A Guardian group life insured with a terminal illness can apply for part of the death benefit early under the accelerated benefit rider, and GG-011711 is the attending physician's statement for that claim. The physician gives the treatment history, mental competency, symptoms and objective findings, current confinement, a detailed diagnosis, treatment with medications, and a prognosis of how long the patient is expected to live.
The attending physician completes the whole statement, including patient information, and signs with degree or specialty. The insured applies separately on the Accelerated Group Life Benefit Application, GG-012406.
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APS for Accelerated Benefit Rider
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The limit depends on the plan. Guardian writes the number of months into the blank at the top of GG-011711, and the insured's life expectancy must not exceed it. The physician answers the prognosis question, how long the patient is expected to live, with that limit in view.
The physician marks whether the patient is ambulatory, house-confined, bed-confined, hospital-confined or in a nursing home, and names the institution if confined. The form also asks for first, last and next visit dates and how often the patient is seen.