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Why does a life insurer need an attending physician statement (APS)?

Part of the underwriting process includes getting an attending physician statement from your doctor, who is best positioned to document your health to the insurer.

When you get life insurance, the life insurance company needs to know how healthy you are at the time you sign the policy. They’ll figure this out through a process called underwriting, during which you’ll have to take a medical exam and submit information about your current health and medical history, your dangerous lifestyle choices, and your family medical history.

The underwriting results essentially calculate your risk to the life insurance. That is, how likely it is that you’ll die from a given illness or medical condition. The higher risk you pose, the higher your premiums will be compared to a healthier person receiving the same amount of coverage. In some cases, your health will indicate too high of a risk and you may not be eligible for life insurance coverage.

Part of the underwriting process includes getting an attending physician statement (APS) from your doctor. As a medical professional, your doctor is best positioned to document your health to the insurer, including what medications you take and the severity of certain illnesses. The APS is a standard summary of your medical history, including descriptions of your health and a checklist of medical conditions the insurer will want to know about.

Read on to learn more about:

What is an attending physician statement?

Underwriting officially begins after you figure out how much coverage you need, get quotes, and submit an application. At that point, the insurer needs to determine whether your quote is accurate and whether it needs to raise or lower it depending on the data that emerges from underwriting.

If you’ve ever visited the doctor to treat a chronic medical condition, you’ll be required to submit an attending physician statement. It’s a standard part of virtually every life insurance application, with some exceptions of life insurance coverage types like simplified-issue life insurance. The APS helps the insurer decide how much risk the treated condition poses to your health. Such conditions range can include asthma, diabetes, cancer, sleep apnea, lupus, and dementia, among many other types of health issues.

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The APS must adhere to the same HIPAA rules as your health history. If an issue pops up during your paramedical exam, an APS will let the insurer know if it’s due to a side effect of some medication you’re taking, or if the cause is an actual medical issue that might have been missed on your application or interview. Insurers need to know what exactly they’re covering with a policy, and an APS sheds light on any ambiguities they might be concerned with.

An insurer will only request an APS if they absolutely have to. It adds an extra step to the underwriting process and it costs the insurance company money. And since it’s on their dime, the insurer doesn’t want to take on any undue costs.

A standard attending physician statement contains the following questions for the doctor to answer:

  • History of the condition. The doctor will explain how long he or she has been treating you for your illness, including when symptoms began, dates of treatment, and what treatments you’ve tried.

  • Prognosis. This section goes into how you’re faring with your illness, and whether you’ve seen any improvements since beginning treatment.

If you’re being treated by different doctors for different conditions, there’s a chance the insurance carrier will ask for an attending physician statement from each doctor per condition. The APS is also a standard part of disability insurance claims, for which you’ll need to provide info like how long you’ve been out of work and the capacity of your physical abilities.

How does the APS relate to the paramedical exam?

The medical exam provides some of the first information about your actual health and medical history. The life insurance company can send a medical technician to your home or work, or you can visit the technician’s lab. As with other components in underwriting, the medical exam won’t cost you anything, and you keep the results and even reuse them when applying for other types of insurance coverage or for life insurance coverage from a different provider.

The medical tech is there to draw blood, check your weight and height, and perform many of the other tasks associated with a regular checkup. But he or she may not be qualified to speak on more complex health issues, which is why you’ll need to get an APS. The APS not only backs up the conclusions of the paramedical exam but also gives a picture of your health to the carrier beyond what simple blood draws, urine tests, and heart-rate measurements can reveal.

The combination of the medical exam and the APS will result in your final premium quote, once the underwriter has finished reviewing your information. The point of the APS and medical exam is to provide a more accurate look into your health history, and if it turns out the insurer will have to take on more risk to insure you than it first estimated, then it will need to adjust the policy accordingly.

How long does it take to get an APS?

You may have heard that it takes a long time for your life insurance application to get approved. Part of that is finding time to schedule your medical exam. The other part is waiting on your doctor to fill out the attending physician statement.

Doctors are generally very busy people. If your insurer requests an attending physician statement, the doctor will have to take time out of his day to fill out the paperwork. Because of this, a process that usually takes three to four weeks will probably be extended by at least a couple more weeks.

After your doctor does fill out the APS, it goes back to the underwriter. They’ll summarize the report, which has its own timeline attached to it. Many underwriters use a template or script to make sure they get all of the important information down as quickly and efficiently as possible.

But the wait will be worth it. Not only will you get life coverage; you’ll also get peace of mind that your coverage is solid. Life insurance coverage has a contestability period, a two-year length of time after your policy during which the life insurance company can contest your beneficiaries’ claim if you die. A mistake or misrepresentation on your life insurance application can cause a delay or even a denial of the claim. Thus, the attending physician statement is a way to help ensure that you represented yourself to the life insurance company as accurately as possible.

Disclaimer: Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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