When Guardian needs to know whether a long-term disability claimant can manage benefit payments, it asks the attending provider to complete this one-page competency statement. The provider says whether the patient can endorse checks and direct the use of the proceeds, the date that ability was lost if not, whether a spouse or relative handles their affairs, and whether and when the ability returned.
The attending provider answers the three questions and signs with printed name and specialty. The patient's name, birth date, claim and plan numbers go at the top.
Download the current version from the source each time; forms change without notice.
Attending Provider's Statement of Competency
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 and their requirements change without notice, so check the official page for the current version before you complete one.
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The form frames competency in practical terms: whether the patient is able to endorse checks and direct the use of the proceeds. It does not ask for a formal capacity evaluation, but the provider dates any loss and any recovery of that ability.
If the patient cannot manage benefit payments, Guardian needs to know who may be handling their affairs. The form asks the provider whether they are aware of a spouse or other relative doing so and requests that person's name, address and phone number.