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Initial attending physician statement - 12900E01 - Desjardins Life 2025

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The document outlines the procedures and requirements for submitting disability claims under group insurance. It emphasizes the importance of having a physician complete specific Initial Attending Physician’s Statement forms tailored to various medical conditions (general, musculo-skeletal, psychiatric, cardiac, and cancer). The document provides detailed instructions on how to fill out these forms, the necessary information required from both the patient and physician, and guidelines for submitting completed forms to Desjardins Financial Security Life Assurance Company.

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Click ‘Get Form’ to open the Initial Attending Physician Statement in our editor.
Begin with Part 1, where the patient must provide their identification details including full name, date of birth, address, and contact information. Ensure all fields are filled out clearly.
Proceed to Part 2, which is to be completed by the physician. Here, the physician will detail the diagnosis, treatment history, and any relevant clinical findings. Encourage them to attach supporting documents if necessary.
In sections regarding treatment and prognosis, ensure that the physician provides comprehensive answers about medications, therapies, and expected return-to-work dates.
Once all sections are completed, review the form for accuracy. Use our platform’s tools to make any necessary edits before saving or sharing.

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2018	4.8 Satisfied (166 Votes)
2013	4.4 Satisfied (52 Votes)

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When would an attending physicians statement be appropriate for life insurance purposes?

This statement, filled out by your attending physician, provides the disability insurance company with vital data to assess the validity of your disability claim. The APS can influence the decision-making process significantly, making it crucial to ensure it is accurately and thoroughly completed.

What is the purpose of an attending physician statement?

An Attending Physician Statement (APS) is a form questionnaire from the insurance company that your treating doctor must complete. The purpose of the APS is for your doctor to certify your inability to work.

What is an attending physician statement for life insurance?

An attending physician statement (APS) is a report by a physician, hospital, or medical facility that has treated, or is currently treating, a person seeking insurance. In traditional underwriting, an APS is one of the most frequently ordered additional sources of medical background information.

Who might be asked to fill out a physicians statement?

In order to be effective, an Attending Physician Statement must be completed by a doctor who knows you in person your insurer or agency will reach out to get information from a physician who has either treated you in the past or is currently providing treatment.