Life Insurance Attending Physician Statement (APS)

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The underwriting risk assessment is performed in various ways. The most notorious are insurance medical exam, Department of Motor Vehicle reports (MVR), Medical Information Bureau reports (MIB), prescriptions database check (RX), phone interview (PHI), written inspections (in jumbo cases), and the most time consuming one, the attending physician statement (APS).

The attending physician statement isn’t necessarily a requirement for going through underwriting in most cases. However, in some circumstances, it could be the final determination in issuing, declining, or rating up a policy. Let’s find out when and why an insurance company requires an APS.

What Is an Attending Physician Statement?

An attending physician statement (APS) is a testament by a hospital, physician, or medical facility who has treated or is currently treating an individual about their current or past health conditions.

The APS is probably the biggest hurdle, time-wise, to the underwriting process because it must be completed and signed by your treating doctor, who is already a busy individual. Additionally, once the underwriter receives the report back, he needs to prepare an accurate summary of the attending physician’s statement, which calls for a skilled underwriter in the first place.

What Does the Attending Physician Statement Reveal?

Each insurance company has its own APS requirements and forms. However, you should expect an in-depth examination into your health conditions that includes four parts:

  1. History: Questions about the time when the condition first developed
  2. Diagnosis: dates of examination by the physician, including any complications
  3. Treatment: What type of remedy, frequency, and first and last visit
  4. Progress: Are any of the medications or treatments working?

Why Does a Life Insurance Company Order an APS?

Many clients ask this question. Some even say, “I’ve had my interview. They did the background check and also took my blood and urine. Why do they need this APS?”

The collected blood and urine samples are only screened for blood lipids, blood sugar, liver and kidney function, nicotine, HIV, and illegal drugs (isn’t this enough??). They aren’t a final picture of your health.

Adding an APS to the mix can support the results from your test or sometimes show abnormalities that aren’t evident via a blood test. The good news is, after the APS review, the underwriter will come back with a final offer. Think of an APS as the last requirement for a final resolution.

When Do the Life Insurance Company Order an APS?

Note that most companies are not interested in ordering an APS because of the increased costs and underwriting processing time. Besides, in many cases, the medical exam results along with the other reports (MIB, MVR, RX) are more than enough to assess your risk and determine your eligibility for coverage.

However, there are a few cases for which the carrier will order the APS regardless of the exam:

  1. Medical impairments: Many times, regardless of face amount or age, an insurance company will order APS if an applicant has had a history of or consulted with a physician about any of the following conditions (not limited to these conditions only) in the past 10 years:
    • Abnormal cardiac test
    • Blood disorder
    • Cancer
    • Crohn’s disease
    • Diabetes
    • Hepatitis
    • Lupus
    • Mental disorder
    • Rheumatoid arthritis
    • Sleep apnea
    • Stroke
    • Suicide attempt
  2. Age and amount limits: There are other times in which there are no present or past health impairments, but a combination of a large death benefit amount and older age (typically over the age of 50) will trigger the underwriter to order an APS. For instance, an applicant age 51 or older seeking five million in coverage will require an attending physician statement with some companies. Other applicants ages 66 and older will also request an APS for all face amounts.
  3. An APS may be required in any case at the underwriter’s discretion.
  4. If the proposed insured was seen by a physician in the past year. If the applicant was seen by more than one physician, the life insurance company could order an APS from all treating physicians.
  5. 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.

How Long Does It Take to Get an APS?

Any time an insurer orders an APS, I typically tell my clients to add another two to four weeks to the underwriting processing time. Many times, I advise my clients to call the doctor’s office and ask him/her to fill out the report. It’s a great tip, especially if you have a good relationship with your doctor.

Lastly, many carriers use a service company such as EMSI, which is not only cost-effective but can reduce the processing time tremendously because they know what types of authorization providers require and how they prefer to receive requests, and they often have it back into their database.

Do Companies Still Order an APS If I Buy a No-Exam Life Policy?

If you apply for simplified issue life insurance, like final expense, for instance, your eligibility is determined by your answers on the application (which are yes or no), then the underwriter will not order an APS.

Nevertheless, if you buy term life insurance without medical exam, which has a higher death amount than the final expense type of coverage, the underwriter will order an APS, if some of the conditions such as medical impairments apply to you.

Bottom Line

Insurance companies will use every advantage in their arsenal to accurately evaluate an applicant’s overall risk and determine their eligibility for coverage. While it may take a little longer if they choose to order an attending physician statement, you actually should be glad they did.

Here is why: If they went through all the trouble of getting an APS, conducting the exam, reading all the reports from MIB, MVR, and issued you a policy, it means your policy is robust and is less likely to be contested.

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Mar 2, 2019 | Categories: Impaired Risk | 0 comments

About the Author: Ron Attias

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