Attending Physician Statement Life Insurance Template

A mistake or misrepresentation on your life insurance application can cause a delay or even a denial of the claim.

Attending physician statement life insurance template. Thus the attending physician statement is a way to help ensure that you represented yourself to the life insurance company as accurately as possible. Essentially the attending physician statement aps is a report from a doctor or medical facility that either has treated or is currently treating someone that is seeking life insurance. W hen you need to provide more information when applying for life insurance policies the attending physician statement is the standard way to obtain that information. You should complete and sign section 1 of this form before giving it to your physician.

Attending physician statement instructions for completing the claim form. Attending physicians statement of critical illness specified. Complete all applicable areas of the claim form. Critical illness portability attending physician statement.

The request can come from either life or a health insurance company but we will deal with the life insurance aspect here. History claim number if available member id number for association only. To be completed by the attending physician at the insured persons expense. Reliastar life insurance company minneapolis mn reliastar life insurance company of new york woodbury ny.

An attending physicians statemtent is a request sent by an insurance company for more detailed medical information about an applicant who is applying for insurance. If you had general testing such as colonoscopy before age 50 mammogram prior to age 40 or mri the underwriter will request an attending physician statement. 2012 stop loss policy sample sloc. Attending physicians statement of critical illness specified disease section 3.

Gmpap 3430 mt voluntary portability application mt. The purpose of an aps is to get a better picture of your overall health condition. Medical science is very detailed and sometimes the smallest things can cause the life underwriter and life. Fines denial of life insurance and civil damages.

Sign the claim form. Attending physician statement group disability income claims information needed from you and your physician use this form to provide us with the information we need from you and your physician to process your claim for disability benefits. D d m m injuryy y y y d d m m y y y y d d m m y y y y sickness yes no yes no yes no yes no if yes please state dates and conditions symptoms. If the applicant was seen by more than one physician the life insurance company could order an aps from all treating physicians.

An attending physicians statement aps is a report given by a medical doctor hospital or other medical facilities who has treated or is currently treating you as you apply for life insurance coverage. How long does it take to get an aps.