Nearly every disability insurance company uses a form called an Attending Physician Statement (or something similar). It is a questionnaire with a lot of blanks and check boxes that the insurer asks the treating doctor(s) to fill out. Sometimes, the insurer will have you take it to your doctor, and other times the insurer will send it directly to the doctor.
Many disability policies and ERISA plans evaluate whether you are disabled based upon an “any occupation” definition. “Any occ” disability is a shorthand way of saying that you must be unable to perform the duties of any job. That can be very difficult to prove. Compare “any occ” to the other type of disability standard – “own occupation.” Under an “own occ” definition, the disability insurer evaluates whether you are disabled from your own occupation, regardless of whether you can another occupation. You must look at your own policy or plan to know which one applies.
The vast majority of disability policies have some type of “any occ” definition of disability built into them. When your doctor receives the Attending Physician Statement (APS) form, there is one section of the form that can make or break your case in one step. This is a sample Attending Physician form:
You can see that there are 5 options for the doctor. The insurance company has listed 4 which mean you can work – #s 1, 2, 3, and 4. These say you can do heavy, medium, light, or sedentary work. These terms all have a special meaning, but they all mean some level of work is possible. Only the last option – #5 – means you cannot work.
Unable to do sedentary work means you cannot do sitting work, the least physically demanding type of work. A sedentary job requires you to sit and lift up to 10 pounds occasionally. If your physical limitations are severe enough to keep you from doing sedentary work, there are no jobs you can do in the workforce.
If you have an “own occupation” definition of disability, it is very important that your doctor checks the box on your form that is most like #5 in the sample above (the highlighted one with the red dot and green check mark next to it) Why? The reason is simple – if the doctor checks one of the first 4 boxes, that means there is some kind of job you can do. If your doctor does not check box 5 on a form like this, it will sink your case faster than the Titanic.
This is not all you need to win your disability insurance case. However, if your doctor does not answer this question by saying you cannot do even a simple sedentary job, you will likely lose your claim…or you are at least in for a very uphill battle.
RECOMMENDATION: Have an experienced disability benefits attorney review the Attending Physician Statement before you send it to the disability insurance company.
Disability Attorney John Tucker helps individuals file or appeal disability insurance claims under Individual Disability policies and ERISA Disability plans. Call (866) 282-5260 for a free consultation.
IMPORTANT: This is general advice and cannot be relied upon as legal advice in your claim. All claims are different, and you need to consult with an attorney to get advice about your claim.
Copyright 2012 – John Tucker and Tucker & Ludin, P.A.