Mental-health-specific attending physician questionnaire for a disability claim.
- Completed by
- Attending physician
- Issued by
- Blue Cross Ontario & Québec (Canassurance)
- Format
- Fillable PDF
- Language
- English
Blue Cross Status Update: Ongoing LTD (Additional APS)
When a disability claim with Blue Cross (Canassurance) is extended, the claimant's attending physician or specialist completes this status update to confirm the long term disability is ongoing. Blue Cross lists it among forms completed during a disability period as the attending physician's statement additional report. It asks what has changed since your last report, from diagnosis and symptoms to treatment, impairment and return-to-work plans.
Who completes it
The physician, or a nurse practitioner where applicable, completes Section B and indicates whether they are the attending physician, a consulting specialist or other. The patient completes and signs Section A, which includes consent to release medical information and acceptance of any fees.
Submitting and payment
- How to submit it
- Blue Cross asks that updated clinical notes and the latest medical reports be attached to avoid delays, and its secure online document submission form accepts documents for disability claims. Its claimant's guide also lists mail, fax and email contacts for the Claims, Life and Disability Insurance department.
- Who pays
- The patient's consent in Section A states that the patient is responsible for any fees related to completing the form.
Good to know
- Diagnosis, complicating factors and medications each have an unchanged-since-last-report option, and symptoms and impairment are rated as improved, worsened or remained the same.
- Attach new and relevant test results, investigations or consultation reports; if none are attached, Blue Cross reads this as no new tests since your last report. Do not send genetic test results.
- Section 4 rates physical and psychological impairment separately as mild, moderate, severe or not applicable, alongside a list of current restrictions and limitations.
- Section 10 asks whether return-to-work goals have been discussed with the patient, what the return-to-work plan is and the prognosis for improvement.
Get the official form
Download the current version from the source each time; forms change without notice.
Status Update - Confirmation of Ongoing Long Term Disability
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
When is the Blue Cross LTD status update requested?
Blue Cross says the additional report must be completed by the claimant's attending physician or specialist if the disability has been extended. It is listed with forms completed during a disability period, separate from the short term disability statement and mental health questionnaire listed for the initial claim.
Can a nurse practitioner complete the Blue Cross status update?
Yes, where applicable. Section B is headed to be completed by the physician, or nurse practitioner where applicable, and the signature block names the attending physician or nurse practitioner. The form also lets a consulting specialist or other provider identify themselves at the start of Section B.
What happens if I don't attach test results to the status update?
Blue Cross will interpret missing test results as meaning no new tests were performed since your last report. The form asks for copies of any new and relevant test results, investigations or consultation reports, and Blue Cross asks for updated clinical notes and the latest medical reports to avoid delays.