If there's one thing that all insurance providers have in common, it's that they won't give you an offer until they've accurately calculated the risk and determined your eligibility for coverage. In the context of life insurance, this means analyzing your past and current health conditions. One of the main reports the insurer will call for is the attending physician statement, or APS. This document sets out your medical history so the insurance company can establish your premium, based on your health.
What Is an Attending Physician Statement?
The APS medical abbreviation refers to a written report by the physician, hospital or medical facility who is currently treating you, or who has previously treated you, for certain medical conditions. Each insurance company has its own form of APS for the physician to fill out but generally, the statement covers four areas:
- Medical History: When did the condition first develop?
Diagnosis: When did the physician examine you, what's the diagnosis and prognosis, are there any complications?
Treatment: What drugs, surgery or medical interventions are necessary or appropriate to treat the condition?
Progress: Are those treatments working?
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The insurance carrier uses this information to determine your risk, and therefore your eligibility for insurance coverage and the amount of premium.
Who Needs an APS?
It's up to the individual insurance carrier whether they require an APS or not. When you first apply for life insurance, you'll fill out a ton of paperwork and be put through a battery of medical exams and blood draws. If the results of these tests are satisfactory, then the carrier may not ask for an APS.
However, if you've disclosed a material medical impairment, then the insurance company will require more details. Examples of conditions that often warrant an APS include abnormal cardiac tests, cancer, diabetes, hepatitis, lupus, rheumatoid arthritis, mammograms and stroke. The insurer might also call for an APS if you have a history of mental illness or past suicide attempts.
If you've seen a medical provider for any reason in the past year (other than your annual physical), or if you're over the age of 65 (each insurer has its own age requirement), then the insurance company might also call for an APS as part of its standard underwriting procedures. Suspicious applications will also warrant further investigation – so watch out if you're 30 years of age and looking for $10 million life insurance coverage!
How Long Does It Take?
The APS can drag out the underwriting process because physicians are busy people and the coverage cannot be approved until the form has been filled out and signed by your doctor. In fact, it's the single biggest cause of delay in getting your insurance coverage.
If your medical history is especially complex, it could take weeks for the physician to file the APS, and weeks or months for the underwriter to review all the medical data that's been provided. The underwriter is responsible for assessing the risk associated with your health status so he has to analyze every item to decide your insurability.
Way Around APS Insurance Requirements
Simplified issue life insurance requires no medical exam. Your eligibility depends on your answers to a health questionnaire and a telephone interview. The maximum you can buy is $500,000 in death benefit and the underwriter will not order an APS for this type of life insurance. On the downside, you may just get a flat denial if your questionnaire throws up any red flags. Eligibility also depends on your age and other underwriting factors.