An attending physician statement (APS) is a document or group of documents from your doctor or clinic. An insurer might ask for one if they require additional information to decide on an insurance application or claim. They don’t ask everyone for an APS.
In our review of the Canadian Life and Health Insurance Association’s life-insurance application guide, the College of Physicians and Surgeons of Ontario’s third-party report policy, and Ontario’s privacy commissioner’s consent guide and its health-record access and correction guide, our MyChoice team found out who asks for an APS and who writes them, what’s in them, rules around consent and fees, what can delay your file, and what to do if you can’t access your health information.
What Is An Attending Physician Statement (APS)?
An Attending Physician Statement (APS) is a third-party medical report that provides information about your medical history, examination, treatment, and follow-up care.
During underwriting, an APS may be requested after the underwriter’s review of information on your application or any additional information. If an APS is requested, you’ll be asked to sign a form that allows the insurer or a medical records retrieval service to request a confidential, professional statement from your doctor. After it’s completed, your clinic will return the statement through a channel the insurer identifies.
During this process, it’s important that you accurately answer questions in the initial request and identify the appropriate health-care provider. Do not draft the medical opinion or tell your doctor what conclusion to reach. Do not assume you can edit a confidential report before the insurer receives it.
When And Why Do Insurers Ask For An APS?
| Underwriting question | Useful medical context | Possible next outcome |
|---|---|---|
| Is a condition stable? | Diagnosis date, symptoms, treatment, follow-up and recent results | Decision, another test, postponement or revised terms |
| Was an abnormal result resolved? | Repeat testing, specialist opinion and current plan | Close the issue or wait for the investigation. |
| Are application dates accurate? | Chart dates, prescriptions and hospital or consultation records | Correction or clarification of the application file |
| How does a condition affect function? | Restrictions, recurrence, work impact and prognosis when relevant | Product-specific assessment rather than a diagnosis label alone |
The information found within an APS may contribute to an offer of insurance on standard terms, at an increased premium, on modified terms, a deferral, a requirement for more evidence or a decline. It is not necessarily indicative of a favourable or unfavourable decision.
An APS may be requested when an applicant has answered questions about a diagnosis, treatment, medical tests, medications, referral to a specialist, disability, symptoms that are not resolved, etc., which require further clarification; there are inconsistencies within the application, such as contradictory responses to questions, conflicting dates, etc., or follow-up is pending; the amount and product require further evidence. This varies between insurers according to each company’s underwriting rules.
Who Requests And Completes An APS?
| Party | Usual responsibility | Question to ask |
|---|---|---|
| Applicant | Identify those providing treatment. Sign informed consent. Give accurate answers to questions. | Which provider and date range does the request cover? |
| Insurer or retrieval service | Determine what evidence is required. Send the request and monitor its receipt. | Was the request sent, to whom and on what date? |
| Doctor or clinic | Review a relevant record and provide an accurate and relevant report. | Was the request received, and is anything missing? |
| Underwriter | Evaluate the APS together with other evidence in the application. | Is another item outstanding after the APS arrives? |
What Information May Appear In An APS?
An APS may include information about the medical condition at issue, purpose of the report, relevant dates, relationship, symptoms, examination findings, test results, specialist reports, medications, treatment, patient response to treatment, adherence, follow-up plans, admissions, surgeries, recurrence, pending investigations, functional limitations, prognosis, and information that is specific to the claim and/or product. There is no standard format.
The College of Physicians and Surgeons of Ontario (CPSO) requires Ontario physicians to comply with the following when completing reports to third parties. Provide information that is within your area of expertise, accurate, objective, relevant to the request, and mindful of any limitations to the information you have. Do not volunteer information that is extraneous or unrelated. A request for a whole chart is not necessarily the same as a custom APS. Read the authorization to understand the type of information the physician should release.
Read More: See How Medical Records Affect Life Insurance
How Long Can An APS Take?
