need to explore other strategies to get the necessary medical support for your claim.
The doctor may not want to get involved in a legal battle or be called to testify.
Your doctor may not know that many disability claims are governed by ERISA (the Employee Retirement Income Security Act of 1974) and under ERISA, disability cases generally do not go to trial. Rather, the case is typically decided based solely on the written documents. This is important because it means your doctor is highly unlikely to be called to testify, despite completing your disability paperwork, if you claim is governed by ERISA.
The doctor may not have the time to complete extra paperwork.
Schedule an appointment with your doctor to review and complete the form. This way, the doctor has time built into their schedule to accomplish this task. It can also be helpful to show the doctor a copy of the APS since they are generally only one to two pages long. If your doctor is exceptionally busy, you may want to ask if there is someone else in their office with whom you can complete the form, such as a physician assistant or nurse practitioner. Once the form is complete, the doctor can then review and co-sign it.
The doctor may not be willing to complete extra paperwork without compensation.
Scheduling an appointment with the doctor to complete the form can assist with this challenge since the doctor can bill the health insurance company for the appointment. Alternatively, if you have an attorney, your attorney may offer to pay the doctor up front for their time spent completing the form until your benefits get approved.
The doctor may not feel qualified to support work-related restrictions and limitations.
Remind the doctor that the APS only requests their opinion regarding your medical conditions and capacity for work. Accordingly, estimates are acceptable.
The doctor’s office may have a blanket policy against completing disability paperwork.
You and your doctor may be able to “work around” this office policy. You should try bringing the APS with you to an appointment and go through each question while your doctor types their answers into their office notes. In this circumstance, the necessary information is memorialized in your medical records despite your doctor not completing the actual paperwork.
What to do if Your Doctor Still Won’t Complete the Paperwork?
Ask one of your other treating providers: For one reason or other, your doctor may still refuse to complete your disability paperwork. Before panicking, think of all your other treating providers – is there another practitioner you could ask? For example, if your primary care provider is not willing to complete your paperwork, you may consider reaching out to your specialist instead (and vice versa). Additionally, in most cases, the APS can be completed by someone besides a medical doctor (MD), such as your physical therapist, chiropractor, psychologist, counselor, nurse practitioner, or physician assistant.
Ask for a referral: If none of your treating providers are able or willing to complete your paperwork, consider asking your doctor to refer you to another doctor within their clinic who would could complete the disability paperwork. Specifically, you may seek a referral to an occupational specialist, also known as a Physical Medicine and Rehabilitation (PM&R) specialist, or a physiatrist. A physiatrist focuses on the ways in which a patient’s medical conditions impact their functional ability, including their ability to perform work-related activities. Given this specialty, an occupational specialist may be more inclined to complete the APS.
Get an independent evaluation: Another option may be to seek independent testing. The type of testing you obtain will vary depending on your medical conditions. If you suffer from a physical impairment, you may choose to undergo a Functional Capacity Evaluation with a physical therapist. Alternatively, a Neurocognitive Evaluation can measure cognitive impairments, such as those stemming from a traumatic brain injury. Finally, if you suffer from mental impairments, you may wish to undergo Psychological Testing to document the ways in which your mental health condition may impact your capacity for work. Although this type of testing can be costly, it can also be an effective tool to prove your disability. If you have an attorney, they may be willing to front the cost until your disability benefits get approved.
Get a second opinion: Finally, if all else fails, you may need to seek a second opinion or establish care elsewhere. The importance of having a doctor’s support as you pursue a claim for disability benefits cannot be overstated. Accordingly, if you are not receiving that support from your current doctor, you will need to seek that support elsewhere. This strategy should be used sparingly, however, as you want to avoid the appearance of “doctor shopping” if you change doctors too many times.
Get help from an attorney: If you are still struggling to get a doctor to support your disability and complete the necessary paperwork, get help from a STDI/LTDI attorney who will have experience explaining the disability benefit process to doctors. As a reminder, when your doctor refuses to complete your paperwork, your chances of your claim getting approved diminish. For that reason, it’s important to promptly seek help securing the medical evidence needed to get your claim approved.
If you or someone you know is struggling to get a doctor’s support for their disability claim, contact one of the experienced STDI/LTDI attorneys at Hawks Quindel, S.C. There are several ways our team at Hawks Quindel can help you receive the short-term and/or long-term disability insurance benefits you deserve. We help individuals facing the following situations:
• Applying for STDI and/or LTDI benefits
• Appealing a denial of STDI and/or LTDI benefits
• Pursuing STDI and/or LTDI claims in court.
- How the No Surprises Act Reduces Patient Medical Expenses - March 18, 2022
- 10 Strategies to Help a Doctor Complete Disability Paperwork - December 16, 2021
- COBRA Health Insurance Subsidies Under 2021 American Rescue Plan - April 29, 2021