An attending physician’s statement (APS) is a common requirement for insurance underwriting. Insurers will order an APS as part of standard age and coverage amount requirements or to explore information received from an applicant’s telephone interview or paramedical testing. The insurer’s underwriting vendor will generally contact a physician’s office to verify that the applicant is a patient, then send a request for file information. The vendor will follow up regularly by email, fax, or phone, as long as the APS remains outstanding. After several follow-ups, the insurer will contact the insurance advisor, and perhaps the applicant, to request their intervention with the physician. If an APS remains outstanding, the insurance application may be closed.
Underwriters can usually expect to wait a minimum of 2 to 3 weeks to receive an APS. Wait times can be influenced by factors such as a physician’s patient volume or absence from the office.
A delay in receiving the APS can significantly lengthen insurance underwriting time. It is not uncommon for a motivated applicant to complete the underwriting requirements within 2 to 3 weeks and then spend an additional 6 weeks waiting for the physician to provide the APS. The underwriter must then review the APS and may need to request further information from the original physician or another source, adding another wait period to the process.
Longer underwriting can increase expense to the insurance applicant. For instance, if applicants are obtaining term life insurance to replace an existing policy that has renewed at higher rates, they must continue paying to maintain that coverage until they are approved for a less-expensive replacement policy. Even a month of delay may mean thousands of dollars in renewal premiums for insurance that could otherwise have been canceled sooner.
Further, a delay in underwriting may impact an applicant’s ability to qualify for insurance. When signing for an approved individual insurance policy, the applicant must disclose any personal health changes since the date of the application. Even a seemingly benign event may cause the underwriter to postpone settlement of coverage and conduct a review. If the applicant has had a routine physical or visited her family doctor with flu symptoms, the underwriter will seek details on any recommended follow-up. Our administrators see multiple cases each year where a member applies for insurance, submits underwriting requirements and is approved for coverage, then advises during policy delivery that the applicant sought treatment for indigestion, chest pain, or a minor injury. Each additional week of underwriting is another week in which the applicant may slip on icy pavement or suffer a heart attack, and the consequences for an insurance application can range from further delay in settling coverage to withdrawal of the insurer’s offer. If the member does obtain coverage, it may then be more expensive or have significant restrictions. In a worst-case scenario the member may be declined for coverage altogether and will remain uninsured. Efficient underwriting, with all requirements including the APS promptly supplied, reduces the member’s risk of becoming uninsurable while waiting for insurance to be approved.
Client Services Administrator, Doctors of BC
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org