There is no dependable 21-day promise. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) has a guideline that a third-party medical report outside a legal proceeding should generally be provided no later than 45 days after the physician receives the request, unless there’s some other legal requirement.
However, this doesn’t mean the insurer will have completed its underwriting process in 45 days.
| Delay point | Useful follow-up |
|---|---|
| Request not received | Ask the insurer to confirm the destination, date, form, and authorization. |
| Clinic needs a fee or clarification. | Ask who must approve or pay and whether the insurer has responded. |
| Records are at another clinic. | Give the insurer the correct custodian and treatment dates. |
| Tests or referrals are pending. | Ask whether underwriting will wait, postpone or accept another update. |
| APS received but file still open | Ask which specific evidence remains outstanding. |
How Much Do Attending Physician Statements Cost?
Before paying a bill, the applicant should ask the clinic and insurer in writing who requested the report, who will be paying, and whether prior authorization is required.
Although there’s no standard fee for applicants, the College of Physicians and Surgeons of Ontario (CPSO) considers a third-party report an uninsured service. Physicians must follow CPSO billing guidelines, including discussing fees with the third-party who has requested the report. In many life-insurance applications, the insurer orders and pays for the evidence, but circumstances vary according to the type of insurance, the kind of claim, the clinic and the request.
Fees for copies of medical records for personal use are addressed separately, and Ontario’s privacy guidelines restrict fees for personal medical records to reasonable cost recovery.
How Consent And Privacy Work For An APS
Ontario’s privacy commissioner says express consent is generally required when a health-information custodian shares personal health information with an insurer that is not a custodian. And consent should be informed and specific to the information and purpose, and not obtained through deception or coercion.
Not every insurer is a PHIPA health-information custodian, and you may refuse or revoke consent to release your medical history. Without that consent, the insurer might not be able to assess your application or claim.
Carefully review any consent or authorization forms:
- who’s being asked for information (health-care providers)?
- Over what period of time?
- What information is being sought?
- Who’s it being shared with?
- What’s it being used for?
- How long will the consent last?
Privacy laws protect personal health information in context. Ask why a broad request is needed if the underwriting question seems narrow.
Can You See Or Correct The APS?
In most cases, yes. You are entitled to ask for copies of your health records with certain legal exceptions, and if they are incomplete or inaccurate, ask for corrections. However, the custodian of the records (doctor, clinic, hospital) may refuse to make corrections to professional opinions made in good faith or correct any record they didn’t prepare or aren’t allowed to correct.
Send any corrections to the insurance company along with corrected reports. Never alter a doctor’s reports yourself. Ask the insurer how it adds the corrected APS to your underwriting file. Corrections to inaccurate APSs should be made to the original record first, then you can give the insurer a copy. Alternatively, you can write a letter of explanation to the insurance company explaining any APS inaccuracies.
Read More: See Where an APS Fits Into Life Insurance Underwriting
When Might An Insurer Not Require An APS?
Certain insurance policies such as simplified issue or guaranteed issue may not require an APS. However, you should not switch policies simply to avoid providing your doctor’s report.
Make sure you compare the benefits, exclusions, total premium, waiting periods, conversion options and the person receiving the money.
Simplified issue policies may ask health questions that will be verified. Guaranteed issue policies may use eligibility requirements, lower maximums, higher premiums, waiting periods and/or graded benefits.
APS Follow-Up Checklist
- Confirm the exact doctor, clinic, treatment dates and spelling of your name before the request is sent.
- Read and understand the consent and keep a copy of the signed authorization.
- Check with the insurer when the APS request went out and whether a retrieval company is involved.
- Contact the doctor’s clinic to advise them that an APS has been requested, but don’t attempt to influence what should be provided.
- As soon as the insurer advises that the APS has been received, check with the underwriter if anything else is required and ask for a timeline for the next update.
Read More: See How to Prepare for a Life Insurance Medical Exam