Permanent Means Permanent: Is Your Doctor Frustrated by Paperwork?
Dec. 7, 2022
Suppose you’ve come down with a mental or physical condition that makes it impossible for you to continue in your job, so you turn to your long-term disability (LTD) to make a claim for benefits. The insurance company requires your doctor to complete an attending physician’s statement (APS) as part of the claims process, but your doctor is reluctant or simply refuses. What can you do? With no APS, there will likely be no benefits.
The same can hold true if you’re applying for Social Security Disability Insurance (SSDI), and the Social Security Administration (SSA) requires a residual functional capacity (RFC) assessment, which your doctor seems reluctant to do or has outright refused. What are your options?
Physicians, when faced with supplying documentary evidence, can sometimes pose a stumbling block in your path to getting the LTD or Social Security benefits you need. Sometimes both instances can apply since your LTD insurer may require you to apply for SSDI as an offset to their own commitment.
If you’re facing a reluctant physician who is not completing the required paperwork you need in or around Minneapolis, Minnesota, contact us at Beedem Law. We can work with you to help get the physician statements you need, so you can get the benefits you need to support yourself while you are unable to continue with your full-time employment.
Beedem Law proudly serves clients in St. Paul and Duluth, throughout the counties of Hennepin, Ramsey, Dakota, and Anoka, and elsewhere in Minnesota.
The Importance of Medical Documentation
Your long-term disability insurer, or for that matter, the SSA, are going to need proof in the form of a physician’s statement and supporting medical evidence to approve your claim for benefits. While a doctor is required to release test results and your health record to you, the insurer or SSA both have forms that they require your physician to complete.
For LTD, that form is the attending physician’s statement (APS), and for SSDI, the required statement is called a residual functional capacity (RFC) assessment. Your physician may be reluctant or even unwilling to provide these documents for a number of reasons. This may be the case even if the forms are mostly filled with checkbox options.
Reasons Your Physician May Not Complete Your Disability Paperwork
Physicians are busy professionals, and they are also in a field where liability claims are common. It is not unheard of for physicians to be reluctant to get involved in matters they’re not familiar with or have had adverse experiences with, such as repeated requests to complete the documents needed to satisfy an insurer or government agency.
Here are some of the reasons your physician may decline, at least initially, to complete your APS or RFC:
Your doctor may not believe your condition is severe enough for long-term disability: This can become a major stumbling block to getting your claim approved, but you need to convince your physician why your condition prevents you from continuing to work. Provide concrete examples or bring statements from coworkers, but don’t get angry with your physician. That won’t help.
Your doctor doesn’t want to get involved in legal battles or be called to testify: LTD policies are covered by the Employee Retirement Income Security Act (ERISA), which rarely requires a physician to appear and testify at a trial. Your doctor may be unaware of this. Both insurance companies and the SSA rely on documentation in evaluating claims. Stress to your physician the fact that documentation is their major and only role.
Your doctor doesn’t have the time to do extra paperwork: This can be understandable, as physicians can have extremely busy schedules and may already be burdened with documentation for Medicare or insurance claims to receive payment for their work. Schedule an appointment and, if possible, bring the necessary form with you to be filled out. Many LTD companies have downloadable APS forms.
Your doctor may be seeking compensation for completing the documentation: Similar to the above situation, you can try scheduling an appointment to have the paperwork completed, so the doctor can bill you for that appointment. If you have an attorney helping you, the attorney can contact the doctor and offer compensation, which you can reimburse them for when your benefits come in.
What If My Doctor Still Won’t Complete the Paperwork?
The above scenarios represent some of the challenges you may face when seeking medical documentation for your disability claim. If, after you’ve tried your best to get your doctor’s cooperation and you can’t, what are your options?
You can reach out to other providers who are helping you with your condition. Ask your specialist if they will help. The forms do not always have to be filled out by a medical doctor (M.D.) Your physical therapist, chiropractor, psychologist, counselor, or nurse practitioner may be brought in to help as well.
The last resort may be to find a new physician, which would be a time- and money-consuming proposition best avoided, if possible. In addition, your insurer or the SSA may view this as “doctor shopping,” which can become a red flag in the approval process.
Overall, if you’re having trouble getting the paperwork you need, your best ally is an attorney experienced in disability claims. Your attorney can not only work with you on strategies and approaches to convince your physician to complete the paperwork, but he or she can also work directly with your doctor to explain the process or to offer compensation if necessary.
Beedem Law: Skilled & Compassionate Counsel
Beedem Law is experienced in dealing with insurance companies and the claims process. If you’re having difficulty getting the benefits you need because of a reluctant physician, contact us immediately. Better yet, as soon as you develop the condition that’s preventing you from working and you need to file a claim, get in touch and let us help you from the beginning. We will work with you every step of the way and provide the guidance and assistance you need to pursue the benefits you deserve.