Attending physician statement, the provider's part of your claim

What is an attending physician statement?

An attending physician statement (APS) is the provider's part of a short-term disability claim. It is a form the insurer or plan supplies, completed by your provider, that documents why you cannot work.

On Unum's short-term disability claim form, it is a section headed Attending Physician Statement. The Standard's form is titled "Employee/Attending Physician's Statement," and it gives its purpose in one line: "The following information is needed to document the patient's inability to work."

An attending physician statement is not the FMLA (Family and Medical Leave Act) certification. One is not automatically accepted in place of the other; a form goes to each, and a provider is asked for both, separately. Our guide to short-term disability and FMLA sets out the difference.

Unum's and The Standard's forms each ask for a diagnosis with its classification code, and the FMLA certification does not require a diagnosis. The WH-380-E guide covers the FMLA certification form.

For short-term disability in New York, the state program has its own form, the DB-450.

Who fills out each part of the claim?

The short-term disability claim is the insurer's or plan's own form, in parts. You complete the employee's statement. Your employer completes the employer's statement.

Your attending or treating provider completes the provider's statement. Unum's header for that part reads "To be completed by physician or treating provider," and The Standard's reads "To be completed by the attending physician."

Unum's guide to its claims process lists what a claim needs: an employee statement, an attending physician statement, an employer statement, and a signed authorization form for release of ongoing medical information. You sign the authorization, and it lets the insurer get medical information.

The Standard's form carries your part and the provider's together, and your part asks for your last date at work before the disability and the date you returned or expect to return. It asks whether the cause was an accident, an illness, or pregnancy, and about any work activity since the disability began. It also asks whether you have filed for state disability or paid family leave benefits.

Certicare is a telehealth service where leave and accommodation paperwork is completed and signed by a state-licensed provider after an evaluation. For a short-term disability claim, that is the provider's statement, and the FMLA certification if your employer asks for one, usually within 24 hours after we have everything needed. That includes the provider's statement for a pregnancy or childbirth claim, where the evaluation supports it.

There's usually no appointment, and a provider may follow up for more detail before deciding. Completing our intake form starts the review; it does not guarantee a signature, and if the review does not support your request you are refunded in full. Our medical leave forms page has the details.

What does the attending physician statement ask?

The questions below come from Unum's and The Standard's public forms, linked above. Every form differs, and your own form sets the questions.

What goes in each section is the provider's judgment, made after the evaluation.

Diagnosis

Each form asks for a diagnosis and its classification code, and whether the condition is related to the patient's work. Unum's form asks for a secondary diagnosis too, and The Standard's form asks about symptoms.

Treatment and dates

The forms ask for the dates of the first visit for the condition and of the latest one. They ask for the date the provider advised the patient to stop work, and whether the patient has had the same or a similar condition before. Unum's form asks for the next visit as well, and The Standard's form asks for the frequency of visits and when the symptoms appeared or the accident happened.

Unum's form asks, "What is your treatment plan? Please include all medications." The Standard's form asks for the planned course and duration of treatment. The forms also ask about hospitalization and surgery, with dates, and Unum's asks which other providers the patient has been referred to.

What you can and cannot do

Unum's form defines restrictions and limitations: restrictions are "activities patient should not do" and limitations are "activities patient cannot do."

Unum's form adds a note to the provider: "Please be specific and understand that a reply of 'no work' or 'totally disabled' will not enable us to evaluate your patient's claim for benefits and may result in us having to contact you for clarification."

Each form asks how long the restrictions and limitations will last. Unum's form asks for a From date and a To date, and The Standard's form asks, "How long do you expect these limitations and restrictions to impair your patient?" The Standard's also asks for factors delaying recovery and for recent chart notes or pertinent records to be attached.

Return to work

Unum's form asks whether the provider has advised the patient to return to work, and the expected return-to-work date. It also asks whether that return is full time or part time, with hours per day.

Pregnancy

Each form has a separate pregnancy section, which asks for the expected and actual delivery dates and the type of delivery. The Standard's is headed "Pregnancy (if applicable)."

Unum's form also asks for the date of the first visit for the pregnancy and any hospitalization date. It asks whether and when the provider advised the patient to stop working, and whether complications caused the patient to stop working before the expected delivery date.

The provider's details and signature

The form asks for the provider's name, degree or specialty, address, and phone and fax. Unum's form also asks for a tax ID number and whether the provider is related to the patient. The provider signs and dates it, on Unum's form under this line: "The above statements are true and complete to the best of my knowledge and belief."

Who can sign it?

Which provider types the disability claim accepts is set by the plan. The header on the provider's part of your own form says who it asks for. Unum's and The Standard's headers, quoted above, differ.

Through Certicare, the provider's part is completed and signed by a state-licensed provider.

How do you get one, and where does it go?

It comes with the claim. The insurer or plan that handles the claim supplies it, or your employer's benefits office does. The insurer can also ask the provider's office for information directly.

Where it goes is set by the return instruction on your form. The Standard's says, "Please complete this form and mail or fax it to The Standard using the contact information listed above." Deadlines are on the claim packet and the insurer's or leave administrator's letter.

Who pays for it?

Your form may say who pays for it. The Standard's says it directly: "The patient is responsible for obtaining a complete form without expense to The Standard."

What happens after the insurer gets it?

The insurer or plan decides the claim, on the whole file. The insurer or plan can ask for more after the claim goes in, whether records or a periodic update from the provider, and it can require an examination.

If the claim is denied, our guide explains how a denial and an appeal work. Where the denial turns on what the provider statement did or did not say, the appeal is where an updated or fuller provider statement goes, and that follow-up is inside your one Certicare case.

Short-term disability does not protect your job. Our comparison with FMLA covers job protection.

If your own provider won't complete the statement, the guide for when a provider won't fill out FMLA paperwork covers the same problem on the FMLA form.

Answer the intake questions, and a state-licensed provider completes and signs the provider section of the paperwork your claim needs, where the evaluation supports it.