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Lincoln GLC-01450ATL: LTD Attending Physician Statement

Lincoln Financial uses this attending physician statement to evaluate a group long-term disability claim. The physician documents diagnosis and findings, treatment, physical and mental impairment classes, cardiac capacity, confinement status, whether the patient is totally disabled from their own job or any work, the date they were certified unable to work, any loss of cognitive function or daily living activities, and return-to-work prospects.

Who completes it

The attending physician completes the whole statement on pages 1 and 2 and signs, confirming they have read the attached fraud warnings. The claim and policy numbers at the top identify the claimant; there is no patient or employer section.

Submitting and payment

How to submit it
Each copy carries a return-by date filled in for that claim; the physician returns it to Lincoln's group disability claims office by fax or as Lincoln directs.
Who pays
The form states it is to be completed without expense to the Company, so Lincoln does not pay for it.

Good to know

  • Lincoln does not post its group disability forms publicly; the claim process supplies them or Lincoln faxes them to the physician. The copy shown here is the 11/10 edition.
  • For each lost activity of daily living (bathing, dressing, toileting, transferring, continence, eating), the physician gives the date hands-on assistance was first required and received.
  • Cognitive impairment is defined as a permanent loss of intellectual capacity requiring another person's hands-on help or verbal cues to prevent harm; supporting testing should be attached.
  • The mental impairment section asks the physician to define stress as it applies to this claimant and describe job stress and interpersonal problems.

Get the official form

Download the current version from the source each time; forms change without notice.

Attending Physician's Statement - Disability

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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.

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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 and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who pays for Lincoln's LTD attending physician statement?

The header of GLC-01450ATL states that the form is to be completed without expense to the Company. Lincoln therefore does not pay the physician for completing it, and any charge is between the practice and the patient.

What return-to-work questions does Lincoln's LTD statement ask?

The physician states whether the patient is totally disabled from their own job and from any other work, when a marked change is expected (1 month, 1 to 3, 3 to 6 months, or never), whether the job can be modified, rehabilitation suitability, and a full-time or part-time return date.