Guardian uses GG-016479 when it is reviewing a disability claim under the disability rider of a group accident policy and needs the attending physician's update on the patient's condition. The one-page physician section covers the date total disability began, treatment dates and frequency, whether the patient is totally disabled from their occupation's strength level, return-to-work dates, the disabling diagnosis code, objective findings and the treatment plan.
The employee completes the Employee Section and signs the authorization. The attending physician completes the Physician Section, items 1 to 13, and signs.
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Accident Policy – Attending Physician's Statement of Disability
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The physician section opens by stating that Guardian is reviewing an accident disability claim for the named patient and needs an update on the current condition. It applies to the disability rider of a Guardian group accident policy, so it follows an accidental injury rather than an illness.
Item 10 asks for current objective findings that support continued total disability, with copies of diagnostic study reports where applicable. Item 8 records whether the condition has recovered, improved, not changed or retrogressed, and item 12 asks about referrals to other physicians.